obturator internus anatomy

Obturator Internus: Anatomy, Dysfunction and Symptoms

In pudendal neuralgia by Stephanie PrendergastLeave a Comment

By Stephanie A. Prendergast, DPT, MPT, Cofounder, PHRC Los Angeles

The Obturator Internus (OI) muscle is an external rotator and an abductor of the hip. It is also a pelvic floor muscle, with half of the muscle belly sitting right next to our Levator Ani muscles. The muscle also forms part of Alcokc’s Canal, which houses the perineal branch of the pudendal nerve.

 

Even though the OI is part of the pelvic floor, it is not innervated by the pudendal nerve like the other pelvic floor muscles. It is innervated by the OI nerve, coming from spinal segments L5 – S2.

 

Impairments of the OI muscle are common in people with pelvic floor dysfunction. The muscle can become tight, weak, and develop trigger points. The impairments can lead to pain at the tailbone, sit bones, buttock area, and anywhere in the distribution of the pudendal nerve.

Consequences of OI Dysfunction Pt1

 

The Obturator Internus muscle is unique because it is an external rotator and abductor of the hip and it is also considered to be part of the pelvic floor muscle group. The muscles makes a 90 degree angle around our sit bones, it is innervated by the obturator nerve, and it forms part of Alcock’s Canal which houses the pudendal nerve.

 

When this muscle is impaired it can cause pain at the tailbone, around the sit bone, and the posterior thigh. It is associated with hip dysfunction and gluteal, groin and hip pain. Because of its close proximity to the Levator Ani muscles many people with pelvic floor pain also have Obturator Internus pain.

 

Weakness and/or tightness in the Obturator Internus muscles is associated with biomechanical abnormalities which can affect our lower extremity and core function. This muscle can be accessed transvaginally and transrectally and a portion of it is also able to be palpated externally. It is common for this muscle to develop trigger points due to its unique anatomy and the physical demands on it.

 

Manual physical therapy, neuromuscular re-education, and home exercises are effective tools to help this muscle function normally and reduce pain and dysfunction!

Consequences of OI Dysfunction Pt2

 

The Obturator Internus fascia form’s Alock’s Canal, which houses the pudendal nerve and vessels. When this muscle becomes overactive or too tight symptoms of pudendal neuralgia can develop. People may feel shooting, stabbing, burning, or itching in the genitals, perineum, and/ or anus.

Many people with OI dysfunction also have pelvic floor dysfunction (PFD) and may experience urinary urgency, frequency, pain, hesitancy, and/or leaking.

OI and PFD can also lead to difficulty evacuating stool, and pain before, during or after bowel movements.

OI myalgia can cause pain with sexual activity, including deeper vaginal pain during penetration and orgasm pain or difficulty.

It is important to remember that pelvic girdle muscles like the OI can also cause pelvic pain and dysfunction and the pelvic floor muscles are rarely the sole culprit!

 

obturator neuralgia symptoms

 

The Obturator Nerve arises from L2 – L4 and provides sensory and motor innervation to the inner thigh.

The Obturator Nerve is responsible for sensation from the upper medial thigh and plays a key role in hip adduction as it innervates multiple muscles in the inner thigh.

The Obturator Nerve is deep inside the pelvis, however, it can become impaired with athletic and surgical injuries, accidents, and pregnancy.

Symptoms of Obturator Neuralgia include medial thigh pain and muscle weakness.

Effective treatment includes pelvic floor physical therapy, nerve blocks, neuropathic medications, and in certain cases, surgical release.

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Are you unable to come see us in person in the Bay Area, Southern California or New England?  We offer virtual physical therapy appointments too!

Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.

In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page

Melissa Patrick is a certified yoga instructor and meditation teacher and is also available virtually to help, for more information please visit our therapeutic yoga page

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