Pelvic Floor Spasm with Q&A

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

What is a pelvic floor spasm? It is the presence of contracted, painful muscles on palpation and elevated resting pressures by vaginal manometry. If the contraction is painful, this is usually described as a cramp. Pelvic floor myalgia (a symptom) may be present without a change in pelvic floor muscle tone (a sign).

 

The term ‘spasm’ when referring to pelvic floor pain is actually a misnomer. (Bear with me here!) Several years ago the International Continence Society and the International Urogynecology Association teamed up to help establish a glossary of proper pelvic floor terms because clinicians, researchers, and authors were all using different terms, making it difficult to truly understand what’s what with pelvic floor function.

 

Most people think pelvic floor pain, correctly termed ‘myalgia’ is a ‘spasm’. This is not correct use of the terminology and we should avoid saying ‘spasm’ if we mean ‘pain.’ Technically true spasms are associated with upper motor neuron lesions, such as in the cases of stroke or spinal cord injury, versus a non-neurologic injury of a muscle.

 

Questions from social media:

 

Q: As a patient, I struggle with using the term “pain” and often refer to my symptoms as pressure or discomfort. Pain to me is associated with laceration, scrap, etc., not a constant muscle tightness, which I’ve grown accustomed to. I often wonder if that contributed to delay in proper evaluation and therapy.

A: Thank you for your insight comments and you have a good point. The point of the ICS/IUGA terminology was to use technically accurate terminology, specifically calling pelvic floor pain a ‘spasm’. In general we recommend that people try to describe their symptoms as accurately as possible, in your case saying ‘pressure’ or ‘discomfort’ is completely ok! It is NOT ok for a medical provider to refer to ‘spasms’ unless it meets the actual criteria. 

 

Q: Can the pain present in different ways besides cramping? And if pain is present without spasm what does that mean?

A: There are many accurate descriptors people use to describe their symptoms: pain, nurning, stabbing, aching, pressure, discomfort, etc. People may actually feel muscle spasms and that is ok to report too!

 

Q: So, just clarifying in layman’s terms: if there’s a sudden stabbing pain because my pelvic muscles are hypertensive, it’s not actually a “spasm”? (All I know is three years out of surgery for Endo stage one + IUD removed, two years out of pelvic floor Botox injection procedure, and pelvic floor PT + biofeedback all the while—the “pain” and trigger points won’t go away) 

A: It is impossible for us to diagnose a true ‘spasm’ by symptom description alone. The word ‘spasm’ has been used for years. It is fine for people with symptoms to use words that describe their symptoms. Medical professionals need to start to do better to use proper, standardized terminology to help with better diagnosis, management and research.

 

Q: But can your pelvic floor muscles spasm? Sometimes it can feel like a true spasm, not just painful or tense only.

A: A pelvic floor can spasm, according to the definition it can only be measured with diagnostic tools. As stated earlier, it is best for people with symptoms to describe them the best they can.

 

Q: According to your knowledge, is there a link between PFM spasms and myofascial syndrome?

A: Pelvic floor dysfunction is associated with myofascial pain syndrome.

 

Q: How can you know if you’re having a spasm vs general pelvic pain ??

A:  Whether here is a spasm or if there is pain, they are not synonymous and we cannot conclude the answer by symptoms description alone. Additionally, you cannot tell this on palpation either, it needs to be determined by electrophysiological tests.

 

If you think you have experienced this or something similar, you can request an appointment through our website to be evaluated by any of our pelvic floor physical therapists. You do not have to continue to be in pain, we are here for you!

 

References

 

Reference: Rogers R, Thakar R, Petri E, Fatton B, Pauls RN, Morin M, Lee J, Kuhn A, Whitmore K. International Urogynecological Association (IUGA) / International Continence Society (ICS) Joint Report on the Terminology for the Sexual Health in Women with Pelvic Floor Dysfunction. Int Urogynecol J,2018; Neurourol Urodyn, 2018

 

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Are you unable to come see us in person? We offer virtual physical therapy appointments too!

Due to COVID-19, we understand people may prefer to utilize our services from their homes. We also understand that many people do not have access to pelvic floor physical therapy and we are here to help! The Pelvic Health and Rehabilitation Center is a multi-city company of highly trained and specialized pelvic floor physical therapists committed to helping people optimize their pelvic health and eliminate pelvic pain and dysfunction. We are here for you and ready to help, whether it is in-person or online. 

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

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FAQ

What are pelvic floor muscles?

The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.

What is pelvic floor physical therapy?

Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.

What happens at pelvic floor therapy?

During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.

What is pudendal neuralgia and how is it treated?

Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.

Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.

What is interstitial cystitis and how is it treated?

Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.

Who is the Pelvic Health and Rehabilitation Team?

The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.

How many years of experience do we have?

Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.

Why PHRC versus anyone else?

PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.

Do we treat men for pelvic floor therapy?

The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.

Do I need pelvic floor therapy forever?

The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.

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