Pelvic Floor Spasm with Q&A

In Pelvic Health, Pelvic Pain by Stephanie PrendergastLeave a Comment

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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