Womens Health

Confusing Pelvis Pain with Muscle Pain

Frederick R. Jelovsek MD

Many women do not realize that pelvic pain can actually be due to muscle problems in the abdominal wall or even back problems of the spinal discs or bones that are referred or perceived as being in the pelvic area. This type of pain is broadly categorized as myofascial pain. Some doctors fail to thoroughly evaluate this possibility as a cause of chronic pelvic pain.

A recent article, Myers CA: Musculoskeletal factors of chronic pelvic pain. OBG Management 1999; Feb:10-12, gave us some information to answer questions about this uncommon cause of pelvic pain.

How can pain actually be "referred" from another site to the pelvis?

The spinal cord is a complex electrical connection system. The nerve roots of the spinal cord send off neurons that sense pain from skin, muscles, bones, ligaments and internal pelvic organs. The same spinal nerve roots that innervate the ovaries may also innervate abdominal wall muscles. Low back pain can arise from pain in the uterus, bladder, faloppian tubes, and cervix because the same nerves innervate those organs as well as the lumbar discs, ligaments and muscles. Conversely, abdominal wall pain, especially around an incision, may actually feel as if it is arising from the uterus or deeper in the pelvis when its origin is from the skin near an incision. Neurologists think that sometimes the spinal cord just gets confused when there are many pain impulses coming in and by the time your brain perceives the pain, it cannot tell whether the source is in the internal organs or the external muscles.

There are also internal muscles lining the pelvic bone such as the piriformis, puboccocygeus, obturator internus and externus muscles. The muscles can present with cramps and achiness and a woman perceives the pain as uterine or ovarian.

 

How is musculoskeletal pain differentiated from pain arising in the pelvic organs?

 

Certain questions help to categorize the pain as more likely to be musculoskeletal in origin rather than urogenital organ in origin if:

  • you have a history of musculoskeletal injury to the back, hips or knees.
  • your occupation is sedentary or labor intensive.
  • you have repetitive musculoskeletal or postural stressors.
  • physical activity worsens or lessens the pain.
  • positional changes (lying to sitting, sitting to standing) worsen or relieve the pain.
  • the pain changes with the time of day.
  • there is noticeable muscle weakness or numbness or tingling.
  • there is a history of inflammatory or collagen vascular disease such as rheumatoid arthritis or lupus.

 

On physical exam, what findings suggest musculoskeletal dysfunction?

 

If there is any abnormal curve in the spinal canal such as a curvature to the right or the left (scoliosis), excessive curve of the thoracic spine like a hunch-back (kyphosis) or increased arching of the small of the back (lordosis), these changes make it more likely for the pain to be musculoskeletal. The doctor will also have you lie flat on an exam table, raise your knee and will rotate the knee from side to side to see if any of the internal and external hip rotators are tight and cause pain with rotation. Next you will be asked to bring the one knee up to the chest. If the straight leg whose knee is not being raised comes up off the table or gives pain, this means the iliopsoas muscle and/or the rectus femoris (hip flexor) muscles are tight and may actually be the source of deep pelvic pain mistaken for internal organ pain. The doctor will also check for any pain in the abdominal muscles and touch the skin of the abdomen and back to see if there are places on the skin that "trigger the pain".On pelvic exam the doctor will have you try to tighten the muscles around two fingers placed in the vagina and will palpate the muscles of the interior pelvic wall to see if any of them are exquisitely tender. All of these screening exams can be checked for by you at home to see if they are abnormal.

 

If pelvic pain is actually coming from the back and spine, how is it treated?

 

Certain postural problems, especially kyphosis and lordosis, have been clinically correlated with pelvic pain as have other muscle weaknesses and spasms. Treatment of those problems has also been shown to help the pelvic pain. If there is any suspicion that pelvic pain has a myofascial cause, a woman should be referred to a physical therapist for a more in-depth evaluation and plan for treatment. You can find medical centers specializing in comprehensive pain management that can aid in treatment. Physical therapy and muscle exercises can also significantly help these problems.

 

What are trigger point injections and are they helpful?

 

Trigger points are areas of skin on the abdominal wall that follow along one dermatome, the area of skin innervated by one specific nerve root. When touching them lightly even with a Q- tip, pain is elicited that feels as if it arises deep in the pelvic organs. When these areas are injected with a local anesthetic, there is pain relief that lasts longer than the expected duration of the specific anesthetic used. After about 5- 6 weekly injections or less, the pain totally goes away. This is thought to work somewhat like acupuncture in that the pain sensation the level of the spinal cord gets rearranged to know that the pain does not actually arise in the pelvic organ where it is perceived.

 

Other Related Articles

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Post Tubal Ligation Syndrome Review
Does Endometriosis Always Cause Pain?

 

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DIAMONDFOX10
If I were you gochoosy I would sue that mad doctor,If you don't watch these doctors these days you are nothing but a guine pig,Them hopeing to become famous to helping one women,I was treated like I had ic and it's not I only have extreme bdominal pain on my right side in my vagina,I have been told I have appendicis ic oh it's your backand this last one said it was acute urinary tract,And I swear if I did not beg my lady that answered the phone to get me a different kind antobotic I would of went into Renal Failure,Coz I could not PEE.Which now I know from going to a med express which I think r better these days then hospital n regular dotors,I have or had VRE,Which my body became supetable to the meds Bactrim they were giving me,I went and got my results from the med express n looked it up on web md and I gave my self a exzame and figured it out myself and got the right antibotics for what my body was trying to fight,I hope it does not come back,It's been 4 years on n off with this and it really put me into a depression,Coz fromt hem having me on the Bactrim it would not show up as Bacteria,Coz the Bactrim was hiding the Flora tht was actually was infecting me,But now I still struggle with right abdominal pain,And I know it's from them because,I never had the pain before I just felt sick,But they put me on Pain medicine and just thought that's all I wanted n the rest was in my head BS I said,Thats esy for them to ay here heres 3 Oxymorone pills for 3 months go away.Pleaseladies always get your records and always check things out on ,Coz u will learn more then what doctors do these days they care nothing about helping a person that is in pain they just want the money and make money off of you by how much medicine you tae,I found that out that they have to have a certain quota out for the month,I was furious when I hear of this,ANd now it just all makes since to me now,Don't let them do things you don't feel is helping you.Ask questions and be a pain in the zza,Coz from what I have learned they could care less if they put u in new pain.And don't go to them stupid so called pain clinics,Coz these are the new drugs that are just on the market.And they hope for the best,Good Luck ladies your going to need it these days.I hope u find out what is really your problem.If u want to friend me and find out more about doctor these days,I can probably help u more then they can.
3 years ago
gochoosy
I was told by my Gyne that I had pelvic organ prolapse and was referrred to a specialist..... a urogynecologist. I have seen the urogynecologist 5-6 times and each time she stuck her fingers inside and pushed super hard on my pelvic floor muscles and actually caused me to have crippling muscle pain that was NOT there prior to my seeing her. When I went back and told her I was in pain she told me to go to physical therapy. I went to 2-3 sessions and was told to do hip rotations.. Now not only do I have the terrible pelvic muscle pains, I have terrible hip pains AND I HAD NONE OF THIS PRIOR TO TREATMENT ...... It has been 4-5 months and I am still in pain. Some days are better than others. While I know this is muscle pain, I also know my uterus in enlarged and falling out, so I am going to go ahead with a hysterectomy and pray the muscle pain caused by the urogyne and P therapist will eventually heal as I heal from the hysterectomy, and I will do my own exercising from now on.. I DO NOT LIKE or trust physical therapists now nor these urogynes who caused acute pain by over stressing/injuring my pelvic floor on purpose. WHO IS TRAINING THESE DOCTORS?????????? This is not good . I have lost my job and can barely take care of the basics. I was walking, dancing, sledding, etc...etc... no problem, until I went in and the docs did this to me. BEWARE LADIES!!!!!
3 years ago