Described as persistent pain felt in the pelvic area for more than six months, chronic pelvic pain can disrupt men and women’s lifestyles physically, emotionally, and sexually. When relief is not found through medication or pelvic floor physical therapy, the next step recommended before surgery is pelvic floor injections.
In this article, we discuss pelvic pain, trigger point pelvic floor injections, what the procedure entails, and how long pelvic floor injections last.
What Is Chronic Pelvic Pain?
Often defined as an ‘incredibly complex’ condition, chronic pelvic pain originates from a tightening of the various muscles around the pelvic area. Because these muscles spread both inside the pelvis as well as around the pelvis, the resulting pain can be felt in the vagina, abdomen, hips, and lower back.
The result of this spasming pain can make it uncomfortable to urinate or pass a stool. Women experiencing chronic pelvic pain might also find that inserting a tampon or having sex is uncomfortable, and some women might even experience tight jaw muscles due to pelvic pain.
What Causes Pelvic Pain?
Although it affects as many as 14% of American women during their reproductive years, the cause of chronic pelvic pain is largely unknown. Studies have found that even though gynecological conditions like pelvic inflammatory disease or endometriosis, as well as childbirth, can result in pelvic pain, chronic pelvic pain can be caused by non-gynecological sources too.
For example, medical professionals suspect pelvic floor trauma could be connected to sports injuries, previous pelvic surgeries, irritable bowel syndrome, fibroids, intercourse, psychological factors, or post-traumatic stress disorder.
Treatment Options for Pelvic Pain
The first line of treatment recommended for pelvic pain is physical therapy, where patients learn how to stretch and relax the pelvic muscles with specific movements and breathing techniques. Biofeedback, manual therapy, and ultrasound imaging are all tools used in pelvic physical therapy to address pelvic pain.
For patients who find little relaxation from these treatment options, trigger point pelvic injections are recommended before a more invasive surgical procedure.
What Is A Trigger Point?
A trigger point is a painful spasm or a hyperirritable nodule that forms on tight muscles which are unable to relax. If located under the skin, trigger points are painful when pressed upon.
Typically the result of trauma, over-used muscles, inflammation, psychological factors, or a succession of minor injuries, a trigger point is capable of aggravating nerves from a distance as well as causing what is called referred pain –which is pain that is experienced in another part of the body rather than where the pain originates.
What Are Ultrasound-Guided Trigger Point Injections?
Proving to be incredibly beneficial for chronic pelvic pain relief, ultrasound-guided trigger point injections are a non-invasive procedure where the guidance of ultrasound is used to pinpoint the exact location of trigger points for pain-relieving injections to be administered.
How Do Pelvic Floor Trigger Point Injections Work?
Trigger point injections typically consist of the pain reliever lidocaine and anti-inflammatory medication, but medication can vary according to the needs of the patient.
Once the injections are administered directly into the irritated nodule, the spasm relaxes almost immediately, naturally increasing blood flow and more abundant levels of oxygen in the muscle. Pain relief is typically felt by the patient within 24-72 hours.
Do Trigger Point Pelvic Floor Injections Hurt?
Trigger point injections for chronic pelvic pain involves injecting pain-relief medication directly into pelvic muscles via the vagina. The 20-30 minute procedure is non-invasive and usually begins with your chosen health practitioner numbing the area before injections are administered.
Some patients report feeling a temporary escalation of pain when the tip of the needle enters the trigger point. This pain is only briefly felt, however, and is believed to be a positive sign that the medication has been administered to the right location.
How Long Does Relief from Trigger Point Injections Last?
The timespan of relief varies from patient to patient. For some women, the relief experienced from pelvic floor trigger point injections lasts for a month, while for others it can last as long as three months.
In some cases, pelvic floor injections are used to deliver enough relief for women to engage in pelvic floor physical therapy, where they learn to relax their pelvic floor muscles for the long term through movement and breathing techniques.
How Often Should You Have Trigger Point Injections for Pelvic Floor Pain?
The answer to this is that every patient is different, so it’s best to consult with your physiotherapist or doctor about how many trigger point injections your condition requires, and how often should have them. The pelvic floor is a large area, encompassing a variety of muscles and several branches from the pudendal nerve, therefore several injections may be required to ensure all are treated for pain relief.
It has also been noted by researchers that trigger point injections work best in an accumulative effect, meaning the best results are achieved gradually with a series of injections over time.
Is the Ultrasound Used Internally During Pelvic Floor Trigger Point Injections?
No. This form of ultrasound is an external procedure, performed by applying some gel to the skin, which transmits the ultrasound waves. The transducer, which is the device that converts the image onto the screen, is then placed directly on top of the gel and moved around gently to locate the trigger points and where the injections should be administered.
Is Ultrasound Safe For the Body?
Ultrasound imaging has been in existence for over 20 years and is considered very safe for the body. In contrast to other types of body imaging systems, such as X-rays, ultrasound is developed with non-ionizing radiation, meaning it does not present the same risks to the body.
How To Prepare for Trigger Point Injections
Make sure you’ve had something light to eat before your appointment for trigger point injections so you don’t arrive on an empty stomach, and also ensure you are hydrated by drinking some water. In addition, it’s helpful to take some ibuprofen approximately one hour before your appointment to ease any discomfort from the initial nerve block.
Should You Rest After Trigger Point Injections?
While it’s perfectly normal to experience some tenderness after trigger point injections, there is no need to rest completely afterward. It is advised that patients refrain from any heavy lifting or strenuous exercise for 24 hours. However, your physiotherapist will more than likely suggest some gentle stretching on the same day, and each day afterward, to further loosen the muscles and ease discomfort for the long term.
Conclusion
Chronic pelvic pain can spread to the vagina, abdomen, hips, and lower back; impacting women not only physically, but emotionally and sexually too. For those who’ve tried treatment options like medication and physical therapy with no relief, pelvic floor injections can provide comfort and a better quality of life.
If you are experiencing chronic pelvic pain, consider contacting your healthcare practitioner or physiotherapist about trigger point injections to start living life pain-free again.
References
The American College of Obstetricians & Gynecologists - Chronic Pelvic Pain - https://www.acog.org/womens-health/faqs/chronic-pelvic-pain
National Library of Medicine – Chronic Pelvic Pain - https://www.ncbi.nlm.nih.gov/books/NBK554585/
Journal of Endometriosis and Pelvic Pain Disorders - Trigger Point Injections for Pelvic Floor Myofascial Spasm Refractive to Primary Therapy
https://journals.sagepub.com/doi/full/10.5301/jeppd.5000283
Official Journal of The American Urogynecologic Society - Transvaginal Pelvic Floor Muscle Injection Technique: Cadaver Study - https://journals.lww.com/fpmrs/Abstract/2017/01000/Transvaginal_Pelvic_Floor_Muscle_Injection.12.aspx