Pelvic Floor Muscle Spasm

Pelvic Floor Muscle Spasm is one of the most common conditions leading to pelvic pain both in women and in men.

This condition is one of the “evil quadruplets” since it tends to co-exist with endometriosis, interstitial cystitis/bladder pain syndrome, and irritable bowel syndrome. The condition is like having a charley horse in the muscles that surround the vagina, urethra, and rectum. There are multiple reasons why this spasm happens.

Most often it is some other pelvic pain condition, that through complex neural mechanisms is irritating the pelvic muscle(s). Patients who have chronic pain from endometriosis, chronic pelvic pain syndrome, pelvic floor disorder, or pelvic trauma may develop the spasm, which unless treated, may last for many years. Some patients may also develop spasms after psychological trauma or even without any significant precipitating event.

Most commonly patients with pelvic floor spasm(s) will experience pain during intercourse, urination, and bowel movement as well as any physical activity. Generally, this pain persists from hours to days after the sexual function or sexual intercourse. It may also persist after urination or bowel movement. Patients with muscle spasms may also have trouble in starting the urine flow or difficulty in completely emptying the bladder. Because of that incomplete emptying, they often get up at night multiple times to urinate.

Pelvic floor spasm(s) may be easily identified during a physical exam or womens health exam by a trained pelvic pain physician or pelvic floor physical therapist. Treatment consists of pelvic floor physical therapy and muscle relaxants.

The majority of patients are helped by those two modalities. In cases where muscle spasm is not relieved by pelvic floor physical therapy and muscle relaxants, botulinum toxin injections to the pelvic floor may be necessary. Treatment of the underlying pain is also very important.

In cases where pelvic floor muscle spasms developed because of other symptoms such as endometriosis, treatment of that underlying condition is very important. If someone has developed pelvic floor muscle spasm after placement of pelvic mesh, the mesh has to be addressed first before addressing muscle spasm.

At Arizona Center for Chronic Pelvic Pain, we work with physical therapists in the Phoenix area and throughout the United States. We strongly believe that pelvic floor physical therapy is the most important part of relieving pelvic muscle spasm(s). In most cases, we will be able to recommend a physical therapist in your area or provide you with resources to find one. Strengthening weak pelvic floor muscles through pelvic floor exercises is critical.

Muscle relaxants are usually used in the form of a vaginal or rectal suppository and seem to be more effective than oral medications. Different formulations of suppositories exist, and they will be discussed with you during the visit. Botulinum toxin A (BotoxÒ) injections are offered to patients when physical therapy and suppositories fail. Those injections relieve muscle spasms and pain in the great majority of patients, but they may need to be repeated every few months. Because those injections are painful, they should always be done under sedation.

If you have difficulty finding a pelvic floor physical therapist in your area, please contact our office. We collaborate with therapists around the country, and we may be able to help you find one in your area. You can also visit the page of the International Pelvic Pain Society (pelvicpain.org), Women’s Section of American Physical Therapy Association (aptapelvichealth.org), or Herman and Wallace Pelvic Rehabilitation Institute (hermanwallace.com) to find a provider in your area.

If you or someone you know is experiencing pain related to pelvic floor muscle spasm contact our office at 480 599-9682 or [email protected] to learn more about available treatments.

What to expect after Botox^Ò injection?

1. Botox^Ò injections to pelvic floor muscles are almost always done in conjunction with pudendal nerve(s) block. The block is done to decrease pain after the procedure. When you wake up from the sedation after Botox^Ò injection, you will feel numbness in the pelvis, and you may have numbness in one or both of your legs. Numbness is completely normal and will disappear when the local anesthetic wears off.
2. If you have numbness in your legs, you should avoid walking until the numbness goes away. You should have someone help you walk the first time you get up after the procedure.
3. After the procedure, you may have difficulty emptying your bladder. Pelvic floor muscles are irritated immediately after the injection, and some patients may need a urinary catheter for a few days. Difficulty emptying the bladder goes away after BotoxÒ starts working and relaxes pelvic floor muscles.
4. You may experience vaginal bleeding for 2-3 days after the procedure. It is completely normal, as long as the amount of bleeding is less than the menstrual period.
5. After the local anesthetic wears off your pain may come back, and it may come back worse than it was before the procedure. This is because muscles are irritated from the injection. Botox^Ò starts working about one week after the procedure, but it may take 10-14 days to feel the relief of pain.
6. It is very important to continue physical therapy after BotoxÒ Botulinum toxin by itself does not permanently cure muscle spasm, but it allows physical therapist to work more aggressively on your pelvic floor muscles.
7. Botox^Ò wears off approximately 3-4 months after the injection. Some patients will not go back into spasm, but most will need a repeat injection. If you or your physical therapist feel your muscle spasm is returning, call our office to be scheduled for a repeat procedure.