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Pelvic Floor Muscle Dysfunction

One of the most common causes of pelvic pain.

Similar to Severe Cramping

High-tone pelvic-floor muscle dysfunction is one of the most common causes of pelvic pain. It is similar to severe cramping you might experience in your leg or other body part.

Sudden and involuntary contractions

A patient with high-tone pelvic-floor muscle dysfunction experiences sudden and involuntary contractions of the levator ani muscles, or pelvic-floor muscles, which hold the bladder, uterus, vagina and rectum in place like a hammock. These spasms also can occur in the obturator internus muscles, which control the rotation of the leg and are closely related to the levator ani muscles.

A pain-causing event

Patients with pelvic-floor muscle dysfunction often experience a pain-causing event, such as surgery, a car accident or traumatic vaginal delivery. They also might be under stress. Patients who have interstitial cystitis, endometriosis, vulvodynia or fibromyalgia also appear more susceptible. It is unclear whether these other conditions trigger the pelvic-floor spasms or vice versa.


The buildup of lactic acid in oxygen-deprived muscles is believed to play a role in causing the spasms.

Lactic acid is the byproduct of your body converting food to the energy your muscles need to work. When your muscles contract, they burn oxygen. If the contraction continues involuntarily, as it does during a spasm, the muscles eventually begin to work without oxygen. This triggers a buildup of lactic acid that further irritates the muscles. This irritation makes the muscles contract even harder and leads to more lactic-acid buildup. This vicious cycle leads to progressively worsening symptoms.

Patients experience a variety of complaints, including:

  • Chronic pelvic pain that radiates to the groin, abdomen and back.
  • Painful sexual intercourse.
  • Strong or frequent urge to urinate.
  • Burning during urination.
  • Urinary incontinence.
  • Vaginal burning.
  • Painful menstrual periods.
  • Difficulty with defecation and constipation.

Patients also might feel like they are experiencing recurrent bladder infections, with symptoms such as burning during urination, frequent urination and a strong urge to urinate. However, if they are experiencing high-tone pelvic-floor muscle dysfunction, a lab test will show no infection-causing bacteria in their urine.

They also may develop other pain conditions, such as vulvodynia, interstitial cystitis, irritable bowel syndrome, endometriosis and fibromyalgia.

High-tone pelvic floor muscle dysfunction is mainly diagnosed with a review of your family medical history and a physical exam. A thorough evaluation of any related pain conditions also is performed. An MRI also might be used to rule out problems with your anatomy.

Because patients with high-tone pelvic-floor muscle dysfunction may experience many different pain conditions, they sometimes see multiple doctors for treatment. Our center’s doctors have the training to identify your various conditions and offer a spectrum of treatment options.There are many treatment options, and a combination often is necessary. They include:

  • Muscle relaxants. These medications are available in oral or suppository forms. Oral medications can cause sedation and other side effects. Suppositories placed in either the vagina or rectum can minimize these side effects.
  • Restore normal tone to the pelvic floor. This approach is critical to managing high-tone pelvic-floor muscle dysfunction. A physical therapist specializing in this condition can teach you techniques to improve symptoms. Therapy includes techniques to help you relax and re-establish normal posture and body mechanics. A variety of exercises may be necessary but results are excellent.
  • Treating related conditions. Treating other medical problems that are occurring with high-tone pelvic-floor muscle dysfunction can improve recovery.
  • Other options, such as injection therapy and surgery, are sometimes warranted.

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