Muscular dysfunction in the pelvic floor starts when something happens that causes an injury or large scale inflammation to the pelvic floor. This causes a large scale release of calcium, which causes the muscle to become too tight (hypertrophic). As a result of this tightness, metabolism in the tissues increases and substances like histamine, serotonin and prostaglandins are released. These mediators trigger neurologic pain perception. The pain causes tightness, which causes more pain, and the cycle continues.
Hypertrophic muscles become musculodystrophic as fibrosis occurs. The muscle becomes atrophied and is replaced by less extensible connective tissue. As a result, the muscles aren’t as flexible as they should be. This also means that they cannot relax normally. This activates trigger points in the pelvic floor and increases tone and spasm in pelvic structures, including the bladder, uterus, and rectum.
Treatment for pelvic floor dysfunction of women is very well described in literature. It relies largely upon patient education and compliance with various exercises to retrain the muscles to relax completely at will. Trigger-point pressure, both internal and external, can be applied by the patient or partner to help the muscles relax. Vaginal or anal dilators, vaginal cones and bladder training can also be effective. Physical therapy including myofascial release and biofeedback are also important to treatment.
While initial treatment of PFD can be complex and time-consuming, the results are very good. One study followed a cohort for ten years. 71% of women in this cohort reported major reduction or elimination of pain level following physical therapy and exercises done at home. After ten years, 89% of women reported major reduction or elimination of pain. Many patients continued their home exercises during that time.
References:
Bortolami A, et al. Relationship between female pelvic floor dysfunction and sexual function: an observational study. J Sex Med 2015; 12: 1233-1241.
Hartmann D, Sarton J. Chronic pelvic floor dysfunction. Best Practice & Research Clinical Obstetrics and Gynaecology 2014, 28: 977-990.
Espuña-Pons M, et al. Pelvic floor symptoms and severity of pelvic organ prolapse in women seeking care for pelvic floor problems. European Journal of Obstetrics and Gynecology and Reproductive Biology 2014, 177: 141-145.
Ramalindam K, Monga A. Obesity and pelvic floor dysfunction. Best Practice and Research Clinical Obstetrics and Gynaecology 2015, 29: 541-547.
Graziottin A, et al. Mast cells in chronic inflammation, pelvic pain and depression in women. Gynecol Endocrinol 2014; 30 (7): 472-477.
Ahangari A. Prevalence of chronic pelvic pain among women: an updated review. Pain Physician 2014; 17: e141-147.