Pelvic contracture

The pelvic floor

The pelvic floor (or perineum) is a complex set of muscles located in the pelvic cavity (in the pelvis) whose main function is to support and to guarantee the functionality of the pelvic organs: bladder, uterus, vagina, rectum, anus.

How does the contracture of the pelvic floor develop?

Most people are unaware of the existence and functioning of this muscle network whose control is physiologically involuntary.

Unfortunately, due to this involuntary control, the pelvic floor can develop excessive contractions or relaxations.

When the contractions become excessive and extend over time, we may have the creation of a contracture.

Among the factors that favor pelvic contracture are:

-> some bad habits

– put the stomach in to look thinner

– practice some “fitness” exercises that strainthe perineum (Kegel exercises in particular)

– pelvic contraction in response to stress or distress

-> pelvic floor painful recurrent episodes

– acute cystitis (bacterial and bacterial)

– vaginitis and acute vaginal infections (fungal infections, vaginosis)

– hemorrhoids or anal fissures

– painful menstruation

-> non-consensual or painful sexual intercourses

-> incontinence and attempts to “hold the urine” that accompany it

-> some surgical procedures, such as episiotomy, genital or urethral surgery, genital radiotherapy

Pelvic contracture symptoms

Pelvic contracture rarely occurs abruptly (except in traumatic situations such as accident, surgery, rape, etc.), it is often a long process that takes place over several months/years and whose symptomatology can be:

– constant with an alternation between “deaf” moments and acute phases

– more often, episodic with recurrence and persistence of discomfort increasingly prolonged over the months (until it becomes constant)

The contracture of the muscles of the pelvic floor compresses veins, arteries and nerves, causing pain and fragility in the pelvic tissue. Therefore, nervous messages will undergo significant changes that will cause an alteration of the sensations perceived in this area (difficulty of the patient to clearly define her damage), but also the functioning of the organs.

As a result, we will observe:

trigger points: areas of the muscle that are tense, rigid and very painful even in the absence of stimuli and whose pain radiates to nearby or connected areas

tender points: areas where pain is caused by pressure (even mild) but is less intense, more circumscribed and does not radiate

Beyond pain (often described as “intimate burn”), pelvic hypertonicity can cause symptoms:

– urological: dysuria (decreased urinary flow, intermittent, sudden, need to “push” for complete emptying, post-evacuation urinary loss), urgency and frequency of urination, urinary and bladder pain, bacterial and bacterial cystitis

– proctological: constipation, difficulty in defecation, anal pains, sensation of rectal “weight”

gynecological: vaginal burns, pain, bacterial or fungal infections, recurrent vaginitis, inability to reach orgasm, vaginismus, dyspareunia

Two common subproblems of pelvic contracture: vaginismus and dyspareunia

Vaginismus and dyspareunia are characterized by a strong contracture of the perivaginal musculature which makes penetration difficult or impossible and painful intercourses that are systematically followed by a disturbance at urogenital level described as a sensation of burning or “cooking” in the crotch and enhanced by urination (passage of a hot and acid liquid over an inflamed tissue), which appears in the hours after the intercourse and may persist for several hours or days after.

It is very important to distinguish this symptomological framework from that of postcoital cystitis to better guide prevention and management.

Complications of pelvic contracture

When the contraction of the pelvic muscles becomes constant, the blood vessels and muscle fibers of the affected area are compressed, which can cause damage to the nerve endings.

Therefore, the pain inherent in the contracture gradually becomes a neuropathic pain independent of the mechanical or chemical phenomena of the area and evolves autonomously even in the absence of stimuli.

Under these conditions, there is a real vicious circle since pain causes a contracture that increases pain, etc.

Depending on the organ involved (the affected muscle fiber), these chronic pains can easily be confused, since they are symptomatically identical, with: cystitis (this is the case of some cases of BPS) or vaginitis.

The diagnosis of pelvic contracture

If, by reading this article, you think you are concerned about this problem, you should contact a specialist to get a pelvic floor evaluation.

The diagnosis can be made by gynecologist, urologist or neurologist, but the evaluation and initial evaluation almost always include the consultation with a pelvic rehabilitation trained obstetrician or physiotherapist.

The evaluation should include:

– a visual observation of the genitourethral area

It can identify redness, abrasions, scars or anatomical abnormalities (too low or too high urethra, narrow vaginal vestibule, etc.).

On the occasion of this observation, the specialist will probably ask to contract and release the genital area (to contain the urine and then to “push”) to visually assess the voluntary motor activity of the pelvic floor.

– a manual evaluation of the musculature

It is practiced more and more with the help of probes and it is a pity because the manual evaluation is still more accurate and effective.

In practice, the specialist, by inserting the fingers into the vagina, examines the thickness of the muscle bundles and their reactions to stretching.

– an assessment of pain sensitivity

The specialist will evaluate the vestibular vulvo area (through the Swab Test) and the elevation of the muscle bundles of the anus by vaginal acupressure.

NB: the urodynamic test, which also reports excessive muscle contraction during urination, is a good complement for a complete evaluation of the pelvic floor.

Solutions to combat pelvic contracture

Here it is important to emphasize that before implementing any approach that aims to act on the pelvic musculature, it is necessary to have at hand a diagnosis of certainty so that not to risk its management, aggravating or complicating another situation.

In case of proven pelvic contracture, the relaxation of the pelvic musculature allows a reduction of the pain and the resumption of the physiological functionality of the affected organs in an increasingly significant and prolonged way as the release work progresses.

Pelvic contracture treatment includes a series of techniques, tools and rehabilitation exercises that are recommended to practice with the advice of a professionist (obstetrician or physiotherapist).

Currently, more and more rehabilitation professionals are aware of contracture problems and their care. If you have difficulty finding a specialist you can follow some exercises and domestic massage as indicated in this other article in the meantime.

Finally, taking certain food supplements such as Etinerv, D-Magnesio and Ausilium Forte can be an excellent coadjuvant support for management thanks to its myorelaxing, neuromodulating, anti-inflammatory and nervous tissue support actions.

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