Posts Tagged ‘pelvic floor muscle tension myalgia’

When Stress Causes A “Headache” In The Pelvis

November 26, 2016

Andrew Siegel MD 11/26/2016


Image above attributed to Dr. David Potter, licensed under the Creative Commons Attribution-Share Alike 4.0 International license.

It is virtually impossible to avoid stress in our lives. A small and manageable amount of stress—“eustress”—triggers adrenaline release, which increases pulse, respiratory rate and blood pressure, dilates the pupils and makes one hyper-alert, focused and motivated. All things considered, this can improve performance—think “caffeine on steroids.” However, excessive stress—”distress”—is clearly a bad situation, causing anxiety that can decrease performance, un-motivate and make life rather unpleasant.

The immediate manifestations of stress-mediated adrenaline release are due to the primitive “flight-or-fight” response that causes us to brace, tighten, clench and compress our bodies. Stress triggers rapid, shallow and less efficient chest breathing as opposed to proper breathing from the diaphragm, which is slow, steady deep and efficient. Slouching and poor posture from clenching and muscle tensioning further exacerbates the breathing issues.

Chronic stress—internalized—can have many physical manifestations, often tension headaches involving taut muscles in the head, neck and back. Other signs of stress-turned inwards are insomnia, fatigue, altered immune system function, depression and loss of sex drive. It can also be responsible for high blood pressure, angina, heart attacks and strokes as well as give rise to gastritis, peptic ulcer disease and irritable bowel syndrome. Urinary frequency is a not uncommon urological manifestation of chronic stress.

When stress is internalized within the pelvic floor muscles it can cause pelvic floor tension myalgia, which causes pelvic pain often accompanied by sexual, urinary and bowel symptoms. It can cause knots within the pelvic muscles—discrete sights of hyper-tensioned muscle. This tension myalgia is a very difficult and frustrating situation that often requires a number of different treatment approaches.

Because the pelvis is the site of important functions– urinary, sexual and bowel–it is a particularly bad location for holding tension. Pelvic “hypertension” can cause urinary, genital and rectal pain as well as adversely affect the proper performance of these systems. It can cause difficulty starting one’s urinary stream, a weak stream, incomplete emptying of the bladder and symptoms of overactive bladder (urgency, frequency, etc.). It can be responsible for pain with sexual stimulation and intercourse, sometimes to the extent that sexual intercourse is not possible. It can also cause constipation, hemorrhoids, fissures and other bowel symptoms.

When anxiety expresses itself through tension in the pelvic floor muscles, the physical tension and pain further contribute to emotional anxiety and stress reaction, which creates a vicious cycle. Poor posture, muscle overuse and abnormalities with the nerve pathway that regulates muscle tone are other factors that contribute to the pelvic tension.

Characteristically, the pain waxes and wanes in intensity, may “wander” to different locations and can be perceived to be superficial, intermediate or deep in the pelvic tissues. It can involve the lower abdomen, groin, pubic area, genitals, perineum, anus, rectum, hips and lower back. The pain is often described as “stabbing,” although it can be cramping, burning or itching in quality. Urination, bowel movements and sexual activity can aggravate the pain.

Because the symptoms of pelvic floor tension myalgia can be vague and variable, those afflicted often have difficulty precisely expressing their symptoms, although they usually have many complaints and have typically seen numerous physicians and have had multiple prior interventions. Many patients thought to have interstitial cystitis/chronic pelvic pain syndrome, irritable bowel syndrome, chronic prostatitis, vulvodynia and fibromyalgia in actuality have pelvic tension myalgia. In fact, this pelvic floor issue is probably one of the most common problems that urologists and gynecologists see and is likely one of the most misunderstood, misdiagnosed and mistreated conditions. Many suffering with it are miserable and deeply frustrated after having endured years of episodic agony without relief.

How Is Pelvic Floor Tension Myalgia Diagnosed?

Most important are a rectal exam in men and a pelvic exam in women to evaluate the pelvic floor muscles. Typical findings are tight, tender and weak pelvic muscles, spasticity, and difficulty in relaxing the muscles following contraction. Localized, knot-like bands can often be felt, similar to tension knots that can develop in back muscles. The pain can often be localized by a vaginal or rectal exam that identifies these trigger points, the sites of origin of the myalgia that when manipulated cause tremendous pain, often replicating the symptoms.

How Is Pelvic Floor Tension Myalgia Managed?

The key to treatment is to foster relaxation and “down-training” of the spastic pelvic muscles in order to untie the “knot(s).” By making the proper diagnosis and providing pain relief, the vicious cycle of anxiety/pain can be broken. Managing it often requires multiple approaches including stress management, anti-inflammatory and anti-spasmodic medications, and physical interventions.

Pelvic muscle training can be a useful piece of this multimodal management approach by its focus on developing proficiency in relaxing the pelvic muscles. The emphasis here is not on contracting these already over-contracted and over-tensioned muscles, which could aggravate the problem. This demands a different spin on the usual concept of pelvic training, which in this instance is not to increase tone and strength—rather it is to instill pelvic muscle awareness and enable the capacity for maximal pelvic relaxation, which is considered to be a “meditative” state between pelvic muscle contractions. Those suffering with this problem need to learn to unclench and release the pelvic floor muscles.

Focused therapies include the application of heat and pelvic massage. Pelvic floor physical therapists can be of great benefit to those suffering with pelvic tension myalgia. They use a number of physical interventions that provide pelvic muscle stretching and lengthening to increase muscle flexibility including trigger point therapy, which compresses and massages the knotted and spastic muscles. Those afflicted that are so motivated can pursue self-treatment regimens using internal, manually guided trigger point release wands that aim to relieve or eliminate the knots by self-directed manipulation and massage. These devices may be obtained without a prescription and are available online. Pelvic muscle tension myalgia sometimes requires injections of medication—including anesthetics, steroids or Botox—into the offending trigger points.

Bottom Line: In people afflicted with pelvic pain, the diagnosis of pelvic floor muscle tension myalgia should be a primary consideration. Physical interventions can be extremely helpful in alleviating the pain and untying the “knots” within the over-tensioned pelvic muscles. By making the proper diagnosis and providing pain relief and fostering muscle relaxation, the vicious cycle of anxiety/pain can be broken.

Wishing you the best of health,

2014-04-23 20:16:29

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In the works is the female PelvicRx DVD pelvic floor muscle training for women.

Pelvic Rx can be obtained at, an online store home to quality urology products for men and women. Use promo code “UROLOGY10” at checkout for 10% discount. 


The Little Muscles That Could: The Mysterious Muscles You Should Be Exercising

November 5, 2016

Andrew Siegel MD 11/5/2016

This entry was a feature article in the Fall 2016 edition of BC The Magazine: Health, Beauty & Fitness.

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Image above: female pelvic floor muscles, illustration by Ashley Halsey from The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health


Image above: male pelvic floor muscles, illustration by Christine Vecchione from Male Pelvic Fitness: Optimizing Sexual and Urinary Health

There are over 600 muscles in the human body and they all are there for good reasons. However, some are more critical to health and survival than others. In the class rank it is a no-brainer that the heart muscle is valedictorian, followed by the diaphragm. What may surprise you is that the pelvic floor muscles (a.k.a. Kegel muscles) rank in the top ten of the hierarchy.

The pelvic floor muscles are a muscular hammock that make up the floor of the “core” muscles. They are located in the nether regions and form the bottom of the pelvis. They are among the most versatile muscles in the body, equally essential in both women and men for the support of the pelvic organs, bladder and bowel control and sexual function. Because they are out of sight they are frequently out of mind and often not considered when it comes to exercise and fitness. However, without functional pelvic muscles, our pelvic organs would dangle and we would be diapered and asexual.

Our bodies are comprised of a variety of muscle types: There are the glamour, for show, mirror-appeal, overt, seen and be witnessed muscles that offer no secrets—“what you see is what you get”—the biceps, triceps, pectorals, latissimus, quadriceps, etc. Then there are muscles including the pelvic floor muscles that are shrouded in secrecy, hidden from view, concealed and covert, unseen and behind the scenes, unrecognized and misunderstood, favoring function over form, “go” rather than “show.” Most of us can probably point out our “bi’s” (biceps), “tri’s” (triceps), “quads” (quadriceps), “pecs” (pectorals), etc., but who really knows where their “pelvs” (pelvic floor muscles) are located? For that matter, who even knows what they are and how they contribute to pelvic health?

Strong puritanical cultural roots influence our thoughts and feelings about our nether regions. Consequently, this “saddle” region of our bodies (the part in contact with a bicycle seat)—often fails to attain the respect and attention that other zones of our bodies command. Cloaking increases mystique, and so it is for these pelvic muscles, not only obscured by clothing, but also residing in that most curious of regions–an area concealed from view even when we are unclothed. Furthermore, the mystique is contributed to by the mysterious powers of the pelvic floor muscles, which straddle the gamut of being critical for what may be considered the most pleasurable and refined of human pursuits—sex—but equally integral to what may be considered the basest of human activities—bowel and bladder function.

The deep pelvic floor muscles span from the pubic bone in front to the tailbone in the back, and from pelvic sidewall to pelvic sidewall, between the “sit” bones. The superficial pelvic floor muscles are situated under the surface of the external genitals and anus. The pelvic floor muscles are stabilizers and compressors rather than movers (joint movement and locomotion), the more typical role that skeletal muscles such as these play. Stabilizers support the pelvic organs, keeping them in proper position. Compressors act as sphincters—enveloping the urinary, gynecological and intestinal tracts, opening and closing to provide valve-like control. The superficial pelvic floor muscles act to compress the deep roots of the genitals, trapping blood within these structures and preparing the male and female sexual organs for sexual intercourse; additionally, they contract rhythmically at the time of sexual climax. Although the pelvic floor muscles are not muscles of glamour, they are certainly muscles of “amour”!

Pelvic floor muscle “dysfunction” is a common condition referring to when the pelvic floor muscles are not functioning properly. It affects both women and men and can seriously impact the quality of one’s life. The condition can range from “low tone” to “high tone.” Low tone occurs when the pelvic muscles lack in strength and endurance and is often associated with stress urinary incontinence (urinary leakage with coughing, sneezing, laughing, exercising and other physical activities); pelvic organ prolapse (when one or more of the female pelvic organs falls into the space of the vagina and at times outside the vagina); and altered sexual function, e.g., erectile dysfunction or vaginal looseness.  High tone occurs when the pelvic floor muscles are over-tensioned and unable to relax, giving rise to a pain syndrome known as pelvic floor tension myalgia.

A first-line means of dealing with pelvic floor dysfunction is getting these muscles in tip-top shape. Tapping into and harnessing their energy can help optimize pelvic, sexual and urinary health in both genders. Like other skeletal muscles, the pelvic muscles are capable of making adaptive changes when targeted exercise is applied to them. Pelvic floor training involves gaining facility with both the contracting and the relaxing phases of pelvic muscle function. Their structure and function can be enhanced, resulting in broader, thicker and firmer muscles and the ability to generate a powerful contraction at will—necessary for pelvic wellbeing.

Pelvic floor muscle training can be effective in stabilizing, improving and even preventing issues with pelvic support, sexual function, and urinary and bowel control. Pursuing pelvic floor muscle training before pregnancy will make carrying the pregnancy easier and will facilitate labor and delivery; it will also allow for the effortless resumption of the exercises in the post-partum period in order to re-tone the vagina, as the exercises were learned under ideal circumstances, prior to childbirth. Similarly, engaging in pelvic training before prostate cancer surgery will facilitate the resumption of urinary control and sexual function after surgery. Based upon solid exercise science, pelvic floor muscle training can help maintain pelvic integrity and optimal function well into old age.

Bottom Line: Although concealed from view, the pelvic floor muscles are extremely important muscles that deserve serious respect. These muscles are responsible for powerful and vital functions that can be significantly improved/enhanced when intensified by training. It is never too late to begin pelvic floor muscle training exercises—so start now to optimize your pelvic, sexual, urinary, and bowel health.

Wishing you the best of health,

2014-04-23 20:16:29

Andrew Siegel MD practices in Maywood, NJ. He is dual board-certified in urology and female pelvic medicine/reconstructive surgery and is Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and attending urologist at Hackensack University Medical Center. He is a Castle Connolly Top Doctor New York Metro area and Top Doctor New Jersey. He is the author ofTHE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health ( and MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health ( He is co-creator of PelvicRx, an interactive, FDA-registered pelvic floor muscle-training program that empowers men to increase their pelvic floor muscle strength, tone, and endurance. Combining the proven effectiveness of Kegel exercises with the use of resistance, this program helps improve sexual function and urinary function. In the works is the female PelvicRx pelvic floor muscle training for women. Visit: to obtain PelvicRx. Use promo code “UROLOGY10” at checkout for 10% discount.