Pelvic Floor Trigger Point Injections in Managing Myofascial Pelvic Pain

INTRODUCTION: Myofascial pelvic pain is an important, albeit neglected component of chronic pelvic pain and has been reported in 14% to 23% of patients. Myofascial pain syndrome is defined as chronic, non-articular, local musculoskeletal pain that manifests as muscle and connective tissue tenderness within the pelvic floor muscles. Myofascial trigger points are intrinsic to myofascial pelvic pain. In order to accurately assess, diagnose, and manage this condition, knowledge of pelvic floor anatomy is imperative. OBJECTIVE: In this video, we will discuss the role of pelvic floor trigger point injections in the management of chronic myofascial pelvic pain as well as the relevant pelvic anatomy. METHODS: We will first identify the anatomy of superficial pelvic floor muscles as well as deep pelvic floor muscles. Then, we will discuss physical exam techniques to locate pelvic pain and/or myofascial trigger points. RESULTS: We will then simulate trigger point injection and pudendal block administration to aid in management of chronic pelvic pain. CONCLUSIONS: A comprehensive external and internal exam is necessary to identify trigger points in the levator ani and obturator internus that can benefit from intervention. Injection of botox or anesthetic into trigger points can aid with symptom management.