Prolotherapy for Pelvic Floor Pain
Written by Ross Hauser, MD
A patient came in with a six year history of pelvic pain, pain behind the vagina, and a tightness in the pelvic floor. She was diagnosed with pelvic floor dysfunction. She had seen around 20 health care practitioners. Her treatment course had consisted of muscle strengthening, relaxation and re-education, along with exercises, stretching, postural education, myofascial treatment, various nerve blocks, epidurals, trigger point injections, as well as manipulation and soft tissue mobilization. Many of which helped temporarily but the condition just continued. The condition was affecting her ability to enjoy sex.
On the initial examination she was noted to be tender over the ischial tuberosities in the front (anterior) and the pubic symphysis and ramus. She wanted to try Prolotherapy.
The first treatment didn’t change her symptoms much. After the second visit she noted much less tension in the pelvic floor. Her progress continued to the point after the fourth visit she was smiling finally. She and her husband were back to normal sexual relations and she was back to exercising. She received a total of six Prolotherapy treatments. She has been pain free for over four years.
The pelvic floor muscles attach to the pubic area anteriorly and the coccyx (tailbone) posteriorly. They form a sort of a sling providing support to the bladder, uterus, rectum. They encircle the bowel and bladder openings aiding in closing and opening these openings (help with continence). Proper functioning of these “pelvic floor muscles” is necessary in the process of urination and defecation. They are also involved in the sexual response. When these muscles don’t work properly they are said to be in dysfunction.
There are many symptoms of pelvic floor dysfunction including:
- Pelvic Pain
- Pain With Intercourse
- Vagina Pain
- Pain Between Vagina and Rectum
- Low Back Pain
- Urinary Frequency and Urgency
- Painful Bowel Movements
- Pain in the Testis or Penis
- Pain associated with ejaculation
- Decreased Urinary Flow
As a Prolotherapy physician I see many of the physiotherapy treated Pelvic Floor Dysfunction failures. I understand that exercises do help people with Pelvic Floor Dysfunction (PFD). Having said that, I believe millions of people live with PFD “controlling” the symptoms but the symptoms still decrease their enjoyment of life. I believe Prolotherapy has the greatest chance of curing the problem.
HOW PROLOTHERAPY CAN CURE PELVIC FLOOR DYSFUNCTION
One basic principle that I think people forget about muscle spasms is that muscle spasms will occur when a muscle contracts against an unstable base. In other words is a tennis players muscles more likely to get strained and torn when the feet are planted and the player has time to set and get ready for the shot versus when they have to run really hard for a ball and then hit it with barely one foot planted and arm stretched out to its maximum? Which posture will allow the athlete to hit the ball with the most amount of force? When the muscle contacts against a stable base (feet planted), it is possible to get maximum force from that muscle and the likelihood of muscle injury is minimum. When the muscle contracts against bone that is moving (like the tennis player diving for a ball), minimal muscle force can be achieved and the likelihood of injury is great. How does this apply to PFD? Good question!
The pelvic floor muscles attach to the pubis and coccyx. The pubic bones are held together by ligaments and the pubic symphysis. The pubic symphysis is a disc. This disc and the supporting ligaments can be torn or sprained. Likely the coccyx is stable because of all the ligament support around it. Let’s see the sacrotuberous, sacrococcygeal and sacroiliac ligaments are vital to providing stability in the “back portion” of the pelvic rim upon which the muscles attach. Injury to the pubic symphysis, pubic ligaments or any of the ligaments that stabilize the lower back (especially sacroiliac joint) would cause the pelvic floor muscles to be contracting continually against an unstable base. This would mean every time we urinated, defecated, held our breath or had sex, the muscles would try to generate force attached to structures that are moving. They be much like the tennis player trying to hit a shot with a lot of force and accuracy while lunging toward the ball. It just isn’t going to work right.
Injury to the pelvic floor ligaments would result in the pelvic bones moving excessively. In such a scenario, pelvic floor muscle spasm has to occur. Massage therapy, exercises, re-education would only have temporary benefit. They would address the muscle spasm part of the problem but not the cause of the muscle spasms.
Prolotherapy to the injured ligaments induces a mild “healing” inflammatory reaction. Generally four to six visits of Prolotherapy, done every two to six weeks is needed. Once the ligaments are normal strength, the pelvic floor musculature can contract with maximum force against a stable base. Thus, the muscle spasms stop. The chronic pelvic floor pain, low back pain, vagina pain and bowel/bladder symptoms stop because the muscle tone in the pelvic floor gets back to normal. Then the person can exercise to their hearts delight. It is then that we say “Prolotherapy is a great treatment for Pelvic Floor Dysfunction!”