Hypertonic muscles (too tight muscles), myofascial trigger points (MTrPs), joint dysfunction, and connective tissue restrictions can cause pudendal nerve irritation and the symptoms of pudendal neuralgia: sharp, shooting, or burning pain in the territory of the nerve.

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Pelvic Floor Physical Therapy (PFPT) with neuromuscular education is the cornerstone of therapy for women with nonrelaxing pelvic floor dysfunction. Therapy is ideally provided by a physical therapist with training in pelvic floor dysfunction. The specific therapy used is guided by symptoms and usually includes strategies to optimize lumbopelvic and spinal function and to improve bowel, bladder, and sexual function. Manual techniques may include trigger point massage, myofascial release, strain-counterstrain, and joint mobilization, among others. In addition, exercises to strengthen and stabilize the core muscles usually are included with pelvic floor physical therapy. 1

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NOTE: No Kegels!  A Kegel attempts to strengthen the pelvic floor, but it really only continues to pull the sacrum inward promoting even more weakness, and more PF gripping. The muscles that balance out the anterior pull on the sacrum are the glutes. A lack of glutes (having no butt) is what makes this group so much more susceptible to pelvic floor disorder (PFD). Zero lumbar curvature (missing the little curve at the small of the back) is the most telling sign that the pelvic floor is beginning to weaken. An easier way to say this is: Weak glutes + too many Kegels = Pelvic Floor Dysfunction (PFD). 2

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Because of where they are – your pelvic floor is the hammock of muscles you sit on.   They’re also tightening up around the urethra, the outlet to the bladder.  Hypertonicity in the pelvic floor can also make the pelvic floor muscles really taut: they can bulk up, they can get tired, they can ache and they can get sore.​

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Causes of hypertonic pelvic floor muscles

• runners, for example, who have tight abdominals and tight hamstrings can often have hypertonic pfms,

• In the same way that some people carry muscular tension between their shoulder blades, others carry it in their pelvic floor eg  some women clench their pfms when they feel stressed, or they might just have their pfms on when they don’t need to,

• some post-menopausal women’s skin becomes thin and dry due to the lack of oestrogen, and they can tense up their pfms without realising if sex has become painful, This is also the same case for aging men regarding hormones. 3

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Please go to website MAIN MENU Pelvic Floor Physical Therapy (PFPT) and at the List of Pelvic Floor Physical Therapists

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The good news if hypertonic pelvic floor muscles are the sole cause for your pudendal neuralgia, PFPT and Botox can cure the condition is just months. Understand however, there may be other causes, but these treatments will still reduce your pain and should be utilized if you are diagnosed with PN because they are non-invasive.

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 Hypertonicity/spasticity of pelvic floor found are most often found along the following muscles:

          1. Obturator Internus 

          2. Pubococcygeus

          3. Ileococcygeus

          4. Coccygeus

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1  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498251/ 

2  https://breakingmuscle.com/stop-doing-kegels-real-pelvic-floor-advice-for-women-and-men/https://www.womens-health-physio.co.uk/2014/08/hypertonic-pelvic-floor-muscles/

3. Hypertonic Pelvic Floor Symptoms, Causes & Treatment (womens-health-physio.co.uk)

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Pudendal Neuralgia Alliance

contact@pudendalneuralgiaalliance.org

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