Fibromyalgia – A pain in the Pelvis

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Pelvic pain and trigger points

Pelvic muscles and the multi-layered muscles of the pelvic floor keep our organs where they should be. That’s a big job and any number of things can lead to development of TrPs that cause muscle dysfunction and pain. Myofascial trigger points are one of the greatest aggravators of chronic pelvic pain seen in both men and women, and pain is not the only symptom.

Trigger points can develop close to blood and lymph vessels, as well as peripheral nerves, which can impede the flow of blood (causing circulation and temperature changes), lymph fluid (leading to swelling and congestion), and peripheral nerve impulses (causing numbness and tingling).

Trigger points

Trigger points can develop because of restrictive tissue after injury, infection, surgery, a disease process that affects the musculoskeletal system, or due to problems in other areas around the pelvis that radiate pain to it. For instance, TrPs in the pelvis can cause pelvic floor spasm and impede urine flow causing urinary retention and hesitancy.

They can cause lower back and abdominal pain, pain in the tailbone, hip or groin pain, or pubic bone pain (the front on the pelvic bowl). TrPs can cause pain locally or radiate pain to other parts of the body specific to their location.  They can also cause erectile dysfunction, sacral dysfunction, painful intercourse, rectal pain, menstrual pain, impotence,

Association between fibromyalgia (FM) and chronic pelvic pain (CPP)

A study published in December 2015 is reported by some to be the first to associate fibromyalgia (FM) and chronic pelvic pain (CPP); however, I know others have made the connection because I live with both and I have been writing on the subject for quite some time. But, it is encouraging that physicians and others are taking note. It’s important to the understanding of pelvic floor pain, urinary distress and fibromyalgia.

European urologists suggest assessment of overlapping disorders, including fibromyalgia, in the 2014 Guidelines on Chronic Pelvic Pain, which is significant because awareness will bring about a better understanding on all commonly known overlapping disorders and others agree. Pelvic disorders not only cause pain, they also contribute to loss of intimacy, anxiety, depression, and unwarranted guilt.


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We may not all experience the same CPP, but we do experience the same effects:  interruption in normal healthy sexual relationships, difficulty sleeping, and disruption to our quality of life.

The root cause of chronic pelvic pain

A lot of conditions can cause chronic pelvic pain. Research links only some of them to FMS and ME/CFS (those are indicated with a * in the list below.) When trying to make a diagnosis, your doctor may want to start with the common overlapping conditions, but he or she may also explore some of the others, as well. It will likely depend on your specific symptoms.

Several conditions that can cause chronic pelvic pain are gender-specific. Causes specific to women include uterine fibroid tumors, Pelvic joint instability linked to childbirth and Endometriosis.


Like FM, CPP can be constant or come and go in flares. Symptoms can range from mild to severe and can fluctuate in intensity. That’s why it is important to identify perpetuating factors to both CPP and FM. They can perpetuate each other. Managing known overlapping disorders, paying attention to posture, mental well-being, sleep problems, and other things we have identified is important.

The more overlapping conditions that exist, the more complex the clinical picture, but this is not a reason your physician or you should give up. We can contribute to unraveling the kinks by indentifying and managing aggravating factors that are within our control.

Other things to help include Acupuncture, Biofeedback, Bladder retraining, Dietary assessment, Intravaginal and perineum transcutaneous electrical nerve stimulation (TENS), Myofascial therapy including both manual therapy and/or intravaginal trigger point injections, Nerve blocks,  Management of sacral joint dysfunction, Ultrasound therapy, Home therapy for pelvic floor muscles and intravaginal modalities, as well as therapy under the guidance and supervision of a urogyenologlogist or specialized therapist, Meditation and relaxation therapy, Medications, probiotics for the bladder and topical analgesics.

Chronic Pelvic Pain in FMS

Chronic pelvic pain, like any pain source, may cause symptoms of FMS or ME/CFS to intensify. Proper diagnosis and treatment of overlapping conditions is an important part of quieting all your symptoms and improving your life. Because some symptoms are common to multiple CSS, you may get double duty out of certain treatments, such as pain medications (NSAIDs, opiates) and SSRI/SNRI antidepressants. If you believe you have chronic pelvic pain, talk to your doctor to get the diagnostic process started.

Role of trigger points as peripheral pain generators in FM

Many do not understand the role of trigger points in CPP or their role as peripheral pain generators in FM. Some may suggest traditional therapies, such as Kegel exercise, which worsens symptoms until and unless trigger points are successfully treated and muscles and attachments are returned to their normal resting length.

Coexisting conditions with myofascial components, such as piriformis syndrome, spinal disease, etc., can cause a host of pain referral patterns. They are not in our head; they are in our pelvis and surrounding structures, and they are treatable.

Talk to your doctor

I understand this may be a difficult topic to discuss with your doctor, but it is imperative that you have the right treatment. There are physicians who specialize in urogynecology (a gynecologist with advanced training in female urology). Some gynecologists (doctors that specialize in women’s health conditions) can also share valuable resources to physical therapists that specialize in urogynecological therapy. Don’t suffer needlessly. Use the information here to be proactive in your care.


For support and Discussion join the group “Living with Fibromyalgia and Chronic Illness”

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Reference: Fight Fibromyalgia

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