Pelvic Floor Muscle Pain

Unpublished

Author: Beth Shelly PT

Last Updated: April 2018

Current ICS definition

Pelvic Floor Muscle Pain also known as Pelvic Floor Myalgia - pain in the muscles of the pelvic floor (perineal or levator ani). (1)
Intra-pelvic Muscle Pain (pain in the pelvic side wall muscles - obturator internus, piriformis, coccygeus) (1)
Levator Ani Syndrome (the term may refer to the same syndrome as ´pelvic floor muscle pain syndrome´/’tension myalgia of the PFM’) as pain with sitting and pain with defecation. (1)
Myalgia: muscle pain. Pelvic floor myalgia (a symptom) may be present with or without a change in PFM tone (a sign). (2)

Other terms

The International Association for the Study of Pain (IASP) (3)
Pelvic floor muscle pain syndrome - the occurrence of persistent or recurrent, episodic, pelvic floor pain.
Muscle tension pain - as a sustained muscle tension

Controversies

Unfortunately current ICS terminology is not clear on whether these terms are being used as a symptoms (patient complaint of pain in the muscle), sign (reproduction of patient's pain by palpating a muscle) or diagnosis (symptoms and related signs).

Muscle pain is determined by palpating the muscle and asking the patient for sensations felt. Any muscle can generate pain if enough pressure is applied. Light pain over a muscle could be pain in the skin or fascia. Depth of palpation is not specified.

Tension myalgia implies the mechanism is related to increased muscle activity. This is often the case but not always - trigger points are electrically silent but very painful and can contribute to pelvic floor muscle pain.

Levator ani syndrome implies the dysfunction is only in the levator ani muscle group. This is also very common but not always the case.

There are currently several terms in the standard documents which essentially mean the same:
• pelvic floor muscle pain (syndrome)
• pelvic floor myalgia / tension myalgia
• levator ani syndrome
Which term should authors / medical practitioner use? Is it not possible to agree on one term?

References

1. Doggweiler, K. E. Whitmore, J. M. Meijlink, M. J. Drake, H. Frawley, J. Nordling, P. Hanno, M. O. Fraser, Y. Homma, G. Garrido, M.J. Gomes, S. Elneil, J. P. van de Merwe, A. T. L. Lin, H. Tomoe. A Standard for Terminology in Chronic Pelvic Pain Syndromes: A Report from the Chronic Pelvic Pain Working Group of the International Continence Society. In publication. 2016.
Bo K, Frawley HC, Haylen BT, Abramov Y, Almeida FG, Berghmans B, Bortolini M, Dumoulin C, Gomes M, McClurg D, Meijlink J, Shelly E, Trabuco E, Walker C, Wells A. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. Neurourol Urodyn. 2017 Feb;36(2):221-244.
Baranowski AP, Berger R, Buffington T, Collett B, Emmanuel A, Fall M, Hanno P, Howard F, Hughes J, Nickel JC, Nordling J, Tripp D, Vincent K, Wesselmann U, Williams AC. International Association for the Study of Pain (IASP) Classification of Chronic Pain. Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms, Second Edition (Revised 2011).