Chronic pelvic pain: Pelvic floor problems, sacro-iliac dysfunction and the trigger point connection

SummaryThe incidence of chronic pelvic pain (CPP) is widespread, with multiple potential aetiological features. There is evidence that CPP is relatively poorly understood, even by specialists in genitourinary dysfunction and disease, and certainly by the wider health care community. Recent research has suggested connections between chronic sacro-iliac restrictions/instability and a wide range of pelvic floor related problems, as well as breathing pattern dysfunction. In addition myofascial trigger points are reported to be commonly actively involved in the pain aspects of problems associated with these structures. Studies have also indicated that in many instances CPP is amenable to manual therapeutic approaches.It has been hypothesized that inadequate force closure may be a common aetiological feature, affecting both urethral and sacroiliac instability. This paper attempts to outline current research-based concepts linking these mechanisms and influences with pelvic pain and dysfunction, including variously interstitial cystitis, stress incontinence, dyspareunia, vulvodynia, prostatitis, prostatodynia, penile pain, sacroiliac dysfunction, myofascial trigger point activity, and respiratory disorders such as hyperventilation. Evidence-based therapeutic approaches suitable for application by physiotherapists, osteopaths and other manual practitioners and therapists are discussed.