Pelvic floor muscles have two important functions. They provide physical support to the pelvic viscera and a constrictor mechanism to the anal canal, vagina and urethra. Newer imaging and physiological studies strongly suggest that these two functions of the pelvic floor are quite distinct and are likely related to different components of the pelvic floor muscles.
When there is dysfunction or malfunction of the pelvic floor muscles the result can be dysfunction or malfunction of the critical functions provided by the pelvic floor.
Pelvic floor muscle spasm can be either primary (there is no underlying cause) or secondary (there is an identifiable underlying cause). When there is primary pelvic floor muscle spasm there is usually a long history of problems such as painful intercourse, urinary problems and constipation. This usually starts in the teen years but certainly may occur in younger girls.
When the pelvic floor muscle spasm is secondary it is usually due to some type of chronic inflammatory problem. The inflammation can come from repeated urinary tract infections (UTI), repeated vaginal infections such as yeast and bacterial vaginosis, or very commonly from underlying endometriosis which is a disease with a high degree of inflammation.
There are 2 main ways to treat pelvic floor muscle spasm.
First, physical therapy by a trained expert can work over a long period of time. This physical therapy will include internal vaginal manipulation, a well-designed home exercise program, vaginal dilators and a biofeedback program.
Often, it is recommended that patients use diazepam (vaginal suppositories) to decrease the overall muscle spasm when there is daily discomfort and/or urinary symptoms associated with the pelvic floor muscle spasm.
The second main treatment for pelvic floor muscle spasm is the use of botulinum toxin A (botox). This is the same botox that is used for muscle spasm in other parts of the body and for cosmetic purposes, except the pelvic floor muscles are very large muscles relative to the facial muscles so much higher doses are needed.
The benefits of botox therapy are that it works quickly and lasts for a long time. Typically, fewer than 5% of patients need a repeat injection. Botox works by blocking the communication between the nerve and the muscle. Thus, it gives time for both nerve and muscle to heal from the hyperactivity. After 8-10 months have passed and the muscle tone returns to normal (or even hypertonic) the pain does not return.
Side effects of botox in the pelvic floor are uncommon (<5%), but can be associated with fecal urgency and incontinence.
Our success rate with botox therapy is approximately 95%. That means that 95% of patients will achieve greater than 75% relief.
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