The pelvis is the lowest part of abdomen. Within the pelvis there are the bowel, bladder, uterus, and ovaries. If something goes wrong with these organs and pelvic surroundings, it can cause pelvic pain. People should know that pelvic pain is not normal. Getting treatment early is important. Pelvic pain can be caused by any of those pelvic organs. Pelvic pain can also originate in the pelvic bones, muscles, nerves, joints, or blood vessels. Pelvic pain from a pelvic floor muscle problem can be helped by a special type of physical therapy known as pelvic floor physical therapy. Pelvic pain sometimes occurs when muscles of the pelvic floor are too tight.
Acupuncture is effective for pelvic floor dysfunction
Pelvic floor consists of muscles and ligaments. These muscles can contract and relax and coordinate with abdominal muscles to assist pelvic organ function. If the pelvic floor muscles and ligaments are impaired and are not be able to contract or relax, this will affect pelvic organ’s function causing pelvic floor dysfunction. For example,50 percent of people with chronic constipation have pelvic floor dysfunction (PFD). The symptoms of pelvic floor dysfunction include urinary problems such as feeling urgent to urinate or painful urination, constipation, low back pain, pain or pressure in the pelvic region, genitals or rectum, discomfort during intercourse, muscle spasms in the pelvis. The common causes of pelvic floor dysfunction are childbirth, pelvic trama, obesity, pelvic surgery, nerve damage. Recent research has shown that acupuncture is an effective treatment for pelvic floor disorders, particularly with respect to pelvic pain.
Arnouk A et al Curr Urol Rep. 2017 Jun;18(6):47. doi: 10.1007/s11934-017-0694-7.
What are pelvic floor muscles and pelvic floor
Pelvic floor muscles are the skeletal muscles spread on the bottom of the pelvis. They stretch from front at pubic bone to the back at the tailbone and from one side of the sitting bone to the other side of the sitting bone. They support the pelvic organs including bladder and bowel in men and bladder, bowel and uterus in women. These organs lie on the pelvic floor muscle layer. The pelvic floor muscle layer has holes for passages to pass through. There are two passages in men (the urethra and anus) and three passages in women (the urethra, vagina and anus). The pelvic floor muscles normally wrap quite firmly around these holes to help keep the passages shut. There is also an extra circular muscle around the anus (the anal sphincter) and around the urethra (the urethral sphincter). The sphincters help conscious control over the bladder and bowel so that the release of urine, faeces (poo) and flatus (wind) can be controlled until it is convenient. Pelvic floor muscles are also important for sexual function in both men and women. The pelvic floor muscles in women also provide support for the baby during pregnancy and assist in the birthing process. The muscles of the pelvic floor work with the abdominal and back muscles to stabilise and support the spine.
Pelvic floor muscles have two major functions; they provide 1; support or act as a “ floor” for the abdominal viscera including the rectum and 2; constrictor or continence mechanism to the urethral, anal and vaginal orifices (in females).
Pelvic floor is the area underneath the pelvis and it comprises muscles and connective tissue such as ligaments and fascia. It separates the pelvic cavity above from the perineal region below. It provides support to the bladder, intestines and uterus (in females). It assists with continence through control of the urinary and anal sphincters. It facilitates birth. it helps to maintain optimal intra-abdominal pressure.
Ligaments of the Pelvis
Iliolumbar ligament - from tip of transverse process of L5 to posterior aspect of inner lip of iliac crest; strengthens the lumbo-sacral joint.
Lateral lumbosacral ligament
Sacrotuberous ligament- from sacrum to tuberosity of the ischium
Sacrospinous ligament - from ischial spine to lateral margins of the sacrum
Ventral/Anterior sacroiliac ligament- from antero-lateral aspect of sacrum to auricular surface of the ilium
Dorsal/Posterior sacroiliac ligament
Upper portion (short posterior sacroiliac ligament) - from 1st and 2nd transverse tubercles of sacrum to tuberosity of ilium
Lower portion (long posterior sacroiliac ligament) - from 3rd transverse tubercle of sacrum to posterior superior iliac spine (PSIS)
Interosseous sacroiliac ligament- lies deep to posterior SI ligament and runs between the tuberosities of the sacrum and ilium
Ventral/Anterio sacrococcygeal ligament -from anterior surface of sacrum to the front of the coccyx; continuation of the anterior longitudinal ligament of the spine
Dorsal sacrococcygeal ligament
Deep portion - from inside sacral canal at the 5th sacral segment to the dorsal surface of the coccyx; continuation of the psoterior longitudinal ligament of the spine
Superficial portion - from free margin of sacral hiatus to dorsal surface of the coccyx; corresponds with the ligamentum flavum of the spine
Lateral sacrococcygeal ligament - from inferior lateral angle of the sacrum to the transverse process of the 1st coccygeal vertebra
Pubic Symphysis Ligaments
Superior pubic ligament - runs between pubic tubercles
Inferior pubic ligament (aka arcuate public ligament) - runs between inferior pubic rami and blends with fibrocartilagnous disc of pubic symphysis
Anterior pubic ligament
Posterior pubic ligament - membranous structure which blends with periosteum
Endopelvic Fascia - Ligaments
Female: Pubovesical ligaments - attach bladder to pubic symphysis
Male: Puboprostatic ligaments - attach bladder to pubic symphysis
Sacrogenital - these are thickenings of the fascia, not specific ligaments
Uterosacral ligaments - attach upper vagina, upper portion of cervix and uterus to the 3rd sacral vertebra
Cardinal ligaments (aka Mackenrodt's) - attach upper vagina, cervix and uterus to the side walls of the pelvis
Round ligaments - attach uterus to mons pubis
Broad ligaments - attach uterus to medial aspect of the ilium
Uracus ligament - attaches bladder to umbilicus (formed from the remnants of the umbilican vein)
Penile Suspensory Ligaments
Penile Suspensory ligament - attaches to anterior aspect of interpubic disc and divides in two to sling around the penis
Fundiform ligament - extends from inferior linea alba and divides to wrap around the penis
Parietal pelvic fascia - lines the internal surface of the muscles of the pelvic floor and walls
Visceral pelvic fascia - invests each pelvic organ
The parietal and visceral fascia are continuous where organs penetrate the pelvic floor. They thicken to form the arcus tendineus, arches of fascia running adjacent to the viscera from the pubis to the sacrum.
Endopelvic fascia* - meshwork of smooth muscle, ligaments, blood vessels and connective tissue lying between the parietal and visceral fascia, sometimes condensing to form fibrous fascial septa which separate and suspend the organs.
Anatomists use the name subserous fascia whereas surgeons refer to this layer of retroperitoneal fascia as endopelvic fascia.
Hypogastric sheath - separates retropubic space from presacral space; conduit for vessels and nerves
Transverse cerical (cardinal) ligaments - part of hypogastric sheath; runs from lateral pelvic wall to uterine cervix and vagina; transmits uterine artery and provides passive support for the uterus