Pelvic Floor Injections

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Pelvic Floor injections exist as a form of treatment for pelvic floor muscle and biomechanical dysfunction, which includes chronic pelvic pain. However, this is a moderately invasive procedure, that is costly and requires hospital admission, with a less than optimal success rate in relieving symptoms. Pelvic floor specific physical therapy should always be the first option for the patient. The chances of complications are minimal, the exercises prescribed are tailored to the individual and their lifestyle needs, it is cost-effective and a relationship of trust and shared knowledge (which is essential when dealing with the pelvic floor) is established with the physical therapist.

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The Side Effects of Pelvic Floor Injections

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For a Pelvic Floor Injection utilizing Botox (the main ingredient of this is Clostridium botulinum toxin type-A hemagglutinin complex), side effects may include swelling, flu-like symptoms, chest pain, cramping and other points of muscle aches and pain. Botox markets that symptoms with a lesser reoccurrence have been “skin rashes, itching and allergic reaction, malaise or tiredness, and (rarely) changes in heart-beat patterns, and chest pain.” A more common side effect for Botox injections is temporary incontinence, or dysfunction when emptying the bladder. For Trigger Point Pelvic floor injections, this report stated that 10% of visits experienced “leg numbness, dizziness, nausea, bleeding, and headaches.”

What are Pelvic Floor Injections?

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Upon examination, tender areas may be found in which it may be suggested that the patient be treated with a trigger-point injection or Botulinum Toxin Type A (Botox) injection. These procedures involve injecting the affected area with an anesthetic, steroid, or botox to relax the muscles. The goal of this injection is to provide either long or short term pain relief and therefore more comfort for the patient. Whilst the medication can be effectively delivered to the pelvic floor muscle groups via injection, there is no confirmed evidence or publications that support the use of pelvic floor muscle injections. Patients who suffer from myofascial pain around the pelvis are better off physically and financially working with a physical therapist who specializes in pelvic floor treatment.

Recovery from Pelvic floor Botox Injections

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Patients with spasm in their pelvic floor muscle group often will be referred to Botox injection due to its nature being a muscle weakening or paralyzing agent. Botox is said to assist tense muscles that are in spasm. In this case, its the pelvic floor muscle group. Before the main injection, the patient is given anesthetic via a drip, monitored by an anesthetist. Botox is injected with a needle into the affected muscles via the vaginal skin. The patient is not often required to stay overnight in the hospital post-injection, despite the higher frequency in the use of general anesthetic for the procedure. In a few cases, a local anesthetic can be used. The doctors will place a bandage-like pack into the vagina to ensure the Botox spreads to the pelvic floor muscles.

Bruising and tenderness are often present around the site of the injection. Sometimes patients will experience a level of incontinence for a short period of time. Studies state that only around 75% of women have the desired response to a Botox injection. Further, the effects often take a couple of weeks to become apparent if the patient has a positive reaction, and only last around 6 months. With appropriate pelvic floor physical therapy, a patient can learn exercises and skills that can be integrated into their daily life. Unlike pelvic floor injections, this is in a non-invasive, personalized, cost-effective manner. Pelvic floor physical therapy should always be the first port of call before any medical procedure is considered. Often, with consistent, specific, and personally tailored exercises combined with manual forms of physical therapy treatment, the patient is relieved of symptoms and comes away with a stronger, efficiently functioning pelvic floor.

Trigger Point Injections (TPIs) for pelvic floor dysfunction

Trigger Point injections are prescribed to patients experiencing localized muscle pain in the pelvic floor muscle group. This muscle pain is often a result of repetitive trauma to the pelvic floor region. To provide some examples, this could be a result of pregnancy and childbirth trauma, sports injury, previous surgical procedures, and sexual trauma. For most patients presenting with chronic pelvic pain, there is a degree of myofascial pelvic pain. Simply put, this means wound-up, tight, short, and tender pelvic floor muscles.

The patient will often present with chronic tightness, and high levels of spasm characterized by the presence of trigger points. Referred to medically as myofascial trigger points, these are specific hypersensitive spots on the muscle that cause extreme discomfort for the individual. For example, trigger points exist on the levator muscles in the pelvic floor which can be a point of pain and a site of inflammation if the patient has experienced a form of chronic muscle contraction. The first form of treatment should always be pelvic floor specific physical therapy to assist in the formation of new, improved habits for the individual. The exercises prescribed will focus on posture correction, the breath, strengthening of the pelvic floor muscle groups where appropriate, a stretching routine, and certain forms of manual therapy. A multi-disciplinary, individual, case-specific approach is always recommended to treat pelvic pain.

For patients who choose to go ahead with pelvic floor trigger point injections, this will involve a steroid and local anesthetic injection. The needle containing a corticosteroid and anesthetic is injected through the skin slowly into the painful trigger point/s. The patient can be injected in one or more sites, in varied locations dependent on where the symptoms presented. The theory behind these injections is to trigger a release of endorphins within the reflex arcs of the affected muscle/s, which is said to trigger positive change in damaged and spasming muscle fibers. This procedure is less invasive than a Botox pelvic floor injection. However, as the site of injection is often painful, and the surrounding nerves are often inflamed, the trigger point injection procedure can be uncomfortable. Pelvic floor physical therapy is a much better treatment option as it educates the patient on how to retrain the pelvic floor muscles to work optimally. Injections are like a bandaid – a costly temporary fix. The patient needs to learn how to work with their body. Interestingly, biofeedback (involving visualization and developing individual specific mental cues) assists with retraining of chronically tight and painful pelvic floors.

How long does it take for trigger point injections to work?

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The trigger point injection procedure lasts around 10-15 minutes, much shorter, and less complicated than a Botox injection as discussed above. The patient is required to wait in a recovery room for a short amount of time post-procedure before they can return home. Normally patients will experience some form of relief within a couple of days (2-3 roughly). However in some cases, patients have experienced relief on the same day as the procedure, and others can take up to 2 weeks. Note that as the anesthetic wears off post-procedure, some pain may present around the site of injection, which can be temporarily more discomforting than relief from the treatment. Most sources explain that the length of time for a patient to experience relief differs depending on the individual and extremity of the case. Repeat injections often have to be given within 4-6 months after the first.