Trigger Point Injections

Women suffering from chronic pelvic pain or pelvic floor dysfunction may also have one or more trigger points contributing to their pain symptoms.

Trigger points describe specific hyperirritable areas of pain in the muscle or fascia (connective tissue), generally in the abdominal wall or pelvic floor. Sometimes you may already know where these pain-triggering spots are, but often, these are identified during a thorough physical exam. 

Common trigger points of the pelvic floor:

• Anococcygeal pain – obturator internus
• Sacrococcygeal pain – levator ani, coccygeus
• Anterior thigh pain – iliopsoas
• Posterior thigh pain – obturator internus, piriformis
• Vaginal pain – levator ani, obturator internus 

Sometimes, self-massage, stretching, and pelvic yoga can soothe trigger points. If these interventions do not provide enough relief, another option worth trying is one or more trigger point injections.

A trigger point injection is performed by injecting a small amount of anesthetic agent (like lidocaine or bupivicaine) with or without a steroid into the trigger point. One or more areas can be treated during the same visit. These can be performed both in the abdominal wall or into the pelvic floor musculature. 

Trigger point injections don’t work for everyone, but for some they provide tremendous relief. If you experience good results, these can be repeated every 3-4 weeks for 6 or more treatments. Our goal with trigger point injections is to “reset” the central sensitization that can occur with chronic pain and allow your body to experience normal sensations as normal again. 

I know, the idea of an injection in the pelvic floor might seem overwhelming. That’s why I take every measure to make the procedure as comfortable as possible.

First, I will repeat a pelvic exam to confirm the target of the trigger point injection. Then I will apply (or if you prefer, have you apply) lidocaine jelly inside the vagina to temporarily numb the area. Finally, I will use a nerve block kit to inject into the specific muscle causing you trouble. 

Trigger point injections can be performed in the operating room at the same time as another surgery, if desired. For some, trigger point injections while under anesthesia is more appropriate.