Muscle Group Muscles Function
Levator Ani Puborectalis, Pubococcygeus, Iliococcygeus Supports pelvic organs, controls bowel/bladder function, stabilizes pelvis
Coccygeus Coccygeus Stabilizes tailbone, assists in pelvic floor support
Deep Urogenital Muscles Perineal Muscles, External Sphincters, Urethral Muscles Controls urination, defecation, and sexual function
Superficial Perineal Muscles Bulbospongiosus, Ischiocavernosus, Superficial Transverse Perineal Assists in erectile function, vaginal contractions, and perineal stability

Pelvic Floor Muscles Trigger Points

Introduction

The pelvic floor muscles are a group of deep muscles responsible for supporting pelvic organs, maintaining continence, and stabilizing the pelvis. When trigger points develop in these muscles, they can cause pelvic pain, urinary or bowel dysfunction, and lower back discomfort, often mimicking prostatitis, endometriosis, or SI joint dysfunction.

Name and Area

Indications

Pelvic floor trigger points may contribute to:

  • Deep Pelvic or Perineal Pain (Mistaken for Prostatitis, Endometriosis, or Pudendal Neuralgia)

  • Pain That Extends to the Tailbone, Lower Back, or Inner Thighs (Can Mimic Sciatica or SI Joint Dysfunction)

  • Pain or Discomfort While Sitting (Common in Cyclists, Office Workers, and Postpartum Individuals)

  • Urinary Urgency, Frequency, or Pain (Can Be Mistaken for UTIs or Overactive Bladder Syndrome)

  • Bowel Dysfunction, Such as Constipation or Painful Bowel Movements (Can Resemble IBS or Rectal Spasms)

  • Pain During or After Sexual Activity (Common in Both Men and Women, Often Mistaken for Hormonal Issues)

Pain from these muscles is often mistaken for pelvic floor dysfunction, SI joint pain, or urogenital disorders.

Muscle Action

  • Supports the Pelvic Organs: Helps maintain the position of the bladder, uterus, and rectum.

  • Aids in Urinary and Bowel Control: Works with the sphincters to regulate urination and defecation.

  • Stabilizes the Pelvis and Spine: Works with the deep core muscles to support posture and movement.

The pelvic floor muscles are essential for pelvic health, core strength, and functional movement.

Signs and Symptoms

Individuals with pelvic floor trigger points often report:

  • Deep, Aching Pain in the Perineum or Pelvic Region (Feels Like a Heavy or Pressured Sensation)

  • Pain That Spreads to the Tailbone, Lower Back, or Groin (Can Resemble Sciatic Nerve Pain or SI Joint Dysfunction)

  • Urinary Issues (Frequent Urges, Incomplete Emptying, or Painful Urination Without Infection)

  • Bowel Dysfunction (Constipation, Pain with Bowel Movements, or Rectal Spasms)

  • Discomfort or Pain During Sexual Activity (Can Affect Both Men and Women)

  • Pain That Worsens with Sitting, Stress, or Increased Pelvic Floor Tension

Pain worsens with prolonged sitting, sexual activity, or stress-induced muscle tension.

Perpetuating Factors

Common causes of pelvic floor trigger points include:

  • Prolonged Sitting or Poor Posture (Can Cause Chronic Pelvic Floor Tightness)

  • Pelvic Surgeries, Childbirth, or Trauma (Can Lead to Muscular Dysfunction and Chronic Pelvic Pain)

  • Chronic Stress or Anxiety (Increases Pelvic Floor Muscle Guarding and Tension)

  • Repetitive Straining During Bowel Movements (Common in Chronic Constipation or IBS)

  • Pelvic Imbalances or Hip Dysfunction (Can Lead to Overcompensation by the Pelvic Floor Muscles)

Trigger Point Referral Pattern

Trigger points in the pelvic floor muscles refer pain to:

  • The perineum and deep pelvic region (Can Mimic Pelvic Floor Dysfunction or Pudendal Neuralgia)

  • The tailbone and sacrum (Mistaken for SI Joint Dysfunction or Coccydynia)

  • The inner thighs and lower abdomen (Can Resemble Groin Strain or Hip Flexor Tightness)

Pain from these muscles is often confused with chronic pelvic pain syndromes, sciatica, or urogenital dysfunction.

Differential Diagnosis

Pelvic floor trigger points may be mistaken for:

  • Prostatitis (Pelvic and Perineal Pain in Men, Often Without Infection Present)

  • Endometriosis (Deep Pelvic Pain in Women, Worse During Menstruation or Intercourse)

  • Interstitial Cystitis (Bladder Pain and Urgency Without a UTI)

  • SI Joint Dysfunction (Pain in the Lower Back and Pelvic Region, Worse with Sitting or Walking)

  • Pudendal Neuralgia (Burning or Numbness in the Pelvic Floor and Perineum, Worse When Sitting)

A thorough pelvic floor, hip, and lower back examination is necessary to rule out these conditions.

Associated Trigger Points

Pelvic floor trigger points often co-exist with:

  • Piriformis (Deep Buttock Pain and Sciatica-Like Symptoms, Affects Pelvic Mobility)

  • Obturator Internus (Inner Hip and Groin Pain, Can Contribute to Pelvic Floor Dysfunction)

  • Quadratus Lumborum (Lower Back and Hip Pain, Affects Postural Stability and Core Strength)

  • Adductor Muscles (Inner Thigh and Groin Pain, Can Mimic Pelvic or Urogenital Pain)

Anatomy and Innervation

Muscle Origin Innervation
Levator Ani Puborectalis, Pubococcygeus, Iliococcygeus Pudendal nerve (S2–S4)
Coccygeus Coccygeus Sacral spinal nerves (S3–S5)
Deep Urogenital Muscles Perineal Muscles, External Sphincters, Urethral Muscles Pudendal nerve (S2–S4)
Superficial Perineal Muscles Bulbospongiosus, Ischiocavernosus, Superficial Transverse Perineal Pudendal nerve (S2–S4)

The pelvic floor muscles are innervated by the pudendal nerve and sacral plexus, which also control bladder, bowel, and sexual function.

Corrective Actions

Dry Needling

  • Dry needling can release trigger points in the pelvic floor muscles, reducing pelvic tightness and improving function.

Manual Therapy

  • Trigger Point Release: Apply direct pressure to tight spots in the pelvic floor and sacral area.

  • Myofascial Release: Helps improve circulation and reduce pelvic muscle tension.

Stretching

  • Deep Squat Stretch: Helps lengthen and relax the pelvic floor muscles.

  • Happy Baby Pose: Opens the hips and relieves tension in the lower pelvis.

Postural and Lifestyle Adjustments

  • Avoid Prolonged Sitting Without Breaks

  • Use Proper Toileting Techniques (Reduce Straining During Bowel Movements)

  • Practice Stress Management and Relaxation Techniques

➡️ Learn more about Trigger Points

➡️ Explore our Trigger Point Index

Sources:

  • Travell, J. G., & Simons, D. G. (1983). Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins.

  • Simons, D., & Travell, J. (1999). The Trigger Point Manual, Volume 2: The Lower Extremities. Williams & Wilkins.