Review of Anatomy, Evaluation, and Treatment of Musculoskeletal Pelvic Floor Pain in Women

Objective: The purpose of this review is 2-fold. The first is to provide a review for physiatrists already providing care for women with musculoskeletal pelvic floor pain and a resource for physiatrists who are interested in expanding their practice to include this patient population. The second is to describe how musculoskeletal dysfunctions involving the pelvic floor can be approached by the physiatrist using the same principles used to evaluate and treat others dysfunctions in the musculoskeletal system. This discussion clarifies that evaluation and treatment of pelvic floor pain of musculoskeletal origin is within the scope of practice for physiatrists. The authors review the anatomy of the pelvic floor, including the bony pelvis and joints, muscle and fascia, and the peripheral and autonomic nervous systems. Pertinent history and physical examination findings are described. The review concludes with a discussion of differential diagnosis and treatment of musculoskeletal pelvic floor pain in women. Improved recognition of pelvic floor dysfunction by healthcare providers will reduce impairment and disability for women with pelvic floor pain. A physiatrist is in the unique position to treat the musculoskeletal causes of this condition because it requires an expert grasp of anatomy, function, and the linked relationship between the spine and pelvis. Further research regarding musculoskeletal causes and treatment of pelvic floor pain will help validate these concepts and improve awareness and care for women limited by this condition.