Chapter 3 58 Introduction The pelvic floor is a multifunctional complex of muscle fibers, fascia, ligaments, and connective tissue that form a hammock at the bottom of the abdomino-pelvic cavity. The muscles of the pelvic floor consist of superficial muscles including the m. bulbospongiosus, m. ischiocavernosus, the perineal muscles and external anal sphincter muscle. The deep pelvic floor muscles are the levator ani composed of the puborectalis, pubococcygeus and iliococcygeus. The pelvic floor provides anatomical support for the pelvic and abdominal viscera and is involved in urinary, defecatory and sexual function.1-4 The pelvic floor is capable of generating and controlling intraabdominal pressure together with other muscles surrounding the abdominal cavity and contributes to lumbar spine stiffness.5,6 Pelvic floor hypertonicity (PFH) is often associated with urological, gynaecological, gastrointestinal, and sexual problems as well as chronic pelvic pain. Prevalence ranges from 50-90%.7,8 These complaints have a profound impact on quality of life.9-12 Several terms are used for PFH in the literature, such as pelvic floor spasm, nonrelaxing pelvic floor, and overactivity. Currently, the International Urogynecological Association (IUGA)/International Continence Society (ICS) defines the term “nonneurogenic hypertonicity” as an increase in muscle tone related to the contractile or viscoelastic components that can be associated with either elevated contractile activity and/or passive stiffness in the muscle.13 In addition, the hypertonic muscle tissue may contain myofascial trigger points (MTrPs).14 A MTrP is a discrete, hyperirritable nodule in a taut band of a skeletal muscle which is palpable and tender during physical examination. An active MTrP is clinically associated with spontaneous pain in the surrounding tissue and/or to distant sites in specific referred pain patterns.15,16 PFH can be a primary problem or a secondary adaptation to an acute or chronic injury to one or more musculoskeletal components in the pelvic floor and surrounding structures. Pelvic surgery, traumatic vaginal delivery, traumatic injury of the back or pelvis, gait disturbances, pelvic pain, experienced threat and (chronic) stress are found to be associated with PFH.17-20 PFH is assumed to be related to learned behaviour, otherwise acquired in adulthood through voluntary holding to inhibit micturition or defecation or to avoid incontinence. This might be related to habit, lifestyle and/or stressful occupation.9 A history of physical or sexual abuse or insecure attachment is common among women with PFH and is associated with impaired sexual arousal, desire, and orgasm.21,22 Laan et al.23 conceptualized PFH as a symptom of chronic activation of the defensive
RkJQdWJsaXNoZXIy MTk4NDMw