Rectus Abdominis Trigger Points and Penile Pain: Pelvic Floor PT

By Dr. Zarina Vitebsky, DPT, MSPT, PRPC, TPS, LPF, DN on 2/27/2024

Rectus Abdominis Muscle Trigger Points Causing Penile Pain: The Role of Pelvic Floor Physical Therapy

Overview

The rectus abdominis muscle is a long, flat muscle that runs vertically along the front of the abdomen. It is responsible for flexing the trunk, as well as providing stability and support to the core. Trigger points, or areas of hyperirritability within the muscle, can develop due to overuse, injury, or poor posture. These trigger points can cause referred pain, meaning pain that is felt in a different area of the body than where the trigger point is located.

Connection to Penile Pain

In some cases, trigger points in the rectus abdominis muscle can refer pain to the penis. This can be due to the close proximity of the muscle to the pelvic floor muscles, which are responsible for controlling bladder and bowel function, as well as sexual function. The referred pain can manifest as aching, burning, or sharp pain in the penis, and can also be accompanied by urinary or sexual dysfunction.

Importance of Pelvic Floor Physical Therapy in Treatment

Pelvic floor physical therapy is a specialized form of physical therapy that focuses on the muscles, ligaments, and nerves of the pelvic floor. It can be an effective treatment for penile pain caused by trigger points in the rectus abdominis muscle. A pelvic floor physical therapist will perform a thorough evaluation to identify any trigger points or other issues in the pelvic floor muscles. They will then develop a personalized treatment plan, which may include manual therapy, exercises, and education on posture and body mechanics to help alleviate pain and improve function.

Anatomy of the Rectus Abdominis Muscle

Trigger Point Locations

Trigger points are hyperirritable spots within a muscle that can cause pain and discomfort. The rectus abdominis muscle has several trigger points, including the upper and lower portions near the rib cage and the belly button. These trigger points can refer pain to other areas of the body, including the pelvic region and genitals.

Role in Pelvic Floor Dysfunction

The pelvic floor is a group of muscles that support the pelvic organs and play a role in bladder and bowel control. Dysfunction in these muscles can lead to pelvic pain and other symptoms, such as penile pain. The rectus abdominis muscle can contribute to pelvic floor dysfunction by causing tension and trigger points in the abdominal region, which can refer pain to the pelvic floor and contribute to overall pelvic pain and discomfort.

Symptoms of Rectus Abdominis Trigger Points

Penile Pain

One of the most common symptoms of rectus abdominis trigger points is penile pain. This pain can range from a dull ache to a sharp, stabbing sensation and may be felt in the shaft, head, or base of the penis. It can also radiate to the groin, lower abdomen, and lower back. This pain may be constant or intermittent and can be worsened by certain activities such as sitting or sexual intercourse.

Pelvic Pain

Trigger points in the rectus abdominis muscle can also cause pelvic pain. This pain may be felt in the lower abdomen, pelvic region, and even in the buttocks. It can be described as a deep, achy sensation or a sharp, shooting pain. This pain may be aggravated by prolonged sitting, standing, or physical activity.

Urinary and Sexual Dysfunction

In addition to pain, rectus abdominis trigger points can also cause urinary and sexual dysfunction. This can include difficulty with urination, such as a weak stream or frequent urination, as well as erectile dysfunction or pain during sexual intercourse. These symptoms can greatly impact a person's quality of life and should not be ignored.

Other Associated Symptoms

Rectus abdominis trigger points can also cause a variety of other symptoms, including abdominal bloating, constipation, and difficulty with bowel movements. These trigger points can also refer pain to other areas of the body, such as the lower back, hips, and thighs. Additionally, individuals with these trigger points may experience fatigue, difficulty with breathing, and even anxiety or depression.

Causes of Trigger Points in the Rectus Abdominis Muscle

Overuse or Strain

The rectus abdominis muscle is responsible for flexing the trunk and stabilizing the core. It is a commonly used muscle in daily activities and can become overworked or strained with repetitive movements or excessive exercise. This can lead to the development of trigger points, which are small areas of tight muscle fibers that can cause pain and discomfort.

Poor Posture

Poor posture, such as slouching or sitting for long periods of time, can also contribute to the development of trigger points in the rectus abdominis muscle. When the muscle is held in a shortened position for extended periods, it can become tight and develop trigger points. This can be especially problematic for individuals who work desk jobs or spend a lot of time sitting.

Abdominal Surgery

Abdominal surgery, such as a C-section or appendectomy, can also lead to the development of trigger points in the rectus abdominis muscle. The trauma from the surgery can cause the muscle to become tight and develop trigger points, which can then refer pain to other areas of the body, including the pelvic floor and penis.

Other Contributing Factors

In addition to the above causes, there are other factors that can contribute to the development of trigger points in the rectus abdominis muscle. These include stress, poor nutrition, and underlying medical conditions such as fibromyalgia or chronic fatigue syndrome. It is important to address these factors in addition to treating the trigger points in order to fully alleviate the pain and discomfort they can cause.

Diagnosis of Rectus Abdominis Trigger Points

Physical Examination

Physical examination is the first step in diagnosing rectus abdominis trigger points. The healthcare provider will palpate the abdominal muscles to identify any areas of tenderness or tightness. They may also ask the patient to perform certain movements to assess for any trigger points that may be causing pain.

Trigger Point Mapping

Trigger point mapping is a technique used to identify the location and severity of trigger points in the rectus abdominis muscle. This involves applying pressure to specific points on the muscle and asking the patient to rate their pain on a scale. This helps to create a map of the trigger points and determine which ones may be causing the patient's symptoms.

Imaging Tests

In some cases, imaging tests such as ultrasound or MRI may be used to diagnose rectus abdominis trigger points. These tests can help to visualize the muscle and identify any abnormalities or areas of inflammation that may be contributing to the trigger points.

Differential Diagnosis

It is important to rule out other potential causes of penile pain before diagnosing rectus abdominis trigger points. This may include conditions such as prostatitis, pelvic floor dysfunction, or nerve entrapment. A thorough medical history and physical examination can help to differentiate between these conditions and determine the underlying cause of the patient's symptoms.

Treatment of Rectus Abdominis Trigger Points with Pelvic Floor Physical Therapy

Manual Therapy Techniques

Pelvic floor physical therapy is a specialized form of physical therapy that focuses on the muscles, ligaments, and connective tissues of the pelvic floor. One of the main techniques used in this type of therapy is manual therapy, which involves hands-on techniques to release tension and tightness in the muscles. For rectus abdominis trigger points, the following manual therapy techniques may be used:

• Trigger point release: This technique involves applying pressure to specific points in the muscle to release tension and alleviate pain.

• Myofascial release: This technique targets the fascia, or connective tissue, surrounding the muscle to release tension and improve mobility.

• Stretching: Gentle stretching can help to lengthen and relax the muscles, reducing trigger point pain.

Strengthening Exercises

In addition to manual therapy, strengthening exercises are an important part of pelvic floor physical therapy for rectus abdominis trigger points. These exercises help to improve muscle strength and stability, which can reduce pain and prevent future trigger points from forming. Some examples of strengthening exercises that may be recommended include:

• Core exercises: Strengthening the core muscles, including the rectus abdominis, can help to support the spine and improve posture, reducing strain on the pelvic floor muscles.

• Pelvic floor exercises: These exercises specifically target the muscles of the pelvic floor, helping to improve strength and control.

Education on Posture and Body Mechanics

In addition to manual therapy and exercises, pelvic floor physical therapy also involves education on proper posture and body mechanics. Poor posture and body mechanics can contribute to trigger points in the rectus abdominis muscle, so learning how to maintain good posture and move in a way that minimizes strain on the muscles can be beneficial in reducing pain and preventing future trigger points.

In some cases, other adjunct therapies may be recommended in addition to manual therapy and exercises. These may include:

• Heat or ice therapy: Applying heat or ice to the affected area can help to reduce pain and inflammation.

• Acupuncture (dry needling): This traditional Chinese medicine technique involves inserting thin needles into specific points on the body to alleviate pain and promote healing.

• Biofeedback: This technique involves using sensors to monitor muscle activity and provide feedback to help patients learn how to relax and control their muscles.

Importance of Addressing Underlying Causes

While pelvic floor physical therapy can be effective in treating rectus abdominis trigger points, it is important to also address any underlying causes that may be contributing to the issue. This may include poor posture, muscle imbalances, or other medical conditions. By addressing these underlying causes, the likelihood of trigger points recurring can be reduced.

Follow-Up and Maintenance Plan

Once the initial treatment for rectus abdominis trigger points is completed, it is important to have a follow-up and maintenance plan in place. This may include periodic check-ins with a pelvic floor physical therapist, continuing with exercises and stretches at home, and making lifestyle changes to prevent trigger points from recurring.

Reach Out to Us

If you’re experiencing pelvic floor dysfunctions associated with the issues above, please reach out to us at Pelvic Health Center in Madison, NJ to set up an evaluation and treatment! Feel free to call us at 908-443-9880 or email us at receptionmadison@pelvichealthnj.com.

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