When the brain perceives an irritation in the pelvis it sends a signal down to the pelvic floor muscle to "protect" your pelvis. This signal puts your pelvic floor muscle in an involuntary contraction.
The irritation may start with a bladder infection, vaginitis, endometriosis, recent surgery, irritable bowel, or interstitial cystitis (breakdown of the bladder lining).
Sometimes, the brain sends an exaggerated response.
Other times the brain continues to send a dysfunctional signal to the pelvic floor to stay in contraction, even after the original problem has cleared up, healed or been controlled. This dysfunctional continuous signal is believed to happen because the brain perceives the discomfort of the contraction as an irritation and it becomes a vicious cycle of involuntary nerve and muscle response.
(In actual fact, it is not so much a signal to contract, but lack of a signal NOT to contract).
Over time the pelvic floor muscle becomes tender from being in a chronic tetanic contracted state, a condition we call pelvic floor spasm.
Pelvic floor spasm can cause pain, urinary urgency, urinary frequency, urinary incontinence, fecal urgency, fecal incontinence. In some people, the spasm is so severe that it inhibits urination and or defecation and the result is urinary retention and constipation.
Diagnosis of Pelvic Floor Spasm
The most effective way to diagnose spasm and determine how your pelvis might feel without the spasm is a "perc test", short for Percutaneous Neurostimulation. This is a test in which we put a small electrode nearby the sacral nerve which stops the overactive nerve signal telling the pelvic muscle to contract constantly. No incisions are involved (the electrode is placed through a fine needle) and you remain awake (although we often use mild sedation) so that you can tell us what you are feeling. Many people feel the first relief they have felt in years. The electrode stays in place for a few days, during which you log your symptoms.
Treating Pelvic Floor Spasm
If you have great relief you are a candidate for a small device that can provide this relief continuously, called "Interstim". Alternatively you may benefit from external neurostimulation with pelvic floor rehab and strengthening. Many people benefit from a combination.