Botox where?

Every day women visit plastic surgeons for Botox to relieve wrinkles in their forehead.  In addition, Botox has been used to a variety of pelvic floor related dysfunctions including neurogenic detrusor overactivity, (bladder spasms due to nerve related pathology), overactive bladder, urinary urgency-frequency, and interstitial cystitis.

Doctors also use Botox injections to treat pelvic floor muscle related pain.  Dr. Kristine Whitmore, MD, from the Pelvic and Sexual Health Institute of Philadelphia, has successfully treated pelvic floor trigger points in over 200 patients.  How does the Botox work? The mechanism, according to Dr. Whitmore, is that “the toxin inhibits release of acetylcholine from motor nerves that make muscle contract, so it ‘freezes’ … muscle…” (ICA Update, Spring 2012).  In other words, the injection helps “turn off” muscles that are “on “ too much by blocking the neurotransmitter to the muscle which otherwise causes it to contract and tighten.  This allows the muscle to relax more completely which results in decreased pain (ex. during intercourse- refer to this article from Marie Claire).  The procedure itself can be painful, so she occasionally injects a pudendal nerve block prior to the trigger point injection to interfere with the transmission of the painful stimulus (the injection) to the brain.

Botox most effective when followed up with muscular re-education with a pelvic floor physical therapist.  Pelvic floor therapists can help facilitate motor recruitment as well as prevent shortening or tightening of the muscle after the injection.  If you or someone you know may benefit from pelvic floor injections and/or pelvic floor physical therapy, please consult with your licensed medical care provider.

Vaginal Pain and Physical Therapy

As Amy writes in her book “Heal Pelvic Pain,” there is much one can do to ease pelvic pain with physical therapy. In an article from the New York Times, “Persistence is Key to Treating Vaginal Pain,” Jane Brody writes about this as well. Check out the article here, and congratulations to our colleagues Deborah Coady and Nancy Fish for being featured in the article!