Trigger Point Pelvic Floor Injections

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Described as persistent pain felt in the pelvic area for more than six months, chronic pelvic pain can disrupt men and women’s lifestyles physically, emotionally, and sexually. When relief is not found through medication or pelvic floor physical therapy, pelvic floor injections are recommended as the next step before surgery. 

This article discusses pelvic pain, trigger point pelvic floor injections, what the procedure entails, and how long pelvic floor injections last. 

What Is Chronic Pelvic Pain?

Often defined as an ‘incredibly complex’ condition, chronic pelvic pain originates from tightening the various muscles around the pelvic area. Because these muscles spread inside the pelvis and around the pelvis, the resulting pain can be felt in the vagina, abdomen, hips, and lower back. 

The result of this spasming pain can make it uncomfortable to urinate or pass a stool. Women experiencing chronic pelvic pain might also find that inserting a tampon or having sex is uncomfortable, and some women might even experience tight jaw muscles due to pelvic pain.

What Causes Pelvic Pain?

Although it affects as many as 14% of American women during their reproductive years, the cause of chronic pelvic pain is largely unknown. Studies have found that even though gynecological conditions like pelvic inflammatory disease or endometriosis, as well as childbirth, can result in pelvic pain, chronic pelvic pain can be caused by non-gynecological sources too. 

For example, medical professionals suspect pelvic floor trauma could be connected to sports injuries, previous pelvic surgeries, irritable bowel syndrome, fibroids, intercourse, psychological factors, or post-traumatic stress disorder.  

Treatment Options for Pelvic Pain

The first line of treatment recommended for pelvic pain is physical therapy, where patients learn how to stretch and relax the pelvic muscles with specific movements and breathing techniques. Biofeedback, manual therapy, and ultrasound imaging are all tools used in pelvic physical therapy to address pelvic pain.

For patients who find little relaxation from these treatment options, trigger point pelvic injections are recommended before a more invasive surgical procedure.  

What is a Trigger point?

A trigger point is a painful spasm or a hyperirritable nodule that forms on tight muscles that cannot relax. If located under the skin, trigger points are painful when pressed upon.

Typically, the result of trauma, over-used muscles, inflammation, psychological factors, or a succession of minor injuries, a trigger point is capable of aggravating nerves from a distance as well as causing what is called referred pain –which is pain that is experienced in another part of the body rather than where the pain originates.

What are Ultrasound-guided Trigger Point Injections?

Proving to be incredibly beneficial for chronic pelvic pain relief, ultrasound-guided trigger point injections are a non-invasive procedure where ultrasound guidance is used to pinpoint the exact location of trigger points for pain-relieving injections to be administered. 

How do Pelvic Floor Trigger Point Injections Work? 

Trigger point injections typically consist of the pain reliever lidocaine and anti-inflammatory medication, but medication can vary according to the patient’s needs.

Once the injections are administered directly into the irritated nodule, the spasm relaxes almost immediately, naturally increasing blood flow and more abundant levels of oxygen in the muscle. Pain relief is typically felt by the patient within 24-72 hours.  

Do Trigger Point Pelvic Floor Injections Hurt? 

Trigger point injections for chronic pelvic pain involves injecting pain-relief medication directly into pelvic muscles via the vagina. The 20-30 minute procedure is non-invasive and usually begins with your chosen health practitioner numbing the area before injections are administered. 

Some patients report feeling a temporary escalation of pain when the tip of the needle enters the trigger point. However, this pain is only briefly felt and is believed to be a positive sign that the medication has been administered to the right location. 

How Long Does Relief from Trigger Point Injections Last?

The timespan of relief varies from patient to patient. For some women, the relief experienced from pelvic floor trigger point injections lasts for a month, while for others, it can last as long as three months.

In some cases, pelvic floor injections are used to deliver enough relief for women to engage in pelvic floor physical therapy, where they learn to relax their pelvic floor muscles for the long term through movement and breathing techniques. 

How Often Should You Have Trigger Point Injections for Pelvic Floor Pain? 

The answer to this is that every patient is different, so it’s best to consult your physiotherapist or doctor about how many trigger point injections your condition requires and how often they should be. The pelvic floor is a large area encompassing a variety of muscles and several branches from the pudendal nerve, therefore, several injections may be required to ensure all are treated for pain relief. 

Researchers have also noted that trigger point injections work best in an accumulative effect, meaning the best results are achieved gradually with a series of injections over time. 

Is the Ultrasound Used Internally During Pelvic Floor Trigger Point Injections? 

No. This form of ultrasound is an external procedure performed by applying some gel to the skin, which transmits the ultrasound waves. The transducer, which is the device that converts the image onto the screen, is then placed directly on top of the gel and moved around gently to locate the trigger points and where the injections should be administered. 

Is the Ultrasound Safe for the Body?

Ultrasound imaging has existed for over 20 years and is considered very safe for the body. In contrast to other types of body imaging systems, such as X-rays, ultrasound is developed with non-ionizing radiation, meaning it does not present the same risks to the body. 

How To Prepare for Trigger Point Injections:

Make sure you’ve had something light to eat before your appointment for trigger point injections so you don’t arrive on an empty stomach, and ensure you are hydrated by drinking some water. In addition, it’s helpful to take some ibuprofen approximately one hour before your appointment to ease any discomfort from the initial nerve block. 

Should you Rest After Trigger Point Injections? 

While it’s perfectly normal to experience some tenderness after trigger point injections, there is no need to rest completely afterward. It is advised that patients refrain from any heavy lifting or strenuous exercise for 24 hours. However, your physiotherapist will more than likely suggest some gentle stretching on the same day, and each day afterward to further loosen the muscles and ease discomfort for the long term. 


Chronic pelvic pain can spread to the vagina, abdomen, hips, and lower back, impacting women physically, emotionally, and sexually. For those who’ve tried treatment options like medication and physical therapy with no relief, pelvic floor injections can provide comfort and a better quality of life. 

If you are experiencing chronic pelvic pain, consider contacting your healthcare practitioner or physiotherapist about trigger point injections to start living life pain-free again. 

About the Author

Amanda Olson, DPT, PRPC, and president and chief clinical officer of Intimate Rose. Dr. Olson is passionate about empowering all people with pelvic health issues, including pelvic pain, incontinence, and pre and post-partum issues. She earned a Bachelor of Science degree from Pacific University and a Doctorate of Physical Therapy from Regis University, graduating as a Jesuit National Honor Society member. She holds a Certification of Achievement in pelvic floor physical therapy (CAPP-PF) through the American Physical Therapy Association and the Pelvic Floor Practitioner Certification (PRPC) through the Herman and Wallace Pelvic Institute. She is also a certified Stott Pilates instructor and RRCA-certified running coach. Dr. Olson teaches various pelvic health topics internationally, including pelvic floor dysfunction in runners. She has written several physical therapy continuing education courses, peer-reviewed journal articles, newspaper and magazine articles on pelvic floor dysfunction and running, and authored the book Restoring the Pelvic Floor For Women.

By Amanda Olson, DPT, PRPC, and President and Chief Clinical Officer of Intimate Rose.

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