Pelvic Floor viagra,
The Not Well Known Malady1
By Emmanuel Arroyo, Lac
21 May 2010 12:03 AM Eastern Standard Time (New York, USA)
Before entering into details on what is Pelvic Floor cialis (PFD) it is necessary to understand its anatomy by which I mean the muscles, places where the muscles attach to or cross and the innervation (nerves that supply those muscles) in what is known as pelvic floor.
The Muscles 2
The muscles involved in PFD are the following: Levator Ani, Coccygeus, Transversus perinei,Bulbospongiosus, Ischiocavernosus, Sacrococcygeus, Obturator internus and Gluteus maximus.
The Levator ani has three parts known as the pubococcygeus, iliococcygeus and puborectalis, while the Coccygeus is also known as the ischiococcygeus muscle. There are two Transversus perinei the superficial one that is known as transversus perinei superficialis and one that is deep which is called transversus perinei profundus.
Ligaments, Tendons and Bony Structures
The ligaments, tendons and bony structures closely related with PFD are Sacrotuberous ligament, Tendinous Arch of the levator ani muscle, Anococcygeal body, Perineal body, coccygeal fascia, Sacrospinous ligament and Sacrotuberous ligament (or sacrotuberal ligament) some important bony structures are the pubis and pubic symphisis, Coccyx, Sacrum, Ischial spine, Ischium and Ischial tuberosity.
An Illustration is Worth Thousand of Words3
Connecting the Dots
The bulbospongiosus goes around the scrotum and base of the penis (or vagina in case of women) to connect with perineal body (Ren 1) and from here it travels around the anus connecting with annococcygeal body (Du1), this portion that wraps around the anus is called sphincter ani externus (there are three one which is superficial and seats on two, one is deeper and one right between the superficial and deep). Forming a horizontal line is the tranversus perinei superficialis which seats between the end part of the bulbospongiosus and ani sphincter (Ren 1 area) and attaches to the ischium tuberosity (sitting bone which is UB 36). This group of muscles form a cross like shape figuratively speaking. Departing from the Ischial tuberosity (UB 36) area is the ischeocavernosus muscle which passes by the pubis (ST 30) to finally end on the symphisis (Ren 2).
The levator ani muscle is kind of an umbrella name which is called differently depending where it is located. The lower portion of this muscle is named pubococcygeus while the upper portion is known as Illiococcygeal muscle. The portion of the pubococcygeus that connects with the perineal body (Ren 1 area) and is right in front of the anus is known as prostate levator muscle (in women it is called pubovaginalis muscle and acts as a sphincter). The posterior portion of the pubococcygeus is referred as the puborectalis and is where the rectum rests. Let me summarize, this muscle has more or less a U shape, the part that goes close to the prostate is called prostate levator and the portion going around the rectum is called puborectalis.
The illiococcygeus muscle connects with the tendinous arch of the levator ani (the tendinous arch goes from the ischial spine to the pubis and attaches to the fascia5 of the obturator internus) and another portion of the muscle goes to the coccyx.
The coccygeus muscle ( deep UB 35 area) attaches along the sacrospinal ligament (UB 34 area, and 1.5 cun lateral to S4) and to the coccyx, this muscle runs next to illiococcygeus.
The Obturator internus (3 cun inferior to UB 54 and like 6 cun medial to GB 30 area and 2 or 3 cun superior to UB 36) passes between the sacrospinal and sacrotuberous ligament covering the obturator foramen and exiting through the lesser sciatic foramen (UB 34 area, 1.5 lateral to S4, and roughly deep UB 36 area).
Gluteus Maximus (a muscle that forms part of the buttocks) has a portion that attaches to the coccyx.
If you need a visual help on where the muscles are located the following link will take you to a nice picture with almost all the muscles. Here is another one that shows where are the bulbospongiosus and ischiocavernosus.
Innervation
The nerve that supply the muscles from the pelvic floor is mainly the pudendal nerve or plexus which branches out supplying S2, S3, S4 and S5. The nerve segment from L5, S1 and S2 supply the obturator internus.
Significance of Muscle Attachments
A person with PFD might experience pain in the following areas: scrotum, vagina, anus, sacrum (ischiocavernosus, bulbospongiosus, perineal body, anococcygeal body, transversus perinei, coccygeus); lateral hip, and posterior thigh pain (gluteus maximus, obturator internus) or might exhibit incontinence, constipation, painful bowel movement or dribbling urine (bulbospongiosus, transversus perinei, perineal body, ani sphincter, puborectalis, prostate levator); painful intercourse, some erectile dysfunction, hemorrhoids or even prolapse could be seen (bulbospongiosus, pubovaginalis,ischiocavernosus, puborectalis); there would be patients that will experience difficulty sitting on erect position or on hard surfaces (coccygeus); pelvic tilt might be present and some dislocation on sacro-iliac joints are possible (sacrospinous and sacrotuberous ligament).
It has been observed the presence of trigger points even on adipose tissue.
Causes of PFD
Some of the causes attributed to PFD are prostate, vaginal, urinary problems, and scar tissue from surgical intervention among others.
Prevalence
PFD has a higher incidence among women and it is a condition that sometimes passes undiagnosed or confused with other syndromes.Acupuncture and PFD
If you are not an acupuncturist you probably have noticed at this point that I have mentioned some acupuncture points. This has been purposely done in order to show that the areas where the muscle(s) attach are linked with some acupuncture points and if you are an acupuncturist you probably have learned which local points to use in order to stimulate the affected nerves and muscles in PFD and bring tonicity back to normal.
Needle insertion with a 3" needle pierces the illiococcygeus, pubococcygeus and puborectalis which comprises the levator ani but remember that this muscle passes next to the prostate (levator prostate muscle) hence we are stimulating all these muscles. The acupuncture points are UB 32, UB 33, and UB 34; these points also stimulate the pudendal nerve hence indirectly stimulating the nerves that supply the penis and muscles that are around and next to it. Needling the left UB 36 acupoint with a 3 inches needle in diagonal oblique insertion aiming the right S2 and S3 but deeper pierces the following muscles gluteus maximus, coccygeus and levator ani. In order to stimulate bulbospongiosus and ischiocavernosus muscles we need to insert a 3 inches needle from ST 30 towards Ren 2 by doing this we are piercing both muscles. I use electricity in all these points and patients report the following: a massage like sensation on the anus, perineum, and scrotum with some sensation at the base of the penis. The purpose is to stimulate the nerves and force the muscles to relax so we can improve blood perfusion in the pelvic floor and eventual tonification of proper musculature. For a clearer idea on the needling technique please follow the proper links for a video clip.
We have to bear in mind that points according to TCM (traditional chinese medicine ) diagnosis should be used. Points to drain dampness, clear heat, tonify kidney or spleen qi or yang, move Qi or blood might be necessarily. It is also important to remember the extraordinary meridians Dai Mai, Du Mai, Chong and Ren Mai to access those deep muscles that compose the pelvic floor.
The majority of the patients that I treat with this approach are patients reporting erectile dysfunction but I have found that stimulation of the pelvic floor muscles increases blood perfusion, enhances nerve impulse conductance with some patients seen results the same day and other after 15 treatments.
If you are not an acupuncturist what I just said on the previous paragraph is simply this: Yes PFD can be treated with acupuncture by stimulating the body's proper musculature, ligaments, innervation by promoting blood, hormonal (or endocrine) and immunological circulation in the affected area.
He can be reached at 917-324-1140 or via email dr.agujas@gmail.com
Disclaimer: This is for educational purposes, you should always consult a professional
Needle insertion with a 3" needle pierces the illiococcygeus, pubococcygeus and puborectalis which comprises the levator ani but remember that this muscle passes next to the prostate (levator prostate muscle) hence we are stimulating all these muscles. The acupuncture points are UB 32, UB 33, and UB 34; these points also stimulate the pudendal nerve hence indirectly stimulating the nerves that supply the penis and muscles that are around and next to it. Needling the left UB 36 acupoint with a 3 inches needle in diagonal oblique insertion aiming the right S2 and S3 but deeper pierces the following muscles gluteus maximus, coccygeus and levator ani. In order to stimulate bulbospongiosus and ischiocavernosus muscles we need to insert a 3 inches needle from ST 30 towards Ren 2 by doing this we are piercing both muscles. I use electricity in all these points and patients report the following: a massage like sensation on the anus, perineum, and scrotum with some sensation at the base of the penis. The purpose is to stimulate the nerves and force the muscles to relax so we can improve blood perfusion in the pelvic floor and eventual tonification of proper musculature. For a clearer idea on the needling technique please follow the proper links for a video clip.
We have to bear in mind that points according to TCM (traditional chinese medicine ) diagnosis should be used. Points to drain dampness, clear heat, tonify kidney or spleen qi or yang, move Qi or blood might be necessarily. It is also important to remember the extraordinary meridians Dai Mai, Du Mai, Chong and Ren Mai to access those deep muscles that compose the pelvic floor.
The majority of the patients that I treat with this approach are patients reporting erectile dysfunction but I have found that stimulation of the pelvic floor muscles increases blood perfusion, enhances nerve impulse conductance with some patients seen results the same day and other after 15 treatments.
If you are not an acupuncturist what I just said on the previous paragraph is simply this: Yes PFD can be treated with acupuncture by stimulating the body's proper musculature, ligaments, innervation by promoting blood, hormonal (or endocrine) and immunological circulation in the affected area.
About the Author
Emmanuel Arroyo is a New York licensed acupuncturist who writes blogs and specializes in pain management, male health, and gastrointestinal issues. Recently he has incorporated chakra balancing and essential oils; currently is researching depression and how it can be treated using acupuncture, essential oils and chakra balacing.He can be reached at 917-324-1140 or via email dr.agujas@gmail.com
Disclaimer: This is for educational purposes, you should always consult a professional
notes
1 Myofascial Pain and Dysfunction, The Trigger Point Manual Volume 2. Janet G. Travell MD and David G. Simons MD. Lippincott Williams & Wilkins. 1993. Page 111-131.
2 http://www.indiasurgeons.com/lectures/ischio_rectal_fossa.htm
3 http://home.comcast.net/~wnor/pelvis.htm
4 A Manual of Acupuncture. Peter Deadman & Mazin Al-Khajafi with Kevin Baker. Journal of Chinese Publications. 2001
5 Fascia is the "skin" of a muscle
