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My hip is connected to my bladder? How urinary symptoms can be associated with hip musculature.

When we look at bladder urgency and frequency, it is often assumed that the bladder is overactive or that the pelvic floor is too weakHowever, research does not support either of these assumptionsWhen we are assessing our patients with bladder urgency and frequency, we need to be paying more attention to the hip and levator ani group

The hip is stabilized in the acetabulum (joint) by the deep hip rotatorsThese muscles help the ball to center in the socket and improve the ability of the larger muscles such as the gluteal group, to work efficientlyThe obturator internus, a hip muscles forms a common tendon (connection) with the piriformis (another hip muscles) prior to the attachment into the hip capsule and the upper femur


The Obturator Internus and Piriformis muscles with the levator ani group

When there is increased tone in the obturator internus the hip can rest in external rotation pattern with increased pull onto the levator ani group of the pelvic floorThe obturator internus shares a fascial connection with levator ani group via the arcus tendineus of the levator ani (ATLA)The ATLA is a thick fascial plane that assists in pelvic floor support with hip stability.

Researchers have found that as the bladder fills, it puts pressure on the obturator internus and the levator groupIf there are trigger points in the either of these muscles, the brain can have a difficult time discerning the trigger point pain and will interpret the signals as bladder urgencyAs this pattern continues, it can lead to a urgency/frequency voiding pattern

When the patient seeks medical treatment, this is the group of patients that do not respond as well to medication as the bladder is not overactive. With the treatment of the trigger points in the obturator internus or the levator ani group, the brain is better able to interpret the signals from the muscles and the bladder and break the dysfunctional voiding pattern.

Digging deeper into the research, there is a strong correlation of pelvic floor muscle trigger points and urinary symptomsIn fact, in one study, 95% of patients who sought care in a urogynecology office for voiding dysfunction had pelvic floor muscle trigger pointsThis was even in patients who did not go to the urogynecologist with complaints of painOf all the muscles palpated in this study, the obturator internus had the highest level of trigger points.

In another study of patients presenting to urogynecology for voiding dysfunction, trigger points in the obturator internus and levator ani group scored higher on the UDI-6, an outcome measure for urinary dysfunctionThis study also found that trigger points in these muscles correlated with patients having difficulty emptying their bladder, frequency and urgency, and incomplete bladder emptying.

As we treat patients that have urinary dysfunction, we need to explore beyond the bladder and doing KegelsIf our patients are experiencing these symptoms, based on the research, we need to explore the musculoskeletal system and the muscles that bridge between the hip and the pelvic floorPaying particular attention to the obturator internus of the hip and how it is impacting the levator ani group of the pelvic floor

We offer a free 15 minute phone consultation to answer any questions and make sure we are the right fit to address your needs.

Sarah is the proud co-owner of Foundational Concepts, Specialty Physical Therapy which opened in March 2013. Sarah lectures at the University of Missouri Department of PT, University of Kansas Departments of PT and Nurse Midwifery, and at Rockhurst University Department of PT. She is board certified in Women’s Health PT and holds certifications in medical therapeutic yoga, lymphedema therapy and dry needling.

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