Levator Ani Trigger Point Injections and Chemodenervation with Onabotulinum Toxin a: An Introduction and How-to Guide

Abstract

<h3>Study Objective</h3> To provide a stepwise description of the anatomy, evidence, and technique for performing levator ani trigger point injections and chemodenervation for the treatment of pelvic floor myofascial pain. <h3>Design</h3> Video demonstration with narrated description. <h3>Setting</h3> Academic tertiary care site. <h3>Patients or Participants</h3> Patients with pelvic floor myofascial pain. <h3>Interventions</h3> Trigger point injections and chemodenervation with Onabotulinum toxin A (Botox) of the levator ani muscles. <h3>Measurements and Main Results</h3> Prior research has indicated that trigger point injections and chemodenervation with Onabotulinum toxin A may provide pain improvement in over 60% of women with pelvic floor myofascial pain. This video reviews the relevant clinical anatomy, benefits and risks of the procedures, type and toxicity of injectate medications, procedural set up, procedural techniques, and post-procedural follow up care. <h3>Conclusion</h3> In expert hands, levator ani trigger point injections and chemodenervation with Onabotulinum toxin A are safe and effective components of a multimodal treatment plan for pelvic floor myofascial pain.