From the Guidelines
Treatment for perineal tendinopathy should begin with conservative measures, including rest, ice application, and over-the-counter anti-inflammatory medications, with a focus on physical therapy and potentially corticosteroid injections or extracorporeal shock wave therapy for persistent cases, as these approaches prioritize reducing morbidity, mortality, and improving quality of life. The initial approach to treating perineal tendinopathy involves avoiding activities that aggravate the condition, applying ice for 15-20 minutes several times daily, and using over-the-counter anti-inflammatory medications like ibuprofen (400-600mg three times daily with food) or naproxen (500mg twice daily with food) for 7-10 days to reduce pain and inflammation 1. Physical therapy is crucial, focusing on gentle stretching and progressive strengthening of the pelvic floor and surrounding muscles, typically 2-3 sessions weekly for 6-8 weeks 1. For cases that do not respond to initial treatment, corticosteroid injections may be considered, though these should be limited to 2-3 injections spaced at least 6 weeks apart to prevent tendon weakening 1. Extracorporeal shock wave therapy (ESWT) can be effective for chronic cases, usually administered in 3-5 weekly sessions 1. Throughout treatment, patients should modify activities that cause pain, use proper supportive seating, and maintain good posture to reduce perineal pressure 1. Recovery typically takes 6-12 weeks depending on severity, with gradual return to activities as symptoms improve 1. This comprehensive approach addresses both symptom management and the underlying mechanical issues causing tendon irritation in the perineal region, aligning with recommendations for treating overuse tendon problems 1. Given the evidence, the most effective treatment strategy for perineal tendinopathy prioritizes conservative management, with surgery considered only for patients who have failed conservative therapy, as indicated by the American Family Physician guidelines 1.
From the Research
Perineal Tendinopathy Treatment
- The treatment of perineal tendinopathy can be managed through various approaches, including physical therapy and pharmacological interventions.
- According to 2, pelvic floor physical therapy is considered effective in managing functional urogenital and anorectal disorders, which may be related to perineal tendinopathy.
- The management of chronic tendon injuries, including perineal tendinopathy, involves activity modification, relative rest, pain control, and protection, as well as early initiation of rehabilitative exercises that emphasize eccentric loading 3.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids may be used to reduce pain and increase range of motion, despite the lack of histologic evidence of inflammation 3, 4.
- Other treatment options for tendinopathy include topical nitroglycerin, extracorporeal shock wave therapy, and platelet-rich plasma injections, although the evidence for these treatments is limited 3, 5.
- Orthopedic manual physical therapy (OMPT) approaches, such as carpometacarpal manipulation and mobilization with movement, may also be effective in managing tendinopathy, including perineal tendinopathy 6.
Treatment Options
- Physical therapy: pelvic floor physical therapy, OMPT approaches
- Pharmacological interventions: NSAIDs, corticosteroids, topical nitroglycerin, extracorporeal shock wave therapy, platelet-rich plasma injections
- Rehabilitative exercises: eccentric loading, strengthening exercises, grip proprioception training
Key Considerations
- The treatment of perineal tendinopathy should be individualized and based on the specific needs and goals of the patient.
- A multidisciplinary approach, including physical therapy and pharmacological interventions, may be necessary to effectively manage perineal tendinopathy.
- Further research is needed to fully understand the efficacy and safety of different treatment options for perineal tendinopathy 5.