— When Frequent Urination Comes from the Pelvis, Not the Bladder —

Today, I’d like to share a case that could easily appear in a medical textbook on myofascial pelvic pain syndrome (MPPS).

Patient profile:

A woman in her late 30s

Main complaint: frequent urination

History: She had been experiencing urinary frequency for over 10 years, and recently, she needed to use the bathroom every 15 minutes.

Detailed urological examinations showed:

Normal cystoscopy (no bladder wall abnormalities, no tumors) Voiding diary showed she could hold 360 ml of urine without leakage

At first glance, it seemed like there was no issue with the bladder itself.

Key findings on physical examination:

Severe tenderness in both obturator internus muscles; the pain was so intense that she recoiled when touched Complete lack of pelvic floor muscle movement Uroflowmetry showed a voiding time of over one minute, and she was voiding with abdominal straining (abdominal voiding)

Understanding the condition

In this case, long-term stress and overload on the obturator internus muscles likely led to:

① Bladder sensory symptoms (sensory abnormalities) via fascial connections

② Disruption of levator ani (pelvic floor) muscle function originating from the obturator internus (motor abnormalities)

MPPS is a condition in which local muscle pain can cause:

Referred pain to other areas Radiating pain Sensory and motor disturbances in distant body parts

In other words, even though the bladder itself was healthy, sensory and motor disturbances triggered by pelvic muscle dysfunction caused the urinary frequency.

Treatment strategy

The key to improving urinary frequency here is treating the obturator internus muscles.

Specifically:

Physical therapy (muscle release and training by a specialist) High-Tesla magnetic stimulation therapy Extracorporeal shock wave therapy Hydrorelease injections to loosen fascial adhesions Oral medications (for pain or bladder overactivity)

Among these, physical therapy to create a pain-free body is the foundation of treatment. Magnetic stimulation, shock wave therapy, injections, and medications can help, but they are mostly supportive or symptomatic treatments.

Summary

For patients with long-standing urinary frequency, sometimes the problem isn’t the bladder but the pelvic muscles—especially the obturator internus.

When bladder exams show no abnormalities, evaluating the pelvic floor muscles can hold the key to diagnosis and treatment.

If you or someone you know is struggling with persistent urinary frequency despite “normal tests,” it may be worth seeking an assessment focused on the pelvic floor.