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Quick Guide: Chronic Pelvic Pain

Chronic pelvic pain is something I, unfortunately, see all too commonly as a physical therapist, and it is not given enough time and attention. I hope to provide some facts regarding chronic pain as well as tips for what you can actually do about your pain!

 

If human beings did not have pain, we would quite literally die. Pain is our warning sign to problems in our body. The real offender is chronic pelvic pain. Having pain every, single day is NOT normal.

THE ABCs OF PAIN

What can cause pelvic pain?

There are many possible causes which can be the START of pelvic pain. Vaginal delivery, episiotomy healing, prostate infection, or even a UTI can cause pelvic pain. However, once these more obvious reasons are properly treated and resolved pain can persist from it. This pain is due to chronic muscle tension. Your pelvic floor is trying to guard against and move away from the pain, BUT in its efforts to do so it is holding constant tension and driving pelvic pain. The more pain, the more it drives the tension creating a vicious pain cycle. A physical therapist can help you retrain and stop this.

What does pelvic pain feel like?

It can feel like MANY things. Pain in the pelvic region can be described as aching, burning, warmth/hot, throbbing, pressure, heavy, sharp, tingling, ripping, shooting, stabbing, cramping, stiff, tearing, or dull. Sometimes it can feel like multiple of these at once. In addition to it being present in the obvious place, pelvic pain can be tricky and also present as low back, buttocks, abdominal, thigh, groin, or even hip pain. I have pushed on tense pelvic floor muscles and reproduced pain in someone’s upper abdominal region. If you are going to traditional pt, and not seeing improvement within 4-6 visits then a pelvic floor pt might be a better fit for you.

What does pelvic pain mean?

Pelvic pain can be an indication of a minor infection that needs to be addressed, a disease process that is occuring, or something more than that. If your condition has been cleared by your primary care provider, but your symptoms are lasting more than 4-8 weeks, it is most likely tight and tender muscles, ligaments, tendons, and other connective tissue. Our bodies can get stuck into a pain loop that goes on and on, until you get help to retrain your body and break that pain-tension cycle.

When should I be concerned about pain?

Pain is, unfortunately, a normal human experience. It is just your body’s way of alerting you to things going on in your body. If you have symptoms that are lasting more than a few days, reach out to your primary care provider. If they give you the all clear, but the pain persists for more than 4 weeks, get in to see a pelvic floor physical therapist.

Does pelvic pain ever go away?

Yes! You can heal and retrain! Tissues in the body typically heal within 6-8 weeks. The important thing to remember is that pain is a normal human experience, but living in pain is not normal. I usually work with pelvic pain patients for anywhere between 8-16 visits (this is variable on the specific patient needs), spread out over 3-9 months.

How is pelvic pain diagnosed?

This will vary depending on what symptoms you report. Your primary care provider may first start with a urinalysis, abdominal or pelvic ultrasound, and a rectal or vaginal exam. Based on your signs and symptoms and what your primary care provider finds in their physical examination and tests will determine if they need to do more extensive testing as a next step. At your first pelvic floor physical therapist appointment , they will perform an extensive internal and external examination to understand your pain.

WHAT CAN LEAD TO CHRONIC PELVIC PAIN

  • Adenomyosis
  • Endometriosis
  • Fibroids
  • Fibromyalgia
  • Hernia
  • IBS
  • Interstitial cystitis
  • Levator syndrome
  • Pelvic congestion syndrome
  • Pelvic inflammatory disease
  • Pelvic support problems
  • Physiological causes (depression/anxiety/stress)
  • Post vasectomy pain syndrome
  • Prolapse
  • Prostatitis
  • Pudendal nerve entrapment
  • Scar tissue (abdominal adhesion?)
  • Tension following appendectomy
  • Tension following STI
  • testicular pain
  • Urethral stricture
  • Urinary stones
  • Uterine fibroids
  • Vulvodynia

A NERVOUS BREAKDOWN

Modern medicine has improved our ability to run tests, scans, and imaging. This has shifted the focus completely to our tissues (ie muscles, ligaments, joints, discs, ect). Within 3-6 months these structures are healed. Which means overall, chronic pelvic pain is less of a tissue issue and more of a nerve sensitivity and brain processing one.

The human body has 45 miles of nerves, with 400 individual nerves!

Your nerves all converge into the spinal cord, and ultimately your brain. The brain then takes in the information from all of these nerves, your previous experiences, your environment, and a whole lot more information. It analyses the situation and then reports to you. It is a complex, yet superspeed process.

A PERSISTENT PAIN PROBLEM

NERVOUS SYSTEM RESPONSE EXAMPLE:

You are walking across the street and painfully step in a pothole. You will definitely stop right away and make sure it isn’t broken. Test it before you walk on it, turn it side to side, and then slowly hobble to the side of the road.

Now, what if the same time you stepped in that pothole, a bus is catapulting your way? You are not going to assess your ankle right away, because your brain has decided it is more important to get out of the way of the bus.

Your brain quiets the information from your ankle so you can get safely to the side of the road in time. Then, it will remind you of the pain in your ankle, so you can assess it and seek medical attention if needed.

This causes stress and confusion constantly as you try to identify and resolve your concern. It becomes a constant distraction and makes it difficult to clear your mind.

THE TENSION SOLUTION

I recommend that my patients begin with the resources below. These can help you begin to understand your pain and get on the path to healing! Give it a try and reach out.

Once you begin to learn about and identify your pain, and get on a path to healing and retraining, I recommend some self care as well! My patients love mindful massage and meditation combined with some of these quality items for at home pain relief!

The Great News? Learning more about how your brain processes pain and what contributes to your pain picture, helps to lessen the sensitivity of your nerves.

Extra References

Pelvic Floor Dysfunction Doesn’t Mean Doomsday

4 Can’t Beat Products for Pelvic Floor Tension Self-Treatment

Your Pelvic Stretches Playlist (with modifications)

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