Pelvic pain is the common term for a set of co-existing pain symptoms in and around the pelvis. It may include musculoskeletal, neurological, fascial and/or visceral pain. Its origin may be multifactorial with a complex history and often unknown cause.
Treatment is usually multidisciplinary, especially when the pain is persistent. When the symptoms have existed for months (3-6 months) – longer than the time it takes for tissue damage to typically heal, it is called Chronic Pelvic Pain (CPP). If you are suffering from CPP you have probably seen many specialists and have had many special investigations to look for the cause of your pain.. You may have also heard the words “There is nothing wrong with you”- they could be translated rather into “There is nothing sinister wrong with you that my tests can detect”.
In theory, you should be re-assured that although you are clearly in distress, there is no sinister cause for your experience. This is where pelvic floor physiotherapists play a role in assessing imbalances and dysfunctions as drivers of your pain. CPP is a complex condition and often we are looking at a very upregulated nervous system as with any persistent pain condition.
Pain symptoms may vary in intensity from mild achy to severe pain, on and off or constant. It may be in the lower abdomen, back, pelvis, hips or perineum (area between the legs). It may include bladder and bowel symptoms and/or pain with sex.
We frequently find painful myofascial trigger points in the pelvic floor with some associated musculoskeletal dysfunction. CPP is a local and system problem and the feelings of stress and anxiety related to the problem in turn feed the tension patterns and the pain. The success of treatment is in addressing all systems simultaneously- often this requires a multidisciplinary team approach.
Persistent, recurrent problems with sexual response, desire, orgasm or pain — that distress you or strain your relationship with your partner — are known medically as sexual dysfunction.
Healthy sexual function requires physical, mental, and emotional well-being. Physical presentations that may limit sexual activity include decreased mobility, alterations in sensation and pain. Pelvic floor trained physiotherapists play an important role in facilitating optimal sexual function by providing treatment to restore function, improve mobility and relieve pain.
Dyspareunia refers to pain during sexual intercourse. It is more common than most people think, and it affects both young and elderly woman. Pain can range from moderate to severe intensity. Dyspareunia can simply be due to dryness or thinning or the labia during menapause, but it is often more complex in nature. Pain or burning on penetration can be due to a tight overactive pelvic floor. Trigger points are often found on palpation in tight pelvic floors. This is released with manual techniques and exercises- but the driver of the overactive pelvic floor needs to be found to limit recurrence. Some sports may predispose you to having an overactive pelvic floor such as: dancing, pilates or horse riding. Other predisposing factors may be conservative upbringing, recurrent thrush infections, and endrometriosis. People with an overactive pelvic floor frequently have other physical presentations such as : neck pain or headaches, TMJ pain or clenching your jaw, very tight upper abdominal muscles and constipation.
Sometimes the pain with intercourse only presents after surgery, trauma, or giving birth- Sometimes this is due to tight scarring or muscle spasm as a reaction to the pain post operatively, or after giving birth. Scar tissue and fascial tightness can also prevent you from experiencing orgasms.
Manual techniques are used to create a shift in the body’s patterns. These need to be ‘owned’ between sessions and may incorporate breathing, muscle activation, or postural awareness. The approach seeks to shift and balance movement patterns and behaviours. A gentle program of decreasing sensitization and increasing trust and tolerance to touch between you and your partner is advised. We work manually, and use dilators and/or vibrators for home progress and maintenance. Posture or position during sex can make a big difference as to the tension of the pelvic floor muscles.
This is such a personal and sensitive problem to treat and often requires a multidisciplinary approach. There may be value in seeing a psychologist with specific training in this area together with your physiotherapist. Sometimes the cause is found to be less physical in nature and more psychological in which case it is imperative to seek help from a psychologist as well. Sometimes due to a decrease in intimacy with your partner, there is value in seeing a psychologist to help with any problems you as a couple may be experiencing, while you work on the physical drivers of your pain with the physiotherapist.
Depending on the history and findings on physical examination a treatment program will be tailored specifically to every patient.
(Most of our patients have at least two or more symptoms)
- Urinary frequency and urinary urgency
- Dysuria (pain or burning during urination)
- Nocturia (frequent urination at night)
- Reduced urinary stream and urinary hesitancy
- Perineal pain
- Sitting pain
- Genital pain
- Suprapubic pain (pain above the pubic bone)
- Coccyx (tailbone) pain or coccygodynia/coccydynia
- Low back pain
- Groin pain
- Excessive discomfort or relief after a bowel movement
- Anxiety about having sex
- Reduced libido
- Anxiety and catastrophic thinking
- Social withdrawal and difficulty in intimate relations
- Impairment of self-esteem
- Sleep disturbance
- Helplessness and hopelessness
- Rectal pain
- Increased pain caused by stress
- Exacerbation of pain related to menstruation
- Pain/trauma related to childbirth or sexual activity