Persistent or chronic pelvic pain afflicts men and women of all ages. Persistent pelvic pain is defined as "Non-malignant pain perceived in structures related to the pelvis of either men or women, lasting continuously or recurrent for at least 6 months" (Bo 2007). What is challenging is that pelvic pain can occur with or without an injury, therefore making it difficult to identify the etiology of the pain. With persistent pain, one can begin to have pain in surrounding areas, including the abdomen, low back, hips and legs. Individuals may also experience emotional and psychological issues such as anxiety and depression, GI upset, symptoms of bowel and bladder dysfunction (including constipation, diarrhea, urinary and/or fecal incontinence, pain with urination or defecation), and even issues with sexual function (examples include pain with vaginal penetration, pain with ejaculation and erectile dysfunction). Lastly, with time, individuals experiencing persistent pain can have biological changes occur in their bodies, making them more sensitive to their pain.
Some of the pelvic pain conditions that are often diagnosed include coccydynia, painful bladder syndrome/interstitial cystitis, vaginismus, vulvodynia, endometriosis, pudendal neuralgia, acute testicular pain, prostatitis and proctalgia.
An individual experiencing persistent pelvic pain is likely to have a multidisciplinary team of medical professionals working with him or her in order to address the individual's symptoms. This team may include one's Primary Care Physician, Ob-Gyn, Urologist, Pain Management, Acupuncturist, Psychologist, and Physical Therapist to name a few.
Your Physical Therapist will evaluate your condition, and is likely to use a variety of interventions in order to best address your specific symptoms. This is likely to include manual therapy such as soft tissue massage, myofascial release, trigger point release and joint mobilization to both the pelvic structures and the surrounding areas (such as the spine and hips/lower extremities). They may also utilize biofeedback in order to re-educate the muscles to contract and relax appropriately, general relaxation training and diaphragmatic breathing in order to calm a hypersensitive nervous system which is common in individuals with persistent pain. Physical Therapists often educate their patients on posture and body mechancis, as how we sit, stand and move throughout the day can have a profound effect on the spine, pelvis and pelvic floor. Exercise is also important in order to improve general circulation, to release endorphins in the brain, as well as to stabilize joints, improve mobility and to reduce fear of movement. Lastly, your physical therapist will likely use modalities to promote pain reduction including the use of ice, heat and electrical stimulation.
Persistent/chronic pelvic pain is a very real condition that many people think they have to live with. There are many options available to successfully assess and treat pelvic pain.
It can often be a difficult road, but having a good team is imperative to one's healing. If you, a friend or family member are living with chronic pelvic pain, speak with your healthcare professional about treatment options in order to reduce pain and restore function.
By Toni Flynn, DPT