Pelvic Pain: Time To Do Something About It

Most of the women that come to see me about their pelvic pain have seen at least five doctors prior to physical therapy. The majority of them have been told somewhere within their search for treatment that they should just relax and have a glass of wine.

This is very upsetting to a physical therapist, knowing that this type of pain and dysfunction is musculoskeletal and can be treated with traditional PT techniques. It just happens to be in a very delicate area of the body. This area has muscles that are similar to other areas of our body. They can become very tight, and this tightness can be treated with appropriate techniques.

No matter the cause, the muscles will reactively tighten and spasm to protect the pelvic floor region. This tightening and spasming can cause difficulty with penetration, including intercourse and tampon use.

Treating pelvic pain has taught me that every pain syndrome is unique. I’ve spent nearly four decades providing pelvic pain treatments so my patients could get back to doing the things they love. And I've seen them because they've had the courage to find answers, a search that begins with the understanding that just because a problem is common, that doesn't make it normal. There are things you can do. 

So first, here's a short class (looks long I know, but it isn’t) on pelvic pain to better understand the issues you might be dealing with and the ways we physical therapists can help.

First, there are two types of pelvic pain, acute and chronic.

Acute pelvic pain:

• Starts over a short period of time, anywhere from a few minutes to a few days
• Many times is experienced after surgery or with soft tissue injury
• Is often short-lived but may be severe
• Is often a warning sign that something else is wrong and should be evaluated promptly

Chronic pelvic pain:

• Severe and steady pain, dull aching or sharp pains with cramping, pressure or heaviness with the pelvis
• Pain with intercourse, having a bowel movement or sitting
• Persists for a period of three months or longer
• May be intermittent or constant; intermittent chronic pain will usually have a cause while constant pelvic pain may be the result of more than one problem

Pelvic pain can be caused by endometriosis, pelvic adhesions, vulvodynia, irritable bowel syndrome (IBS), interstitial cystitis (IC), diverticulitis, kidney stones, pelvic inflammatory disease, vaginal infection, vaginitis, STDs, ovarian cysts, an ectopic pregnancy, tension in the pelvic floor muscles, chronic pelvic inflammatory disease, pelvic congestion syndrome, ovarian remnant, fibroids, disease of the reproductive system, scar tissue, urinary tract and bowel dysfunction, physical and sexual abuse, depression, anxiety or musculoskeletal problems of the pelvic floor.

Yes, that was a long list. You should have seen how long it looked when I made it a bulleted list (the above paragraph is nice and tidy in comparison).

Physical therapy is prescribed when there is a musculoskeletal or visceral component to the pain. Many times the muscles of the pelvic floor are over-stretched, torn, cut during childbirth or weakened from disuse or injury. There may be movements and postures that compress nerves and structures of the pelvis that can lead to pain and dysfunction. Spasming of the muscles of the pelvic floor can cause dyspareunia, which is pain with intercourse. Many times the deep pelvic pain can be caused from the deep pelvic floor musculature. These muscles, the levator ani muscle group, form a sling from the pubic bone to the coccyx. These muscles lift and support the pelvic organs – bladder, uterus and rectum.  When there is a spasm of the levator ani muscle group, it can cause pelvic floor tension, myalgia or levator ani syndrome. Many times these muscles of the pelvic floor will have trigger points that are tender to touch. They can also refer pain to the pelvis, lower back and abdominal region.

Pelvic physical therapy may include:

• An application of heat or cold to the pelvic floor, abdominal area, or both
• Stretching exercises or strengthening exercises
• Manual therapy techniques for soft tissue mobilization and myofascial release
• Relaxation techniques
• Transcutaneous electrical nerve stimulation (TENS)
• Modalities such as ultrasound or electrical stimulation
• Dry Needling

Additionally, we can use Biofeedback to control the pelvic floor musculature and decrease the response to pain:

• Uses special monitoring equipment that picks up the EMG activity of the pelvic floor musculature
• Teaches the patient to relax spasming pelvic floor musculature
• Retrains muscles to begin strengthening
• Can be performed externally, vaginally or rectally

The cause of chronic pelvic pain is often hard to find. Because a specific diagnosis is difficult and finding the problem that explains your pain is not clear, that does not mean your pain isn’t real or is not treatable. If you’ve been having pelvic floor pain, discomfort, or other issues, we know how to help.

Chances are, I’ve helped someone with symptoms very much like yours. And I’d love to bring my experience to find ways that will help lessen your pain and improve your function.

So let’s do it.

Connie Strey is a Physical Therapist at PT Center for Women, the premier physical therapy clinic in Northeast Wisconsin for pelvic health. 

To make an appointment with Connie, please call 920.729.2982.

PT Center for Women is one of the only physical therapy centers in Wisconsin that specializes in pelvic pain and pelvic muscle dysfunction, offering women of all ages comprehensive evaluation and treatment for their physical therapy needs.