Chronic Pelvic Pain
Condition Overview
Chronic pelvic pain is pain in the pelvic region (from belly button to mid-thigh) that lasts longer than 6 months. Chronic pelvic pain can be constant or intermittent. It can feel like sharp pains, cramping, dull achy pains, or pressure/heaviness in the pelvis. For women, the pain may or may not worsen during menstruation. In both men and women, pain may be exacerbated after eating or sitting/standing for prolonged periods of time. This pain may also worsen with and/or can affect bladder/bowel function and sexual health.
What causes chronic pelvic pain?
Occasionally there is one answer to this question, but the majority of times there are a few factors that are all playing a role in pelvic pain.
When pain becomes chronic, there is a phenomenon that occurs known as central sensitization. Central sensitization is when our central nervous system is heightened and it causes everyday events to feel like a threat. This increased sensitivity to everyday activities can increase our pain response and it takes a lot more work and time to turn down that volume button than an acute issue or injury would require. In this case, we need to determine what events heighten or reduce your pain response. For instance, good sleep, self-care, consistent exercise routine, and healthy social activities can all reduce the threat response; whereas, stress, poor work-life balance, decreased sleep, poor diet and exercise routine may all increase that sensitization and in turn increase the pain that you feel. Therefore, we can’t only work at the pelvic region but we need to look at all of the biopsychosocial factors that could be affecting your pain on a day to day basis.
Despite the central sensitization effect that occurs with chronic pain in general, chronic pelvic pain can have a few direct causes such as:
Pelvic floor tension or overactivity
Endometriosis
Interstitial cystitis or bladder pain syndrome
Pelvic inflammatory disease
Post-surgical response (cesarean, hysterectomy, fibroid removal)
Pelvic congestion syndrome
Previous pelvic or sexual trauma or injury
Treatment for chronic pelvic pain
If there is a direct cause, such as endometriosis, interstitial cystitis, or pelvic inflammatory disease, medical intervention may be required as part of the multidisciplinary treatment approach. Despite medical intervention, pelvic floor physical therapy is an essential part of the treatment process to reduce the pain response and improve pelvic health. In physical therapy, we will discuss the characteristics of your pain including onset, type, what worsens and improves it, and changes in lifestyle due to pain. We will also review each of the systems of the pelvic floor (bladder, bowel, sexual health, and gynecological health) in order to diagnose your symptoms appropriately. We will perform a low back/ hip screen and assess muscles that attach to the pelvic structure to note signs of decreased range of motion, impaired joint mobility, muscle atrophy, and tension. With your consent we will perform an external and internal pelvic floor muscle assessment to determine muscle function, strength, and coordination. We will also assess the abdominal wall since these muscles are so closely connected to the pelvic floor and can be the source of chronic pelvic pain.
From our findings we will set-up a treatment plan depending on your pelvic floor characteristics! We may recommend lifestyle changes, dietary/fluid intake modifications, and perform manual treatment that can include but is not limited to dry needling, myofascial release, cupping, and connective tissue mobilization. With each session we will progress as able and learn new activities to include in your daily routine to manage and prevent worsening symptoms!