Chronic pelvic pain can be a disabling, severe, frustrating and confusing condition that affects up to 21.5% of Australian women 5% of Australian men. In the absence of a specific disease we consider it a ‘syndrome’ rather that a ‘condition’ or ‘disease’ because it occurs out of a complex interplay between muscles, organs, nerves, connective tissue, inflammation and the parts of the body that are responsible for pain itself: the brain and spinal cord. Pain in the pelvis may in fact be a symptom of a condition elsewhere in the body, or it could be a result of ‘central sensitisation’, where basically the pain becomes the condition in it’s own right and the pain is caught up in a downward spiral of pain, negative emotions, avoidance behaviours and more pain. As I said, chronic pelvic pain can be a hugely complex phenomenon and can be very hard to treat.
People who suffer from chronic pelvic pain often suffer from more than just the raw pain. Pelvic pain can accompany painful intercourse (sometimes making intercourse impossible), bladder and bowel dysfunction, anxiety, psychological effects, emotional heartache as well as social and relationship issues.
“Pelvic pain is truly an awful condition, and unfortunately it is not widely understood, sometimes missed and often mistreated.”
We hope this blog opens up a conversation if you or anyone you care about suffers from pelvic pain. It can be treated and you deserve to have your condition addressed with compassion and respect. Even if the cause of the pain cannot be identified, it doesn’t mean the pain is any less real! (visit our previous blog “Chronic pain: Is it all in my head?” to find out more about how persistent pain works).
Why does it hurt down there?
As mentioned earlier, there are a myriad of reasons as to why someone may be suffering from pelvic pain. A pelvic floor and continence physiotherapist will be able to help you work out what is driving the pain and help separate the causes from the symptoms. One cause of pelvic pain that physiotherapists are often concerned with is ‘pelvic floor muscle pain syndrome’, or ‘muscle pain’, or ‘myalgia’, or ‘pelvic floor over-activity’, or ‘levator ani syndrome’. (These all mean the same thing- hence the confusion…). Basically it means muscle tenderness or pain or the pelvic floor muscles, the muscles deep within our pelvis that support our pelvic organs. It can be accompanied by painful trigger points (muscle knots) in the muscle belly, high resting muscle tension, reduced ability to relax the pelvic floor muscles, difficulty emptying the bladder and bowels and spasmodic contraction of the muscles around the vagina that may affect intercourse of use of a tampon. This last one is often referred to as ‘vaginismus’. We don’t know for sure what came first, the pain or the muscle spasm (kind of like the chicken and the egg), however experts consistently see a relationship between pelvic pain and spasm of the pelvic floor muscle, and this gives us therapists a clue about how to break the cycle.
How do I know if I am suffering from ‘pelvic floor muscle pain syndrome’?
There are many different presentations of pelvic floor muscle syndrome, and each person’s body will react slightly differently. As I mentioned the best way to find out if you are suffering from this condition is to have a comprehensive pelvic floor assessment with a pelvic floor and continence physiotherapist. That being said, some tell tale signs may point to the muscle being the pain driver. For example you might have noticed…
- Pain is the main reason for your physio visit
- The pain often feels like discomfort, soreness, tenderness, pressure, sensitivity or aching
- Pain may change with your position or the type of activity you are doing
- Pain may be precipitated by a trauma, abuse or pelvic floor injury
- The pain is diffuse and you may have difficulty pointing to with your finger
- Multiple gynaecology tests and scans have returned negative
- Sexual intercourse is painful or difficult
- You experience heightened pain following intercourse
- You often feel that you haven’t completely emptied after using the toilet
- You find it difficult to activate or relax the pelvic floor muscles
- You have a history of holding onto pelvic floor tension and your toileting habits make you feel anxious
Oh what to do? What to do?
Sounds pretty bleak right? Well fear not! Conservative management options exist that can help you manage your pain without invasive testing or medications. Pelvic floor physiotherapists are highly trained in administering therapies that can help reduce and alleviate pelvic floor muscle pain syndrome. Your main symptoms and pain drivers will determine what therapy will work best for you. And guess what? The pelvic floor muscles are just like any other muscle in your body, such as your bicep or hamstrings. They have the same basic structure and they can get tight, weak, sensitive or have knots within them. The only difference is that they are internal and they are surrounded by some pretty precious things, like your bladder, bowel and uterus. So saying that, it makes sense that you can treat these muscles in much the same way as any other muscle in the body. Some therapies that pelvic floor and continence physiotherapists are trained to administer include:
- Education on pain, muscle activity and function
- Lifestyle and exercise modifications
- Guided imagery
- Muscle stretching and tension point releases (yes, in the same way you release tension in your shoulder, yes, internally/and sometimes externally).
- Scar tissue mobilization
- Toilet technique training
- Relaxation techniques
- Use of biofeedback machines and electrical stimulation (yes, internally and externally).
- Use of dilators (yes, you can look this one up!)
The results? Most studies that are good quality report a positive improvement in patient’s symptoms. The longest lasting treatment was reported for mental training based approaches to train relaxation of the muscles, with the benefits lasting 12 months. Targeted muscle releases and stretches appeared to be very beneficial in numerous studies and electrical stimulation was more effective than a sham treatment. The risk of adverse effects with these treatments is documented as low or absent and this includes some post therapy soreness (similar to effects of a deep tissue massage). In my book- the risk-benefit ratio is a lot better than medication, lasers or surgery!
Chronic pelvic pain is not something that just comes and goes, it is a long term condition that requires extensive therapy and treatment. It often requires a team of healthcare practitioners working toward the same goal, such as general practitioners, psychologists, physiotherapists and sexual health counsellors. My recommendation is to find someone experienced who you can build a rapport with. It is important to trust the therapist you are working with so that you can feel comfortable and in the best state-of-mind to begin your road to recovery. Being kind to yourself will be the first step…
Did you know that Jane Strachan has completed a Masters of Clinical Physiotherapy in Continence and Women’s Health (Curtin University of Technology) and is an APA titled member in Continence & Women’s Health. She is our resident expert (: (: (: Give us a call to book an appointment with Jane or book your session online, Remember… you don’t have to live with this pain.
Be kind to yourself,
Frawley, H. Pelvic floor pain and overactive pelvic floor. In. Bo, Berghmans, Morkved, Van Kampen. 2015. Evidenced-based physical therapy for the pelvic floor. 2nd Ed. Churchill Livingstone.