Pelvic Pain: Why, What, and I how do I Make Changes?

Wait…pain “down there?”

Yes, pain in the nether regions. Areas that we tend to talk about in hushed tones, in private, or with an embarrassed laugh.

An issue for women and also for men, and still not discussed, addressed, and treated as openly and easily as it should be.  Pain is a warning;  your body and brain having a discussion that something is “off”. When that warning signal works well, like after birthing a baby and having an episiotomy or c-section scar and having pain remind you to slow down and heal, it’s a great thing.  However, sometimes the brain perceives that something is not right on a continual or repeated basis, and the system becomes sensitized and hyper-aware of pain. The warning signals are on all of the time, sometimes for reasons that are not fully known. When the tissues and the area that we feel the pain are areas associated with privacy, pleasure, and reproduction, it can be very confusing, scary, and frustrating. Living with pelvic pain can be exhausting. It may seem that it rules your life.

The good news is that there is a growing body of clinical knowledge about working with individuals with pelvic pain, and helping them find solutions and live a full life without pain stopping them. There are many different descriptions of types or pelvic pain, and they can overlap. Treatment and solutions to your pain are about more than “do kegels” or “don’t do kegels”, “just relax”, and other things that you may have read or heard about.

 We thought it would be helpful to make a list of some of the more common types of pelvic pain we work with at Embody, and a bit about each diagnosis.This list is not all inclusive, and the descriptions are general. The same diagnosis can present differently from one person to another, but even so, treatment, change, and life without fear of pelvic pain is possible. If you or someone you care about is struggling with pelvic pain, please contact us, ask, learn about solutions!

Post birth:. Some women have more pain related to episiotomy and pelvic floor tears during childbirth, and scarring than others as they heal and begin the road to recovery after birth. Some women also experience vaginal dryness or tissue changes related to the hormonal fluctuations before, during, and after childbirth (especially if nursing). And although c-section scars do not directly affect the pelvic floor, it is all attached, and some women do experience post- cesarean discomfort or pain. NOTE: while pain immediately after childbirth is normal while the tissues heal, it is NOT normal to have continued pain and discomfort. It IS ALL something that can and should be addressed. Solutions are available!

Pelvic Ring, SI, and pubic symphysis pain: common during pregnancy, along with the description of “sciatic pain” or butt and leg pain. The body is going through incredible changes and the muscles are not always supporting as adequately during rapid changes as is optimal. Working with you early is great as we are able to teach you to change and modify how you use your body and muscles as the baby grows, but if you are having pain or problems later in pregnancy, we can help (and with Round ligament pain, or the pain that goes into the groin, as well).  Please don’t let your care provider tell you that you must deal with it or that it will “get better” after giving birth; studies show that approximately 30% of women continue with pelvic ring pain after delivery. Take care of it sooner than later.

DyspareuniaPain with intercourse or attempts at vaginal insertion. This can occur for many reasons (see above and below). It is frustrating for those who experience it, and care providers can add to the frustration by telling you things like “it will get better”,  “that’s normal”, or “have a glass of wine”. NOT normal!!!  Treatment varies based on our evaluation. There are solutions for this!

Vulvodynia: pain, itching, burning, or discomfort around the opening of your vagina (vulva) for which there’s no identifiable cause and which lasts at least three months. The pain and symptoms may affect activity, make sitting very challenging, and dyspareunia is often present. There are several factors that we believe contribute to vulvodynia, like repeated yeast or vaginal infections, chemical reactions (no harsh soaps and no fragrances on the lady parts, please!!), hormonal changes, and musculoskeletal issues. It is a truly frustrating problem for anyone diagnosed with vulvodynia, but working with a knowledgeable team provides answers and lets you resume a full life!

Vestibulitis (or vulvar vestibulitis): a stinging or burning-like pain at the entry to the vagina that is brought on by sexual intercourse and the insertion of objects such as a tampon or speculum into the vagina.

Vaginismus : Vaginismus is a spasm or contraction of the muscles around the vagina. This can happen during sexual intercourse. It can also happen when you try to insert a tampon into the vagina, or during a Pap test. Usually women with vaginismus do not have pain without attempts at vaginal insertion, but it may be present with vestibulitis.

Prostatitis (chronic) and Male Pelvic Pain :  Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and interstitial cystitis/bladder pain syndrome collectively referred to as urologic CPPS (UCPPS) . There is no bacterial infection; from a clinical exam, muscle and other soft tissue tenderness may be present along with  changes in mobility and core coordination,  and often GI dysfunction (constipation or IBS are present. Individuals with male pelvic pain benefit from and respond well to PT addressing the entire individual.

IC/Interstitial Cystitis/Bladder Pain Syndrome (BPS) :  It is a feeling of pain and pressure in the bladder area. Along with this pain are lower urinary tract symptoms which have lasted for more than 6 weeks, without having an infection or other clear causes. In PT, we often see soft tissue, visceral, and muscle mobility and tenderness, as well as changes in mobility. These symptoms may be present with other pelvic pain diagnoses.

IBS (Irritable Bowel Syndrome) a common disorder that affects the large intestine. Signs and symptoms include cramping, abdominal pain, bloating, gas, and diarrhea or constipation, or both. We often see IBS symptoms in our patients with other pelvic pain diagnoses.

Pudendal neuralgia: pain resulting from irritation of the pudendal nerve. You may have pain with sitting (often but not always improved with standing or sitting on the toilet), with intercourse or with  tight clothing. You may experience bladder and bowel problems and  genital pain.

Post-menopausal tissue changes: vaginal and the surrounding tissues become thinner and may lose elasticity after menopause due to changes in hormonal levels. Strategies for tissue mobility and pelvic floor work may improve symptoms, as well as proper lubrication and moisturizing.

Endometriosis: an often painful disorder in which tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus. Endometriosis most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis. The endometrial tissue continues to act as it normally would — it thickens, breaks down and bleeds with each menstrual cycle. The tissue has no way to leave your body and may thicken or create scar tissue and adhesions. Endometriosis can cause pain ,especially during menstrual periods. Fertility problems also may develop. Endometriosis is diagnosed by laparoscopic procedure. Physical therapy assists with pain, tissue mobility, and regaining motion and strength.

This list and these descriptions can sound scary. You may be struggling with pelvic pain and feel disheartened. You may have heard only negative things and feel as though there is no help or that you are broken…you are NOT!  You may be worried that Physical Therapy will be painful; please know that our goal is NOT to create more pain! Our goal is to help you lead a full life and to do the activities you want and need to do without fear or limits.

Finding a Physical Therapist in your area who specializes and is knowledgeable in assessment and treatment of pelvic pain is important.  If you are outside of the western PA area, we are happy to discuss options and may be able to help you find a PT in your area.

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