Pelvic pain & discomfort

Women (and men) may experience pelvic pain for a variety of reasons. It is important to know that pelvic pain is multifactorial and patients should be their own best advocates to explore the many treatment options available to them, starting with their physician.

The pelvic floor is the area between the pubic bone in the front and the tail bone at the back. It is richly meshed with several small muscles, nerves, and other soft tissues. These structures form a sling that supports the abdominal and pelvic organs primarily the bladder, uterus and bowel. These muscles also encircle the openings of the bladder (urethra), bowel (rectum) and uterus (vagina) – they provide closure as appropriate for these openings and enhance sexual activity. The muscles of the pelvic floor are the primary target for physical therapy treatment. In the case of pelvic pain, treatment is directed towards relieving pain and tension in these muscles.

To understand the role of physical therapy in the assessment and treatment of pelvic pain it may be easier to think of pelvic pain syndromes into three broad categories:

Myofascial (Muscle and fascia) Pelvic Pain:

The cause for pelvic pain is primarily the muscles and soft tissues of the pelvic floor. Muscles of the pelvic floor can be tense, weak, shortened or uncoordinated. The muscles do not have the normal ability to contract, relax, stretch and work in sync with neighboring muscles as needed. Also scars and fascial tightness may contribute to the pain. Most commonly, because the muscles in this area are tense or uncoordinated, patients may experience sexual pain, constipation, tailbone pain, coccygodynia, anal/rectal pain, and other tension myalgias in the pelvic area.

Organ related Pelvic Pain:

In this case the origin of pain is primarily from an organ (vulva, bladder, bowels, and uterus). Common medical diagnoses are: Vulvodynia, Interstitial cystitis, painful bladder syndrome, endometriosis, irritable bowel, menstrual pain. Each condition has specific symptoms.

Vulvodynia is characterized by rawness, itchy, burning, throbbing or tenderness in the area around the opening of the vagina. Interstitial Cystitis is characterized by pain with bladder filling; most other conditions cause pelvic pain in varying degrees and at varying times of day/month.

Nerve Related Pain:

Pudendal Neuralgia is sometimes called “the carpal tunnel syndrome of the pelvic floor”. It is caused by the compression of the pudendal nerve causing perineal and/or rectal pain. Primary symptom is difficulty sitting. Injuries during childbirth, prolonged downward pressure on the pelvic floor and/or prolonged sitting, and bicycling are common causes of pudendal neuralgia. (see PUDENDAL NEURALGIA FOR DETAILS)

In the case of organ or nerve related conditions, muscle tension is a secondary condition that comes from prolonged pain. The simplest way to explain this is that when organs get “angry” they want the neighboring organs and muscles to be “angry” also. This results in a growing cycle of ongoing pain and disability to where patients, because of pain, slowly become less active. Postures change, breathing patterns change, exercise becomes infrequent or impossible, activities of daily living become more difficult and painful. The goal of physical therapy is to decrease pain/tension and improve your daily functional ability and minimize the pain/tension/pain/tension cycle.

Physical therapy assessment includes the examination of overall posture and movements, followed by a detailed assessment of the muscles of the pelvis, both the larger external muscles and the smaller intravaginal and/or intra-rectal muscles.

Physical therapy treatment includes one or more of the following:

MANUAL THERAPY (gentle manipulation of tissues in a variety of ways to soften and relax tense tissues)

  • Release of trigger points in the muscles
  • Connective Tissue massage for thick/dense tissue to restore circulation and tissue health (skin rolling)
  • Gentle stretching/massage of tissues, scars and muscles that are tense or “stuck” (myofascial release)
  • Gliding techniques for enhancing mobility of the pudendal and/or sciatic nerves (neural mobilization)
  • Correct misalignments of the joints in the pelvis and/or spine: tail bone, sacroiliac (joint mobilization). These misalignments may be perpetuating or contributing to pelvic pain
  • Gentle movements to mobilize stiff or tense organs and related structures (visceral mobilization)

Pelvic floor BIOFEEDBACK or Surface EMG -

Biofeedback involves the insertion of a small probe into the vagina or rectum that “records” muscle activity and translates these signals onto a computer screen so that patients can “see” their muscle contraction, level of muscle tension and relaxation. The ability to view muscle activity helps patients to see the results of their efforts as muscles strengthen or relax and adjust their efforts as needed.

ELECTRICAL STIMULATION: for pain or muscle re-education
Interferential electrical stimulation consists of transmitting gentle/pleasant vibrations via externally applied electrodes over the painful area to lessen muscle tension and ease pain. Electrical stimulation may also be applied directly into the vagina or rectum to ease tension in these deeper muscles. Patients are given resources on how to rent or purchase “home units” if necessary.

ULTRASOUND for muscle tension or scar tightness
High frequency sound waves applied to tense muscles or scars will soften tissue making scars more pliable and easier to massage and stretch. Ultrasound also softens tense muscles. PRESCRIPTIVE EXERCISE: tailored flexibility and strengthening exercises will be prescribed to patient tolerance and ability. Exercises are made more challenging as you progress. The goal of the exercises is to minimize muscle tension and promote comfortable activity so that patients do not become increasingly immobilized with pain.

Our therapists will provide information about a variety of comfort measures and modifications to your daily routine to ease discomfort. These include hints on seating options, support cushions, postural comfort, pain management. Home units can be rented or purchased if needed.

How often and for how long will I need to come to therapy?

You can expect to attend therapy 1-2 times per week for 6-12 weeks depending on the complexity of your symptoms. For patients traveling long distances, other accommodations are suggested.

You will need a prescription from your physician and physical therapy services are reimbursed by most insurance companies.

Patients should know that it is not common, nor should they expect to experience significant pain when they are sexually active, sit for moderately long periods of time, use a tampon, or even wear tight-fitting jeans. It is important that patients know their options for medical treatment and be their own advocate for pelvic health.

Physical therapists are health care professionals who assess and manage patients who have medical problems or other health related conditions that limit their ability to move and perform their daily activities comfortably. Your Physical therapist will take a detailed health history, examine you and develop a personal plan of care.

Treatment techniques are used to promote movement, reduce pain, restore function, and prevent disability. Your Physical therapists will work with you to enhance health by developing fitness- and wellness-oriented programs for healthier and more active lifestyles tailored your ability.

For more information or to schedule an appointment call 713-799-6193.