The pelvic floor is the area between the pubic bone in the front and the tailbone at the back. It is richly meshed with several small muscles, nerves, and other soft tissues. These structures form a sling that supports abdominal and pelvic organs - primarily the bladder, uterus, and bowel.
Women and men may experience pelvic pain for a variety of reasons. These pain syndromes can be separated into three categories:
- Myofascial (muscle and fascia) - muscles of the pelvic floor can be tense, weak, shortened, or uncoordinated. Scars and fascia tightness may contribute to pain.
- Organ related - the origin of pain is primarily from an organ: vulva, bladder, bowels, or uterus. Common medical diagnoses are vulvodynia, interstitial cystitis, painful bladder syndrome, endometriosis, irritable bowel, or menstrual pain.
- Nerve related - pudendal neuralgia is sometimes called “the carpal tunnel syndrome of the pelvic floor.” It is caused by the compression of the pudendal nerve and can cause perineal or rectal pain. Injuries during childbirth, prolonged downward pressure on the pelvic floor, and/or prolonged sitting and bicycling are common causes of pudendal neuralgia.
Physical therapy targets the muscles of the pelvic floor. Treatment is directed towards relieving pain and tension in these muscles and may include: manual therapy, biofeedback, cold laser therapy, electrical stimulation, ultrasound, and/or exercise.