Updated: Feb 17
When it comes to chronic pelvic pain, many patients unfortunately end up seeing 5, 6, 10+ doctors trying to find answers to why they have pain. Patients may see various specialists and can go through a slew of tests like blood work, ultrasounds, CT scans, MRIs, exploratory surgery, and multiple rounds of medications like antibiotics and pain medications with no resolution of their symptoms. It can be incredibly frustrating.
Chronic pelvic pain could look like any of these following symptoms:
Pain can vary from mild to severe
May be constant or come and go
Pain might be dull, sharp, and/or radiate
Might be located in the tailbone, pelvic floor, genitals, groin, hip, and/or lower abdominals
Might see a pattern of pain with certain activities or positions
Sexual activity may cause or increase the pain
Urination or bowel movements may be painful
Pelvic floor myofascial pain occurs in approximately 85% of patients with pelvic pain (Meister). Pelvic floor physical therapists are movement experts that specialize in assessing and treating myofascial pain (Myo= muscle) anywhere between the ribs and knees. At RVA Holistic PT, we have advanced training in orthopedics, intravaginal pelvic floor assessment, intrarectal pelvic floor treatment and visceral training , but we look at the pelvic floor as well as the entire body because dysfunction in one part of the body can contribute to dysfunction in another part of the body.
Why you need to look at the entire body: For example, a runner had a foot sprain many years ago. She had treatment for it, but it still bothers her from time-to-time and she now walks every so slightly favoring that foot. That slight change in walking also affects the hip. The hip muscles attach into the pelvic floor, so tension in the hip can create and contribute to tension in the pelvic floor. Tension in the pelvic floor can lead to pelvic pain. In this case, her symptoms resolved through treating the affected hip and pelvic floor muscles, as well as treating that original foot injury. We needed to restore her foot mechanics in order to restore her hip and pelvic floor function.
Why you need to thoroughly assess local tissues: Another example would be a recent patient of ours who came in to see us after being on hormonal contraceptives for 15 years. We do a thorough assessment of the vulvar tissue and in her case she had several signs and symptoms that she may have a hormonal deficit that is contributing to tissue sensitivity in her vulva. In her case, referring her to a trusted gynecologist to help her address her local hormone problem completely solved her vulvar pain.
What Can Physical Therapists do to help pain? A lot.
We complete a comprehensive orthopedic and manual examination of the musculoskeletal and neuromuscular system. Then, we find the ROOT cause of the pain and treat those root causes.
Treatment Techniques We May Use
Movement Dysfunction Correction
Soft Tissue Mobilization
Therapeutic Exercise Training Specific for the Patient
Helping recalibrate your nervous system
Vagus nerve activation
Corrective Breathing Training
We take a holistic approach to each and every one of our patients. For example, sleep. There is a strong link between chronic pelvic pain and sleep problems. Not sleeping well increases the chance of pain and the sensitivity to pain. Pain can also effect quality and length of sleep. Poor sleep is also found in those with depression and anxiety and these mood disorders are more common with those that have chronic pelvic pain. Negative mood can increase the effect of poor sleep on pain. Round and round the cycle goes. Improving your sleep patterns can help break this cycle.
We work closely with the patient to come up with an individualized treatment plan to help you get out of pain and back to living your very best life. If you are in the Richmond area and would like an integrative approach to treating your pelvic pain, you can book with us for a clinic visit.
Written by Alison Gallup, PT, DPT, OCS and edited by Kelley Ryan, PT, DPT, WCS, PCES