Chronic Pelvic Pain (CPP) is defined as pain in the abdomen or pelvis that has lasted longer than three months. CPP affects 1 in 7 American women ages 18-50 and many women (61%) suffering from CPP have no diagnosis (pelvicpain.org). Women often feel hopeless or discouraged because their doctors are unable to give any reason for their pain. It is important however, to seek medical evaluation from your physican before pursuing physical therapy in order to rule out any current medical conditions that could be treated by your doctor.
What does CPP look like, and how do I know if I have it?
- Do you have pain in your lower abdomen, vagina, anus, or tailbone?
- Do you spend 2-3 days per month in bed?
- Are your daily activities limited 1-3 days per month?
- Do you have pain with intercourse (dyspareunia)?
- Do you feel sad or depressed?
- Do you have difficulty using the restroom (pain, urgency or frequency issues, constipation)?
- Is sitting painful?
- Is it difficult to wear tight clothing/jeans due to your pain?
- Do you have burning, stinging, irriation or rawness of the genitals (vulvodynia)?
Where is my pain coming from?
- Possible current or prior pathology or illness of the pelvic region
- Possible history of pelvic trauma due to surgery, childbirth, sexual injury, infection, falls etc.
- Possibly referred pain from another area of your body
- Muscle and/or fascia pain
- Irritated nerves
- Possible hormone deficiency causing skin changes
How can physical therapy help me?
Let’s talk about muscles! Did you know that your pelvic floor is made up of three layers of muscle tissue, ligaments, and nerves? Each layer is responsible for support, stability, sexual function, and control of bowel and bladder. Its a big job. Just like other muscles in your body, these muscles can be tense, tight, short, or weak. Physical therapists trained in pelvic dysfunction can assess the muscles of your pelvic floor and come up with a plan suited for you. This will best be determined with an internal pelvic exam. Treatment may include: exercise, stretches, manual therapy, ultrasound, and electrical stimulation for pain relief.
How long until I will feel better?
Unfortunately, with CPP results may take awhile. Your physical therapist will encourage you to be patient and stick with it. Some women experience some level of relief pretty quickly, while others take longer. Your physical therapist will likely want to see you on a weekly basis and will be there to walk with you through this difficult time. Some weeks you may see big improvements, and then some weeks may feel like you’ve lost some ground. This is normal when dealing with chronic pain. When we are more stressed, pain is typically more intense. When we have a good day, pain can be lessened. That’s right, our emotions and stress levels play a role in our pain!
Types of Pelvic Pain
Sexual Dysfunction/Pain With Sex
Dyspareunia is defined as pain or discomfort associated with attempted or complete vaginal penetration. There are two types of dyspareunia: superficial and deep depending on when pain is felt. Pain is usually felt in the absence of any disease and may be localized to the vagina or lower pelvis (Haylen et al. 2010).
Treatment for dyspareunia may include treating any underlying skin issues due to hormone changes, surgical scars, disease, and education in proper lubrication and understanding your hormonal cycle. Often tools such as dilators can be used to aid in stretching tight pelvic muscles and relax the opening of the vagina along with relaxation techniques. Physical therapy will focus on this and treating any underlying muscle tension or over activity of the pelvic floor muscles.
Vulvar Pain and Vulvodynia
Vulvar pain (genital pain) can be caused by many factors: infection, trauma, hormone deficiency to name a few. When the pain has lasted at least three months and has no clear cause we call the condition vulvodynia. Characteristics of vulvar pain may include pain with sex, skin irritation, urinary urgency and frequency and tender points. Some patients describe the pain as burning, stinging, irritation or rawness of the genitals. (Herman and Wallace).
Treatment approaches for vulvar pain are most successful when physical therapy is working along side your physician and may include manual therapy, education in vulvar care, medication, and/or surgery. Some success has been shown with the use of lasers as well. Here at Motion Physical Therapy, laser treatment with your physical therapist is an option.
Other types of pelvic pain that physical therapy can address include:
- Painful menstruation
- Painful Bladder Syndrome (Interstitial Cystitis)
- Pudendal Neuralgia