Guide to Chronic Pelvic Pain And Rehabilitation

Introduction to Pelvic Pain

 

Chronic pelvic pain is usually used to describe the persistent pain felt in a woman’s reproductive organs. It’s a significant and common problem that can affect any woman, regardless of age. Often times, the etiology is unclear,  and the pain sometimes lasts for months.

Researchers aren’t certain about the number of women in the US who have chronic pelvic pain, but some studies have reported that up to 15% of women of childbearing age have experienced it. Worldwide, this ranges from 14–32%. In 32% of affected women, this pain is so severe that they have to miss work.

 

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Percentage Of Childbearing Women Who's Had Pelvic Pain

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Percentage Of Women With Pelvic Pain So Severe They Had to Miss Work

But did you know that the condition can occur in men, too?

It may indicate an infection or may be caused by pain in the pelvis or a non-reproductive organ such as the bladder or colon in men and women. Areas of reproductive organ pain can affect men and women but are vastly different indications of a potential underlying problem in a reproductive organ within the pelvic area. These organs can include the ovaries, testicles, uterus, cervix, penis, fallopian tube, and vagina. Conditions stemming from these reproductive organs can manifest themselves as erectile dysfunction, pain with intercourse, persistent genital arousal disorder and much more. 

What are the causes of chronic pelvic pain?

There are various causes of chronic pelvic pain. In fact, it may difficult to determine a specific cause as there can be more than one contributor to the pain. Sometimes it’s a harmless sign that you’re fertile while at other times it could arise from an underlying internal problem.

A woman may experience pelvic pain as a result of multiple causes, all occurring at the same time. Typically, a woman suffering from one type of chronic pain is at a greater risk of developing other types of chronic pain.

It’s important to note that the intensity of the pain doesn’t necessarily indicate the severity of the problem or condition causing the pain. For instance, women with small endometriosis areas may feel more intense pain than their counterparts. Our female pelvic pain overview gives a great introduction to the gender-specific around pelvic pain such as finding relief from endometriosis pain.

Let’s look at some of the causes of pelvic pain in both men and women.

 

Conditions and causes of pelvic pain for men and women

Chronic Pelvic Pain Syndrome (CPPS)

Chronic pelvic pain syndrome (CPPS) is a blanket term to describe recurring pain syndromes in both men and women. The hallmark symptom is chronic pain in the pelvis, pelvic floor, or external genitalia. Both men and women characterized by chronic pelvic pain syndrome have extensive pelvic pain lasting more than 3 months.

Chronic pelvic pain in men is often caused by chronic prostatitis, levator ani syndrome, coccydynia, or other male pelvic issues.

Chronic pelvic pain in women is commonly caused by endometriosis, dyspareunia, pudendal neuralgia, persistent genital arousal disorder, pelvic floor muscle hypertonia, or other bowel conditions.

 

Pain During Intercourse

Pain during intercourse, or dyspareunia, can cause problems in a couple’s sexual relationship. Typically when a female experiences pain during sex, it could be caused by a number of issues, including, but not limited to: vaginismus, vaginal infections, problems with the cervix, problems with the uterus, endometriosis, problems with the ovaries, pelvic inflammatory disease (PID), injury to the vulva or vagina, and vulvodynia.

In addition to the physically painful sex, there is also the possibility of negative emotional effects. So the problem should be addressed as soon as it arises.

 

Perineal Pain

Perineal pain is also called perineum pain. In men, the area between the testicles and the anus is called perineum. In women, the area between the vagina and the anus is called perineum.

Pudendal Neuralgia (PN) is a condition that involves pain of the pudendal nerve, which runs along the perineum. This condition is commonly associated with pudendal nerve entrapment (PNE), or the pinching and compression of the nerve.

 

Tailbone Pain

Coccydynia is a pain felt in your coccyx, or tailbone. You can get it if you injure or strain your coccyx or the surrounding muscles and ligaments. Symptoms of coccydynia are usually a focal pain and tenderness at the tailbone, often caused by inflammation.

 

Levator Ani Syndrome Chronic Pelvic Pain Location

Rectal Pain

Chronic pelvic pain can be diagnosed as rectal pain, or levator ani syndrome / spasms. This is caused by ongoing muscle compression in the pelvic floor. Levator Ani Syndrome can include pain with sitting, pain with bowel movement, pain during intercourse, and high-stress situations.

 

Painful Bladder Syndrome

Also known as interstitial cystitis, painful bladder syndrome is a bladder disorder characterized by pain in the bladder and an urge to urinate urgently and frequently. It may be a burning or sharp pain and occurs in the bladder or at the opening of the urethra where urine leaves the body. Pain is usually relieved when you empty your bladder.

 

Kidney Conditions

Kidney infection or kidney stones could also lead to pelvic pain.

Kidney stones are salt and mineral deposits that the body tries to release in urine. They can differ in size from tiny grains of sand to large golf balls. They can really hurt.

If your urine looks pink or red, see a doctor. It could be kidney stones. While most stones will pass on their own, some will require treatment and your doctor can help with medication to relieve pain.

 

Sexually Transmitted Diseases (STDs)

Pelvic pain could also be a sign of specific STDs, the most common being chlamydia or gonorrhea. Often, the two appear at the same time. Symptoms you may experience are: pain when peeing, bleed between periods, and/or abnormal vaginal discharge. At the onset of symptoms, it’s important to see a doctor and get partners treated.

 

Pain During Bowel Movement or Irritable Bowel Syndrome (IBS)

IBS, also known as spastic colon, is a problem with the digestive system that could lead to pain, constipation, bloating, or diarrhea. Researchers aren’t quite sure what causes IBS but stress and certain foods have been linked to the symptoms.

Pelvic Floor Disorders

Pelvic floor disorders occur when you injure the muscles and connective tissues that hold the pelvic organs in position. This may occur during childbirth, for instance. This frequently causes discomfort and may lead to frequent urination or stool incontinence (uncontrolled urine and stool loss, respectively).

 

External Trauma

If you have suffered a severe external trauma that was never treated this can lead to underlying chronic pelvic pain. Where structural injuries like this are best treated immediately by an orthopedic specialist. If left untreated, the stress and tension in the injured area can lead to other pron;e,s. A severe trauma to the pelvic region, and potentially shift internal organs, can lead to nerve compression if not properly treated over time.

Hernia

Hernias occur when fatty tissue or an organ squeezes through a weak spot in connective tissue or surrounding muscle. There are different types of hernias including inguinal, incisional, femoral, umbilical, and hiatal hernias.

All hernias ultimately result from a combination of pressure and a nearby weak spot or opening as the pressure pushes the tissue or organ through the spot. Any activity that causes significant pressure to the abdomen could lead to a hernia. This includes lifting heavy objects before stabilizing abdominal muscles, sneezing or persistent coughing, and even constipation or diarrhea.

 

Pain with Sitting

Sitting for long periods of time can also cause pain on the pelvic floor. With prolonged sitting, nerves running from your low back through the pelvic floor become irritated and with time it becomes difficult for you to sit without exacerbating pain. Having the body in an unnatural state for long periods of time came simply turn into pain while sitting.

This condition is especially relevant for bicyclists. Cycling for long periods of time can cause the same effects as a sedentary lifestyle.

 

Stress

Often people transfer their high-stress levels and tension to their muscles. For instance, they may grit their teeth and hold their breath. Consequently, the pelvic floor can also become clenched due to stress. Apart from the pain, this can result in digestive issues, bowel movement syndrome, and even sexual dysfunction.

 

Hypermobility

Hypermobile people are really flexible. This includes people with knees and elbows that can almost go all the way backwards when their arms and legs are straightened out. Think of groups such as gymnasts, yogis, and dancers. If they are too flexible, and have weak hips, back, and abs, it means their pelvic floor might have to bear the whole weight. This can get both tight and painful at the same time.

 

Conditions and Causes of Pelvic Pain in Women

 

Post Partum Pain

Women can have a range of conditions after giving birth due to the stress pregnancy puts on the body. Postpartum pelvic pain is one such condition. Because of childbirth, the pelvic muscles and tissues may become damaged. While symptoms may develop during pregnancy, the postpartum symptoms occur due to the stretching of the pelvic floor to allow the baby to pass through.

 

Persistent Genital Arousal Disorder

Persistent Genital Arousal Disorder, also known as PGAD or Restless Genital Syndrome or Persistent Genital Arousal Syndrome, is a condition characterized by relentless and involuntary genital arousal in females.  Arousal with orgasm and/or genital engorgement may or may not be symptoms of PGAD. Very often patients have approached medical health professionals who have not heard of PGAD and often times their symptoms are dismissed. PGAD is a real disease and must be treated by professionals who have significant experience with PGAD.

 

Vulvodynia or Vulvar Pain

Vulvodynia is a condition characterized by pain or discomfort of the vulva, especially during sex. This pain may range from a sharp sensation, to a burning pain, to just an itch. Although this pain lies outside the pelvis, professionals dealing with pelvic pain can also help patients with vulvar pain.

 

Menstrual cramps

During the monthly period, the uterus tightens to push out the lining previously created in readiness for an embryo. As a result, you may feel cramps in the lower belly or back. Use of a heating pad or use over-the-counter pain relievers can help alleviate the pain. Exercise and stress relief can also help. If the pain is too much, talk to your doctor about it.

 

Ovarian cysts

When a follicle fails to release an egg during ovulation or relocates after releasing the egg, it may swell with fluid. Ovarian cysts are usually harmless and stop on their own. However, before they go, you may experience pelvic pain, swelling, pressure, and bloating.

If the cyst bursts or twists, you may experience a sudden severe pain that could send you to the ER. Your doctor can easily spot an ovarian cyst during an ultrasound or pelvic exam.

 

Uterine cancer

Uterine cancer or endometrial cancer occurs when abnormal cells grow in the lining of the uterus, called the endometrium. This usually occurs in women over 50 years of age and is often cured if found early. Symptoms include pain during sex, bleeding or a vaginal discharge that’s unrelated to menstruation, and pelvic pain.

 

Cervical cancer

Cancer of the cervix is commonly caused by human papillomavirus (HPV). Symptoms include vaginal bleeding and discharge and pain during sex. You can reduce the risk of developing cervical cancer by taking an HPV vaccine.

 

Endometriosis Pain

Endometriosis is a condition that results when tissues that are supposed to grow inside the uterus grow somewhere else, such as in other pelvic regions, like outside the uterus, fallopian tubes, or ovaries. The most common symptoms of endometriosis are pain and infertility. Endometriosis is a complex disease and can often need surgical intervention. Managing the pain throughout treatment is a specialty in itself. Whether you are already diagnosed or not a pelvic specialist can guide you through managing the pain and finding the appropriate specialists for comprehensive treatment.

 

Uterine fibroids

Uterine fibroids refer to the overgrowth of muscle cells within the uterine wall. These tumors, which are noncancerous, may result in heavy, painful, or irregular periods and local pressure symptoms such as difficult defecation, frequent urination, and pain in the lower back. Uterine fibroid pain can be debilitating but it has several treatment options that can help manage the pain especially when surgery is necessary to remove the fibroid. 

 

Pelvic Inflammatory Disease

Pelvic inflammatory disease is an STD complication and is the most preventable cause of infertility in women. It could result in permanent damage to the uterus, fallopian tubes, and ovaries. Symptoms include pain in the belly, fever, an abnormal vaginal discharge, and pain during sex or urination.

 

Conditions and Causes of Pelvic Pain in Men

Erectile Dysfunction

Erectile dysfunction (impotence or ED) is the inability to get and keep an erection firm enough for sex. Having erection trouble once in a while isn’t always concerning. If ED is a reoccurring issue, it can cause anxiety, affect your confidence, and cause relationship issues. Problems getting or keeping an erection can also be a sign of an underlying health condition that needs treatment and is a risk factor for heart disease.

 

Numbness or Tingling in the Testicles or Penis

Numbness and/or tingling in testicles or penis can have many causes including nerve damage. Nerve damage is also known as neuropathy. Injury and constant compression of the perineum due to riding a bike can cause damage and neuropathy. Diabetes and multiple sclerosis (MS) are some diseases that may also cause nerve damage. Peyronie’s disease, a condition where scar tissue builds in the penis, can also affect sensitivity and cause numbness.

 

Hemorrhoids

Hemorrhoid pain is often associated with general rectal pain or anal fissures, and constipation. The problem area can become inflamed and lead to chronic pain and sensitivity. Often hemorrhoids and anal fissures can resolve itself after a flare-up, but some men experience ongoing issues that need further treatment.

 

What are the symptoms of pelvic pain?

Although pain is obviously the main symptom of chronic pelvic pain, the characteristics of the pain and other accompanying symptoms may vary from person to person. These are some of the symptoms you should watch out for:

  • Severe menstrual pain
  • Worsening menstrual cramps
  • Abnormal vaginal bleeding and discharge
  • Pain or difficulty in urinating
  • Pain during sex
  • Pain with ejaculation
  • Constipation or diarrhea
  • Bloating
  • Bowel movement accompanied by blood
  • Fever or chills
  • Hip pain
  • Pain in the groin

 

How to describe your pelvic pain to your doctor

 

The specifics of the pain and the symptoms you experience may vary. You should try to describe your pain as accurately and thoroughly as possible. This will help your health provider find the cause of the pain and treat it accurately.

Make sure to ask yourself these questions:

  1. Duration:
    1. How long have you been feeling the pain?
  2. Location:
    1. Where do you feel the pain?
    2. Is it in a single spot or spread out?
    3. How does it feel? Is it severe?
    4. Are there activities that make it worse? Are there activities that make it hurt less??
  3. Effect:
    1. How does it limit what you can do?
  4. Frequency:
    1. How often do you experience the pain?
    2. How long does it last?
    3. Is it constant or does it come and go?
    4. Is there anything else that triggers the pain?

To make sure you describe it accurately to your physician, keep a record of the pain from the first time you experience it and track the triggers, symptoms, and anything in between.

 

How is the cause of pain determined?

 

The first step to determining the cause of your pelvic pain will be answering your doctor’s questions as thoroughly and accurately as possible. Your symptoms and past medical history are especially important. Your doctor may also perform a physical exam and offer tests that may include:

  • Blood and urine
  • Pregnancy
  • STDs
  • Stool sample testing
  • X-rays of the abdomen and pelvis
  • Bone density test (a special X-ray is taken to determine the strength of your bone)
  • Diagnostic laparoscopy – A procedure to look at the pelvic and abdominal structures
  • Hysteroscopy – A procedure to examine the uterus
  • Lower endoscopy – A procedure to examine the inside of your rectum
  • Ultrasound – A procedure to examine internal organs
  • CT scan – A special scan to view abdominal and pelvic anatomy

 

How is chronic pelvic pain treated?

 

Treatment of pelvic pain may vary depending on factors such as:

  1. The cause of pain
  2. Intensity of pain
  3. Frequency of pain

Your doctor may administer medication that may include antibiotics. If your pain results from a problem with one of your organs, surgery or other procedures may be required.

Your doctor will give you more information about the different types of treatment as well as an explanation for the method they recommend.

Below are some of the methods used to treat Pelvic Pain:

 

Ultrasound Guided Trigger Point Injections

Pelvic Rehabilitation has developed a unique treatment option it refers to as “Ultrasound Guided Trigger Point Injections”. The method which is primarily used to treat the pelvic floor uses ultrasound technology to locate not just the locations of muscles but also the specific parts that require relief. By using Traumeel, a type of anti-inflammatory plant-derived medication, the injections are able to give the patient a boost in muscular and nerve-based disarray as well as an increase in blood flow, resulting in sufficient oxygen supply to the site.

 

Peripheral Nerve Hydrodissection

Nerve hydrodissection is a method used to treat peripheral nerve entrapments. It typically entails injecting an anesthetic, or solution such as saline, to separate the nerve from the surrounding tissue, fascia, or adjacent structures. The peripheral nerve hydrodissection technique allows the nerve to have space to calm down and reduce its irritation.

 

Nerve Pain Medications

Nerve pain medications can be very helpful in reducing the intensity of pelvic pain and helping to break the chronic pain cycle. These may include medications in the antidepressant class, or in the anti-seizure class. These medications are a treatment to help dial down the nervous system and are much more effective in treating pain long term than opiates. These are not life-long medication treatments but rather used to retrain the nervous system to no longer be in a painful state.

 

Restorative Yoga

Restorative Yoga helps create space in the pelvis which helps you heal faster. In addition, it improves your flexibility, boosts flexibility, and generally improves core strength. Apart from the physical aspects, Restorative Yoga also helps improve the coordination between the mind and the body to help calm down your central nervous system (CNS).

 

Cognitive Rehabilitation Therapy (CBT)

CBT is especially important in helping manage chronic pain. It works based on the idea that you can impact physical pain by your thoughts and behaviors. Thus, CBT helps you change your mindset as well as reduce stress, which is a great motivator for physical pain.

 

pelvic floor muscles during breathing

Proper Breathing Techniques

Proper breathing can help relax your pelvic floor. This treatment method helps you learn how to breath properly and effectively to enhance pain relief on your pelvis.

 

Will alternative pelvic pain therapy work?

Some people may opt for alternative medicine. Although there’s little evidence showing the effectiveness of these remedies, treatments such as Vitamin B1, magnesium supplements, acupuncture, and acupressure may work in some cases.

Before exploring alternative routes, ask your healthcare provider about the safety and scientific evidence surrounding that particular product or procedure. Also, consider your current line of treatment. Some alternative remedies will work with your medication while others will cause problems if mixed.

 

Does pelvic pain affect your ability to get pregnant?

Certain chronic pelvic pain conditions have been linked to difficulty in getting pregnant. For instance:

  • Thirty to fifty percent of women suffering from endometriosis can’t get pregnant. This makes the condition a top-three cause of female infertility.
  • Pelvic adhesions forming on the ovaries, uterus, or fallopian tubes can contribute to difficulty or even impossibility of getting pregnant.
  • While most women with uterine fibroids are fertile, fibroids located in the uterine cavity may increase the risk of a woman losing the pregnancy early.

Also, there are treatments for pelvic pain that could affect your ability to get pregnant. For instance, hormonal birth control is commonly used. Hysterectomy (surgery to remove the uterus) may be a last resort procedure when other treatments don’t work.

 

How do you cope with long-lasting pelvic pain?

Along with a specific treatment regimen, it’s important to find healthy strategies for coping with pelvic pain. These include:

  • Counselling
  • Support groups
  • Physical activity

If you or someone you love lives with long-lasting or chronic pelvic pain, ask your doctor about their options. Do your best to get second or third opinions to identify the cause with some degree of certainty and make sure you get a checkup as soon as possible.