Many women suffer in silence, afraid or embarrassed to talk about such a personal issue – pelvic pain. Others visit numerous health care providers seeking answers about the source of their pain. An estimated 15% of women 18-50 experience chronic pelvic pain, though it is difficult to know accurate numbers as many women do not report their symptoms. It is also often misdiagnosed. Chronic pelvic pain can vary in intensity, and often increases in severity during menstruation. It can affect a woman’s ability to work and perform activities of daily living, including walking, sitting, bowel movements, sexual intercourse, and the use of tampons. It can also impact their relationships with their spouse or significant other, as many women avoid sexual relations because of pain. It is important to realize, this problem is common, and it can be treated effectively.
Chronic pelvic pain can present itself in numerous ways:
- Lower abdominal pain
- Painful sexual intercourse (dyspareunia)
- Itching or burning around the vagina or pelvic floor (may have diagnoses of frequent yeast infections)
- Pain in the bladder or rectal areas (may have diagnosis of interstitial cystitis)
- Painful clitoral area and/or inability to achieve orgasm
- Lower back pain
Other names/related diagnoses can include:
- Vulvar Vestibulitis
- Interstitial Cystitis
- Pudendal Neuralgia
- Pelvic Inflammatory Disease
- Perineal pain
Sometimes these symptoms can be related to endometriosis, ovarian cysts, yeast infection, or other medical problems. In some instances, the woman has undergone numerous diagnostic procedures including laparoscopy, and yet the source of the pain remains unknown. A relatively new specialty within physical therapy can help. A physical therapist trained in women’s health can evaluate the pelvic area from a muscular, skeletal, and nerve standpoint. The physical therapist may find that muscles are in spasm, the spine or pelvis may be malaligned, and nerves may be irritated or not functioning properly, all of which can result in pain and dysfunction.
The following are examples of actual cases treated with physical therapy: (names have been changed for confidentiality):
Sara suffered from chronic pelvic pain for years. She had pain with pelvic exams, sexual intercourse, and rectal pain following bowel movements. Because a gynecological cause was suspected as the source of her pain, she underwent a hysterectomy. She continued to suffer following this surgery for another 2 years. She admits thinking her doctor was crazy for suggesting she see a physical therapist. She could not imagine what type of physical therapy could be done for the problems she was having. Reluctant, but desperate for a solution, she went to therapy. Within a few weeks, she had a decrease in her symptoms by 80%.
Bev experienced pain in her low back, lower abdomen, and groin for more than 2 years. Similar to Sara’s story, a gynecological cause was believed to be the source of her pain, and she underwent a hysterectomy. In addition to her other symptoms, she began to experience vaginal pain following the procedure. She didn’t understand how physical therapy could possibly help, but thought she should explore every possible option. Her symptoms were related to nerve irritation in the spine and she did very well with physical therapy.
Jill remembers pain with any attempt to use a tampon from the time she was 15 years old. She recalls pain with pelvic exams, and on occasion not being able to tolerate the exam due to pain and muscle spasm. She had saved herself for marriage, was newly married, and experienced severe pain with intercourse. This took a toll on her physically, and emotionally. Following evaluation and treatment with a women’s health physical therapist, she realized decreased pain with intercourse, decreased cramps with menstruation, decreased constipation and improved bowel function.
Kari lived with pelvic pain and complained of burning and itching in the vaginal area for more than 3 years. Her symptoms were worse with sitting, walking, and during menstruation. She saw numerous specialists and was treated for various diagnoses including vulvar vestibulitis and contact dermatitis, without relief. A physical therapy evaluation revealed her symptoms to be related to her spine and nerve irritation. She was 75% better and managing her symptoms independently within 1 month.
The back pain experienced in these instances is not always severe. The more severe symptoms are due to irritation and inflammation of the nerves that go to the pelvic floor from the spine. Physical therapy can be very effective in treating these symptoms. The spine is evaluated for abnormalities, irritated nerves are calmed, and muscles are gently stretched back to their normal lengths. Recent studies show that a manual physical therapist that specializes in pelvic floor dysfunction can relieve discomfort, improve muscle, bowel, and bladder function.
Chronic pelvic pain can be effectively treated with physical therapy. It is not “all in your head”, nor is it an inevitable part of menstruation. Women do not have to live with the pain. It’s important to realize the problem is not uncommon, and it is possible to get relief. It’s worth talking and doing something about! If you are experiencing symptoms of pelvic pain, consult a women’s health physical therapist to evaluate your needs and move toward recovery.
These notes were written by Susan Palmer, PT.