Understanding and Managing Pelvic Pain: A Comprehensive Guide

Jun 9

Pelvic pain is a condition that affects numerous individuals, but it disproportionately impacts women. Approximately 14% of women and 9% of men suffer from chronic pelvic pain.1,2 In this blog we will focus on pelvic pain in women.

The pelvic floor consists of muscles, ligaments, and tissues that support the bladder, uterus, and rectum. When the pelvic floor goes into spasm, it can lead to chronic pelvic pain. Pelvic pain may be difficult for patients to describe. In this blog, we will explore the causes, symptoms, diagnosis, and various management strategies for pelvic pain to help you start a conversation with your patients.

Causes of Pelvic Pain

There are several factors that can contribute to pelvic pain, including:

Muscular Dysfunction: Overactive pelvic floor muscles can cause pain and discomfort.
Trauma or Injury: Pelvic trauma from accidents, childbirth, or surgery may result in pelvic pain.
Chronic Conditions: Conditions like endometriosis, interstitial cystitis, and irritable bowel syndrome (IBS) can be associated with pelvic floor pain and are likely triggers to pelvic muscle spasm.
Psychological Factors: Emotional stress, anxiety, or past traumatic experiences can contribute to pelvic floor muscle tension and pain.

Symptoms of Pelvic Floor Pain

Pelvic pain can manifest in various ways, and symptoms vary from person to person. Common symptoms include:

Pain in the pelvic region, lower abdomen, or lower back
Discomfort or pain during sexual intercourse
Increased urinary urgency or frequency
Bowel-related issues, such as constipation or pain during bowel movements
Muscle spasms or tightness in the pelvic area

Diagnosis of Pelvic Floor Pain

To diagnose pelvic pain, healthcare professionals employ various methods, including:

Physical Examination: A thorough assessment of the pelvic region is necessary to evaluate muscle tone and identify tender points.
Medical History: Discussing symptoms, past medical conditions, surgeries, and lifestyle factors can help identify problem areas.
Imaging Tests: Ultrasound, MRI, or CT scans and in some cases laparoscopy may be used to rule out other underlying causes.
Pelvic Floor Evaluation: Internal examinations or electromyography (EMG) can assess muscle function and detect abnormalities.

Management and Treatment Options

The management of pelvic pain typically involves a multidisciplinary approach, including:

Pelvic Floor Physical Therapy: Intravaginal manual therapy with therapist’s finger, targeted exercises, stretches, and relaxation techniques to relieve muscle tension and restore proper function.
Red Light Therapy: High power transvaginal red light therapy, photobiomodulation, is a relatively new modality that has shown very promising results in the treatment of pain associated with pelvic muscle spasm. Many doctors and physical therapists are adding this innovative approach to their treatment portfolio by way of the SoLá Pelvic Therapy laser system.
Medications: Muscle relaxants, compounded valium containing vaginal suppositories, Botox injections, and even anticonvulsants such as gabapentin may be prescribed to manage symptoms.
Behavioral and Psychological Therapy: Cognitive-behavioral therapy (CBT), relaxation techniques, and stress management can help address emotional factors contributing to pain.
Complementary Therapies: Techniques like acupuncture, myofascial release, biofeedback, or yoga may provide additional relief.
Lifestyle Modifications: Diet changes, bladder retraining, and adopting proper posture and body mechanics can contribute to symptom improvement.

Seeking Support and Expert Guidance

Living with pelvic pain can be challenging, both physically and emotionally. It is important to seek support from healthcare professionals, join support groups, or find online communities where individuals with similar experiences can provide advice, empathy, and understanding.

Pelvic pain can significantly impact a person's quality of life, but with the right diagnosis and management strategies, it is possible to find relief. By understanding the causes, recognizing symptoms, and exploring various treatment options, individuals affected by pelvic pain can take steps towards improved well-being. Remember, seeking professional help and building a support network are essential components of the journey toward managing and overcoming pelvic pain.

References

1 Lumsden MA, Kelly RW, Baird DT. Primary dysmenorrhoea: the importance of both prostaglandins E2 and F2 alpha. Br J Obstet Gynaecol. 1983;90(12):1135-1140.

2 Creatsas G, Deligeoroglou E, Zachari A, et al. Prostaglandins: PGF2 alpha, PGE2, 6-keto-PGF1 alpha and TXB2 serum levels in dysmenorrheic adolescents before, during and after treatment with oral contraceptives. Eur J Obstet Gynecol Reprod Biol. 1990;36(3):292-298.

Amanda Hoffmeyer