Chronic Pelvic Pain

On Friday August 7, 2009 ABC's 20/20 aired a show on medical mysteries. The first segment of the evening was about a condition that thousands of women suffer from, but few talk about: Sexual Pain. Please take a few moments to view the video link at www.abc.com.

With this new national attention, I thought it appropriate to dedicate this issue of Lessons for Health to chronic pelvic pain. The information I present here is merely the tip of the iceberg when it comes to pelvic pain, but I hope to shed some light on this topic that is often silenced.

What is Pelvic Pain?

Pelvic Pain is a general term used to describe debilitating discomfort in the pelvic region. Pelvic pain can occur at any time in a woman's life, frequently causing significant emotional distress and adversely affecting her quality of life. Chronic pelvic pain is any pelvic pain that lasts for more than 6 months. Unfortunately many women develop chronic pelvic pain, and if it is left untreated additional bladder, bowel, and sexual dysfunction may develop.

Chronic pelvic pain is a debilitating condition. Twenty-five percent of women with chronic pelvic pain may spend 2-3 days in bed each month. More than half of the women with chronic pelvic pain must limit their daily activities and 90% have pain with intercourse (sex). Almost half of chronic pelvic pain suffers feel sad or depressed.

What Causes Pelvic Pain?

The pelvis serves many roles in our bodies. Nearly every movement and position of the human body depends on the pelvis. Proper activity and balance between all of the muscles, joints, and tissues of the pelvis are essential for normal pain-free function. The pelvis also plays a role in sexual function, support and protection of the internal organs, and control of bladder and bowel function.

Dysfunction and pain in the pelvis may have origins or can result from a combination of factors. Each joint, tissue, and organ (uterus, vagina, bladder, bowel), may produce a specific pattern of pain or vague pelvic discomfort. Pelvic pain and symptoms need to be discussed thoroughly with a physician to rule out systemic causes or possible problems with the organs.

There are many possible musculoskeletal sources of pelvic pain as well. These things must also be addressed to ensure proper treatment and optimum outcome. This is where the expertise of a women's health physical therapist can be invaluable. The bones, muscles and soft tissues (ligaments, tendons and connective tissue) of the pelvis can all contribute to pelvic pain syndromes. Examples of musculoskeletal conditions that may result in pelvic pain include:

• Improper alignment or impaired mobility of the pelvic bones and joints
• Overactive pelvic muscles (muscle spasm)
• Underactive pelvic muscles (muscle weakness)
• Restrictions or impaired mobility of ligaments, tendons or connective tissues and structures
• Improper movement patterns about the trunk, hips, and or pelvis.

These problems can occur for a number of reasons including a fall, a car accident, or other trauma, as well as childbirth, surgery, radiation, disease processes, inactivity, and repeated faulty movements or postures. Injuries or problems with hips, abdomen, lumbar spine, or pelvis (including the sacroiliac joints, pubic bones, or tailbone) may also cause dysfunction and lead to pelvic pain.

Potential Treatments

Managing chronic pelvic pain is usually a multi-factorial process that often involves many different medical practitioners such as: OBGYNs, urogynecologists, physiatrists, physical therapists, psychologists, and orthopedics. If a specific underlying cause can be identified then treatment will focus on eliminating that particular cause. However, if no cause for the chronic pelvic pain can be found (as is often the case in a chronic pain condition), treatment goals will focus on managing the pain. Potential treatments may include:

One of the most frustrating aspects of chronic pain is that it can strongly impact daily life. Pain can limit sleep, exercises, the ability to perform daily tasks, and participation in social situations. It is important to bolster emotional and mental health to help ease discomfort. Making sure that there is good emotional support around can ease the burden by keeping family and friends in the loop. Effective stress management techniques can help reduce stress levels, and may have an indirect effect of easing stress-triggered pain.