Pelvic pain is pain in the area around the sexual organs or inside the pelvis. It can occur in either men or women. Pelvic pain becomes chronic pelvic pain when it has been present for more than 3 months.
Chronic pelvic pain has many names, neuralgia, pudendal neuropathy, coccydynia, levator ani syndrome. In women it can be called vaginismus, vulvodynia, vestibulitis and in men it is often initially called non-bacterial prostatitis, chronic prostatitis or prostatodynia. Experts agree that in the absence of a definitive diagnosis, chronic pelvic pain is the correct name.
Chronic pelvic pain can occur with other conditions. Endometriosis is a common co-diagnosis as is chronic spinal pain. Bladder and bowel conditions such as irritable bowel syndrome and interstitial cystitis. Pelvic pain can also occur after trauma or surgery.
Signs and Symptoms
The main symptom is pain in the vulva, scrotum, vagina or penis and in the pelvic floor area. Pain can spread to the bottom, to the back and down the legs. Pain can also be found above the pubic bone or in the bottom of the tummy. Pain can seem to come from the bladder or bowel as well. Some people have pain when they empty their bladder or open their bowel.
Pelvic pain is often described and being either sharp, burning, aching, cramping or stabbing. Sometimes it can be there all the time or just now and then. It is often so severe that it affects daily activities and life in general. Sitting may aggravate the pain or standing for longer periods of time
For many women the pain may only occur with intercourse or when trying to put in tampons. For men the pain may occur with orgasm or with hardening of the penis. For others the pain comes and goes without reason.
Chronic pelvic pain is diagnosed by exclusion of other conditions. Low back injuries, gynaecological problems, infections and hernias all need to be ruled out. Then it is appropriate to be assessed by a physiotherapist specialised in the assessment and treatment of chronic pelvic pain.
Initial Assessment
The initial assessment will be an in depth history looking at when the pain started, how it behaves and what makes it worse and better. You may be asked to keep a pain, bladder or bowel diary. The assessment may be over several sessions and will also include an examination of the pelvic floor. This examination may include an internal exam.
Treatment
Treatment of chronic pelvic pain is not easy. There are many facets that need to be addresses. The physiotherapist will discuss these with you. A big part of the treatment will be education about chronic pain and how pain changes the way that the brain works. See below for an interesting video explaining this.
See below for a longer talk about how we experience pain.
This education is combined with physical therapy to reduce the tension in the pelvic floor muscles and to avoid stimulating the pain fibres in the pelvic floor, bladder, and bowel and in the pelvis. It will also include learning to reduce the effect pain has on your life.
If you experience chronic pelvic pain please contact me for an appointment.
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