Chronic Pelvic Pain

Chronic pelvic pain in women refers to pain in the lower part of the abdomen, pelvis or pelvic floor. It is pain that has lasted for six months or longer. It can be a symptom of another disease, or a condition in its own right. The cause of chronic pelvic pain can often be hard to find.

Causes

There are many excellent websites dedicated to providing information on the various causes of chronic pelvic pain. Some of these causes and the websites are listed below.

Pudendal neuralgia / Pudendal neuropathy / Pudendal nerve entrapment
Disorders that involve compression or restriction in mobility of the pudendal nerve along its pathway and causing pain may be called pudendal neuralgia or where the nerve is truly entrapped it may be diagnosed as an entrapment. These are quite rare. Sometimes the pudendal nerve is involved in chronic pelvic pain conditions and sometimes it is diagnosed as being involved where it is not the main cause of the pain.

See more on www.pudendalhope.info

Vulvodynia
Vulvodynia is a term used to describe vulval pain. is a generic term and there is a further sub-classification depending on how the pain in the vulva comes on.  This depends on whether it is with provocation or is permanently present. Typically the skin is very sensitized. There may or may not be involvement of the pudendal nerve as well and the two conditions are often confused and need to be evaluated differently.

See more on www.vulvalpainsociety.org or the National Vulvodynia Association www.nva.org  and www.issvd.org

Vaginismus:
Vaginismus is a condition where the pelvic floor muscles have become so tense that penetration with intercourse or even the use of a tampons are impossible or at least very painful. It can be associated with vulvodynia (vestibulodynia) and or pudendal nerve conditions but can also present on its own. The cause is often unknown. It can take a long time for the muscle tension to ease out and dilators are often recommended as a treatment. They may or may not be helpful. It is important to know that assessment with an experienced physiotherapist may help in finding specific areas of restriction and therefore accelerate the process.

Interstitial Cystitis (IC) / Bladder Pain Syndrome
There is no definitive test for IC. The diagnosis is based on the presence of pain related to the bladder, usually accompanied by frequency and urgency of urine and in the absence of other diseases that could cause the symptoms. In response to the pain, urgency and frequency the pelvic floor muscles and abdomen become tense going into a holding pattern. The tension becomes part of the problem further feeding into the holding patterns and pain cycle. The pelvic floor muscles need to be able to control at the neck of the bladder.

Read more about IC at www.ichelp.org

Pain post surgery
Vaginal tissue can be painful following any pelvic floor surgery. This should not be the case and intercourse should not be painful. It may be necessary for you to seek physiotherapy after your surgery even though your underlying problem has now been corrected by the surgery.

In each of these cases the spine, pelvis and abdomen should be evaluated for posture and holding patterns. The pelvic floor muscles may have set up in tension in response to a specific posture. The pelvic floor muscles should be evaluated in detail.

Treatment

Postural exercises
Breathing release techniques (Sniff Flop & Drop)
Pelvic floor manual therapy (where accessible)
Correct pelvic floor activation patterns (Pelvic Floor Strengthening)

It is important to note that a multidisciplinary team approach is best with chronic pain conditions. Ideally in addition to the above the patient will be under the care of a GP and an anesthetist for management of pain. Cognitive behavioral therapy may be sought when pain has been present for a long time. The patient may have been under the care of a urologist or a urogynaecologist for initial diagnosis and evaluation.

How do I know if I am doing the exercises correctly?
Follow the exercise guide on this website – they will apply to everyone. If you are still struggling after a few weeks then you need the help of a physiotherapist who specialises in this area.