Pelvic pain is pain felt in the pelvis, lower abdomen, or perineum and has many possible causes and numerous symptoms that can make you feel uncomfortable and embarrassed. When pelvic pain lasts for more than 6 months it is considered chronic. Some of the more common causes of pelvic pain are:
- Pelvic joint problems
- Pregnancy and childbirth (due to changing hormonal levels that affect muscles and lead to joint laxity
- Muscle imbalances or weakness within the muscles of the pelvic floor, trunk, or pelvis
- Tender points in the muscles of the pelvic floor
- Pressure on one or more nerves in the pelvis
- Lack of muscular coordination that controls the bowel and bladder
- Scar tissue that forms after pelvic or abdominal surgery, such as after a C-section or episiotomy (incision), or as a result of a tear in the vaginal area
- Pelvic organ prolapse (a shift in the position of the pelvic organs)
HOW IS PELVIC PAIN DESCRIBED?
Some individuals who have experienced pain in their pelvis and lower abdomen have described the discomfort as an aching pain while others have reported feeling a sharp, stabbing, pins and needles, and even burning. Other symptoms may include:
- Pain in the hip, buttock, tailbone, or pubic bone
- Inability to sit for normal periods of time
- Tender points in the muscles of the abdomen
- Pain with sex
- Difficulty walking, sleeping, and performing physical activities
- Urinary frequency, urgency, or leakage
- Painful bowel movements (that may also include straining and constipation)
HOW CAN PHYSICAL THERAPY HELP?
First of all, your Physical Therapist should perform a comprehensive evaluation to determine the cause(s) of your pelvic pain, along with any associated joint problems, muscle imbalances (tightness or weakness), and pinched nerves. They will then recommend whether you should be referred to a physician for additional tests or to a Women’s Health Specialist.
Based on the findings by your Physical Therapist, they should choose from various treatments designed to improve muscle strength, reduce muscle tightness, which leads to decreased pain and improved function. Your Physical Therapy program may include:
- Instruction in exercises to stretch and strengthen important muscles and to retrain them to work together normally
- Instruction in relaxation exercises
- Instruction in pelvic floor exercises to strengthen muscles that support the pelvic organs. These can include Kegel’s exercises, where you gently squeeze the buttocks, thighs, stomach, and sphincter muscles
Depending on your level of discomfort and symptoms, your Physical Therapist may utilize biofeedback to get you to be aware of how to control your pelvic floor muscles better as well as how they work. Electrodes are usually attached vaginally or rectally to provide measurements of muscle activity and display them on a monitor–you will then be instructed by your Physical Therapist in how to understand and change those readings.