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Pelvic Pain
What is it and
what do you do about it?

Pelvic pain is a topic that is less talked about or understood among women even than urinary incontinence.

What is pelvic pain?

It is described as pain in the lower abdominal, pelvic, low back, or tailbone areas.

What causes it?

Sometimes pelvic pain has a known cause such as trauma, surgery, inflammation, or childbirth. For other women pelvic pain persists without evidence of disease or pathology.

Can you be more specific?

There are several categories of pelvic pain. These include scarring, high muscle tension pain (myalgia), muscle relaxation syndromes (rectocele, cystocele, prolapse), and bladder syndromes (interstitial cystitis and others).

What triggers pain with no known origin?

Pelvic pain of unknown causes may be triggered by, among other things, organ dysfunction, reproductive hormone imbalance, myofascial trigger points, skeletal joint dysfunction, nerve entrapment, or fibroid tumors.

What are the symptoms of pelvic pain?

There are many. They include, but are not limited to, pain in rectal and vaginal areas, the groin, buttocks, back of thighs, and tailbone. Some women have difficulty initiating urination or difficulty with bowel movements; others have vulvar pain, pain on intercourse, or pain with sitting.

Anything else?

Those with pelvic relaxation syndromes may have a painful, heavy, downward dragging feeling in the groin and pelvis. Those with bladder syndromes may have urgency, frequency, pressure, difficulty urinating and nighttime wetting (nocturia).

How is pelvic pain diagnosed?

Generally a physician will diagnose this through a history, a pain diagram, and medical tests for tumors, cancer, inflammation, infection and neuologic deficits.

Who has it?

According to Janet Hutme, M.A., P.T., national expert in pelvic pain, one in every seven women between the ages of 18 and 50 has experienced pelvic pain. And, chronic pelvic pain, defined as persistent pain of unexplained nature that is six months or longer in duration, effects more women than men.

This sounds complex. Is there an effective intervention?

Pelvic pain is complex and effective intervention begins with a detailed assessment. The first step is a thorough history. This needs to include information gathering about current and past symptoms; bladder, bowel, and menstrual symptoms; sleep/wake patterns; medical, reproductive, sexual, and family history, as well as medications.

What else?

Your family physician will complete a medical evaluation and may complete blood work or X-rays. Other tests that indicate how well the body control centers are working include body temperature, blood pressure, heart rate, and breathing pattern/rate.

What treatment is available?

Treatment is a multi-faceted approach that may include medications, nutrition, self-care strategies and physical therapy. Trigger point injections and herbal/natural products may be used. Accupressure or acupuncture is sometimes recommended, as is massage therapy.

How are Physical Therapists qualified to treat pelvic pain?

Physical therapists are trained to evaluate and treat the skeletal and muscular systems, the fascial system which includes the connective tissue, and nervous system. They also evaluate and treat pain, posture, and movement. Some are especially trained to assess and treat the motility of organs, the mobility of scar, and skin problems.

Does this prepare them to treat complex pelvic pain?

Some Therapists have specifically studied the pelvis and developed an expertise in treating this area of the body.

What can a Physical Therapist do?

After an evaluation, therapy will include a number of interventions. A detailed self-care/self-management program will be initiated. This will often include a sleep routine program and some self care technique or exercise that is performed frequently and briefly thought out the day.

What else?

Pacing and resting may be included. Exercises for quieting the nervous system's bodily response to pain are important. Core exercises, manual therapy (including myofascial release and soft tissue or scar mobilization), stretching, strengthening, and postural awareness or therapeutic ball exercises may all be included. Modalities such as heat, cold, and others are helpful.

Is this really effective?

What creates effective therapy is working closely with care providers who are experienced in treating pelvic pain and who understand its complexity. If you can find knowledgeable care providers, you will have effective intervention.

How do I know if my care providers are knowledgeable?

You need to ask before you make an appointment if the provider has experience in the area of pelvic pain. Not all physicians or physical therapists have expertise in this area.

How do I find what I need?

Rehab Professionals of Cleveland has relationships with knowledgeable physicians. We have therapists with an expertise in women's health or we can help you find a therapist is your area. Just call us at (216) 221-2525 or (440) 526-8566.

Reprinted with permission of The Cleveland Women's Journal

Cleveland Women's Journal

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