Pelvic Pain Causes and Treatment Options
Many individuals with pelvic pain struggle to find answers and relief. Early diagnosis and treatment with a supportive medical team can be game changing for managing pelvic pain -- but how do we get there when no one seems to understand what is going on with you and what is causing your pain?
We are here to help uncover the mystery of under-discussed pelvic pain and how to start treating it using a collaborative approach. It is never too late to find answers and start getting the relief you deserve.
What does pelvic pain feel like?
Pelvic pain can feel and present differently for everyone, even with people that end up having the same diagnosis. For some, pelvic pain can start strong and be brief while in others, pelvic pain onset can be more gradual, persistent, or seem to linger with possible fluctuations for 6 months or more. We refer to these two types of pelvic pain as acute and chronic, respectively.
Common symptoms of people dealing with pelvic pain may include:
Pain in the vulva, vagina, or anal area that some may describe as stabbing, shooting, burning, aching, itching, or irritating
Painful sex or penetrative intercourse
Inability to wear a tampon, feels like hitting a wall
Hypersensitivity or pain with clitoral stimulation (direct or indirect)
Pain with sitting or prolonged standing
Pain with wearing underwear or pain with wearing pants
Pain or irritation that is seemingly random or that is brought on only when provoked (i.e., penetration, touching the area, exercise)
Longstanding history of pain or a more recent onset
Pain starting after an inciting event or that seemed to start out of the blue
Co-occurring abdominal pain and bloating or bowel health concerns, such as constipation
Pain more commonly referred to as pelvic girdle pain, sacroiliac or SI joint pain, tailbone pain (coccydynia), or discomfort anywhere more related to the bony pelvis and surrounding musculature
What causes pelvic pain?
Pelvic pain symptoms rarely stem from a single cause; clients often experience multiple symptoms and co-occurring diagnoses that contribute to their pain.
Common diagnoses or conditions of female pelvic pain include:
Vulvodynia
Vestibulodynia
Clitorodynia or clitoral pain
Vaginismus or Genitopelvic Pain and Penetration Disorder (GPPPD)
Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS)
Pudendal Neuralgia or nerve entrapment
Persistent Genital Arousal Disorder (PGAD)
Endometriosis or Adenomyosis
Ovarian cysts or uterine fibroids
Pelvic Organ Prolapse (POP)
Pelvic Inflammatory Disease (PID)
Pelvic Floor Dysfunction (PFD) or Hypertonic Pelvic Floor Disorder (HPFD)
Vulvar skin conditions, such as Lichen Sclerosus, Lichen Planus, or Lichen Simplex Chronicus
Vulvar Intraepithelial Neoplasia (VIN)
Chronic candidiasis (yeast infections)
Bacterial vaginosis
Sexually Transmitted Infections (STIs) - HSV, HPV
Pelvic pain can stem from various factors including hormonal changes, childbirth, pelvic injuries or trauma, gynecological or dermatological disorders, infections, certain medications, surgeries, GI disorders, and orthopedic issues. These contributors and their impact on pelvic floor function and pelvic pain are often amplified by stress and anxiety that is either related or unrelated and can contribute to the vicious cycle of pelvic pain.
How to diagnose pelvic pain?
Better treatment outcomes and in turn, a better quality of life, often come after identifying the proper pelvic pain diagnosis. We are passionate about educating on how to navigate the medical system when you are living with pelvic pain to find the relief you need more efficiently. We know it can be very hard to know where to begin or where to go from where you are now in the process.
Pelvic floor therapists assist clients in finding a diagnosis for pelvic pain, often being the first point of contact. They help build a medical team, identify pain causes, and initiate treatment without needing a specific diagnosis or referral. Pelvic floor therapists guide clients through the process for effective symptom resolution so they can start feeling like themselves again.
Having a well equipped medical team is essential to ensuring no stone if left unturned when determining the root cause of pelvic pain. Diagnosing pelvic pain conditions may occur after a number of steps, which may include a thorough medical history, imaging, speculum exam, Q-tip test of vulvovaginal tissues, pelvic floor therapy evaluation, laparoscopy, endoscopy, urodynamics, anorectal manometry, blood tests, and additional measures depending on the professional’s specialty. Professionals that may be on someone’s medical team at some point throughout their pelvic pain experience may include but are not limited to:
Gynecologist
Urologist or Urogynecologist
Pelvic Floor Therapist
Gastroenterologist
Colorectal Doctor or Surgeon
Primary Care Doctor
How to treat pelvic pain?
Utilizing a multidisciplinary approach is key to healing pelvic pain, which may include rehabilitation (i.e., pelvic floor therapy), medication, surgical procedures (i..e, cyst removal, fibroid removal, laparoscopy or excision for endometriosis), lifestyle modifications, and alternative strategies.
Not all medical professionals are equipped to support those with pelvic pain due to various factors, whether due to their educational or practice background and specialization, constraints of brief appointments, demands of insurance companies, and so forth. It's crucial to find experts in pelvic pain for proper support. Researching the organization and professional beforehand can help ensure they are capable of providing the necessary treatment and answers.
When there is any sort of pelvic pain going on, a common denominator is often pelvic floor muscle tension or dysfunction. By participating in pelvic floor rehabilitation and treatment, the muscles and nerves become less contributory to the pain and limitations brought forth by pelvic pain, allowing you to live your life with more freedom for movement without pain or worry.
How will pelvic floor therapy help my pelvic pain?
If you are curious if pelvic floor therapy can help you, we encourage you to partake in a pelvic floor therapy evaluation with a pelvic floor therapist (PT or OT). Clear answers start with having the opportunity to share details of your concern in a safe and comfortable setting where you are not rushed or dismissed. After discussing with your pelvic therapist and sharing additional medical history, your pelvic therapist will complete a physical assessment of the pelvic floor and surrounding muscles, nerves, joints, and soft tissue. The pelvic floor therapist will also assess your whole-body movement patterns to better understand contributors to your concerns. As the root cause of your symptoms are better understood and communicated with you, you will create a plan for your care with your pelvic floor therapist. This will guide your upcoming sessions and ensure the goals that are most important to you are of utmost priority and are met.
Follow up appointments should be based on your unique plan and may include hands-on manual techniques externally or internally with myofascial release. Internal manual therapy techniques are provided either vaginally or rectally (depending upon which muscles are affected) often to decrease tension in pelvic floor muscles or mobilize fascial restriction or improve coordination. Outside of manual therapy, there are also movement-based strategies, lifestyle changes, and behavior modifications you may discuss with your pelvic floor therapist. It all depends on you and which interventions you and your body need. You should leave each visit with an increased understanding of your condition and progress, as well as actionable items through a home exercise program to progress you in reaching your goals.
Knowledge is power when it comes to better understanding your pain. Though this experience is difficult, we want to remind everyone that they are not alone. At Bloom Pelvic Therapy, we are here to both listen and help you start breaking this cycle.