Chronic Pelvic Pain

Chronic pelvic pain

Chronic pelvic pain affects 10-15% of North American women and 10% of men. It is pain which may be felt in and around the genitals (vagina, penis or scrotum), the rectum, pelvis, groin, abdomen, hips, thighs or buttocks. It may be mild or severe, constant or only when sitting, vaginal insertion, exercising, cycling, or wearing certain clothing. The pain may be described as burning, aching, stabbing, shooting, or like ‘paper cuts’ or ‘something ripping’.
The pain may have been present for many years, seemingly without a reason, or may have started following an infection, allergic reaction, trauma or stressful event.
Pelvic pain may also be associated with other medical problems, such as interstitial cystitis, fibromyalgia, irritable bowel syndrome, endometriosis and chronic fatigue syndromes.
Chronic pelvic pain is a complex condition that can be difficult to get a correct diagnosis for or find the right help. Frequently our patients have seen several doctors and specialists trying to find effective treatments before they find us. This can be over may many years and can be a very frustrating and often depressing experience.
For men with pelvic pain go here.

Vulvodynia: a general term for pain in the vulvar area. It may be felt in one specific area or be more widespread. It may only be felt on touch, may be present constantly, or may vary from day to day.
Provoked Vestibulodynia Syndrome (PVD): is the most most common form of vulvodynia, affecting 1 in 6 women. It is the most common cause of painful sex (dyspareunia) in pre-menopausal women.
Women frequently describe it as a burning sensation at the entrance (vestibule) to the vagina, often felt specifically in a U-shaped area at the base of the vaginal opening – nearer the anus. Pain may be felt on pressure from a finger, tampon, or during penetration. The pain may last for many hours following intercourse and may cause a burning sensation when the bladder is emptied. The body’s response to pain is to tighten the muscles in the affected area, to try to protect from further damage (pain). This is a useful response in the short term, but if the muscles keep on contracting, they will create further problems, see ‘over-active pelvic floor muscles’.
Vaginismus: an uncontrolled spasm of the pelvic floor muscles at the entrance to the vagina, preventing penetration. It can make gynaecological exams or tampon insertion difficult or impossible. It can feel as though there is a complete ‘blockage’ and attempting to get beyond this can produce feelings of extreme anxiety.
Coccydynia: pain felt in or around the tailbone.

Physiotherapy is always done in a private treatment room with the same physiotherapist, providing sensitive, professional treatment. It starts with a thorough assessment. Detailed questions will ask about your pain, affects on your lifestyle, your medical history, questions about your bladder, bowels, diet and menstrual cycle.
A physical examination will then follow, which may include your posture, lower back, hips, abdominal muscles and breathing patterns. When possible, an internal vaginal and/or rectal examination will be performed. The internal exam helps to identify any dysfunctions with the pelvic floor muscles: are they too weak or too tense and tight? Are you able to contract and relax them freely? The exam will move at your pace, so that you feel safe and in control at all times. No speculums or stirrups are used, and we only proceed with your consent.
Once the examination is complete, a discussion follows: explaining the findings, and exploring treatment options. It is a good opportunity for you to ask questions to gain a better understanding of your problems.
The goal of Physiotherapy is to restore normal range of movement to any restrictions in joints and muscles, and to correct movement patterns to improve and restore function. We will teach you how to move and control your muscles in a coordinated fashion with other muscle groups: lengthening tight muscles, strengthening weak muscles.
We will educate you on the science of pain, and coach you on how to pace activity in a safe way for return to normal activities. It is a good opportunity for you to ask questions to gain a better understanding of your problems.