Pelvic dysfunction physiotherapy is the assessment and treatment of problems involving the pelvic region of the body by a physiotherapist who has specialized training in pelvic conditions.

Chronic Pelvic Pain

Chronic pelvic pain is a common problem, affecting 10-15% of North American women and many men too. It is pain which may be felt in and around the genitals (vagina, penis or testicles), the rectum, pelvis, groin, abdomen, hips, thighs or buttocks. It may be mild or severe, constant or only on certain activities such as vaginal insertion, exercising, cycling, sitting 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.

Unfortunately chronic pelvic pain is a complex condition; it can be very difficult to get a correct diagnosis and find the right help, and often there is little or nothing to be found on a physical examination. Frequently patients will see numerous doctors and specialists and may spend many years trying to find effective treatments: obviously a very frustrating and often depressing experience.

To add to the confusion, there are many medical terms used and it is easy to get lost in the jargon!

Vulvodynia: a general term for pain in the vaginal area – it is a symptom, rather like a headache, it tells us where the pain is, but does not explain why it is there.

Coccydynia: pain in the tailbone or anus.

Provoked Vestibulodynia (PVD aka Vulva Vestibulitis Syndrome): probably the most common cause of painful sexual intercourse (dyspareunia) in pre-menopausal women. There is severe burning pain at the entrance (vestibule) to the vagina, often felt in a U-shaped area at the base of the vaginal opening. Pain may be produced by the pressure from a finger, tampon or penetration during intercourse. The pain may last for many hours following intercourse and may cause burning after as the bladder is emptied. The body’s response to pain is to tighten the muscles in the affected area, to try to protect the area from further damage. This is a useful response in the short term, but if the muscles keep on contracting, they will create further problems, see ‘Levator Ani Syndrome’.

Vaginismus: an uncontrolled spasm of the pelvic floor and vaginal muscles, (see Levator Ani Syndrome) completely preventing entry into the vagina, and therefore, sexual intercourse, insertion of a tampon or gynaecological exam. A woman with PVD may go on to have Vaginismus.

Prostatitis: a general term for inflammation of the prostate gland. It may be due to an infection or other factors which irritate the gland. When there is inflammation, but no infection, the pain can persist and become a chronic problem, often in combination with bladder problems (urgency, pain on urinating). The pelvic floor muscles often go into a protective muscle spasm, see ‘Levator Ani Syndrome’. See Magazine Article (Original)

Levator Ani Syndrome: a condition in which the pelvic floor muscles, which create a sling-like support for the vagina, bladder and rectum, are in constant or frequent, muscle spasm and tightness. This muscle spasm is often the body’s reaction to the pain produced by Vulvar Vestibulitis Syndrome or Prostatitis. However, the muscle spasm can last long after the initial cause of pain, and the muscle spasm itself can cause pain and restrict the blood supply to the damaged tissues. A cycle of pain → muscle spasm → pain, has then been set up.

This muscle spasm is similar to spasm and tension people often get in the neck and shoulder muscles, but in that case, you are often aware of the tension, you can feel your muscles tightening and see the effect as your shoulders rise up towards your ears. You can then use techniques to reduce the tension, such as massage, exercises, relaxation techniques or just remind yourself to let go of the muscles. However with the pelvic floor muscles, we are often unaware that they exist, let alone aware that they might be in spasm or particularly tight. If we are unaware of the muscles, then we are unlikely to be able to relax them or reduce the tension in them. This is where Physiotherapy is particularly effective.

PHYSIOTHERAPY TREATMENT FOR CHRONIC PELVIC PAIN

Physiotherapy is always carried out in a private treatment room, always 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 and abdominal muscles and an internal vaginal and/or rectal examination.

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 reduce the pain and burning and to restore normal function. Physiotherapy is often focused on the pelvic floor muscles – teaching you to be able to identify them, how to tighten them and therefore, how to relax them. It is the ability to relax the pelvic floor muscles which provides the key to breaking the pain → muscle spasm → pain cycle.

Computerized biofeedback is a very useful tool in teaching pelvic floor awareness. Through the use of carefully placed electrodes, you are able to see on the computer screen the activity of the pelvic floor muscles. Being able to see when the muscles are contracting and when they are relaxed, teaches you how to control muscles that you have previously been unaware of.

When there is chronic pain there is often a change in the way in which the nerves work and transmit messages to the brain. They frequently become too sensitive – and all messages start to be perceived in the brain as signals of pain. Physiotherapy can help this by using techniques to desensitise the area, so that the nerves start to respond and relay information to the brain in a more normal fashion.

Muscles which have been in spasm for a long period of time will often become shortened and tight. Manual therapy techniques can be used to gradually stretch the muscles and tissues to improve their flexibility, work might then be done to strengthen them. This might involve muscles of the pelvic floor, hips, buttocks, back or abdominals.

Throughout treatment you are given support and encouragement as you begin home exercises and learn techniques to take control of your symptoms.

Caroline Allen P.T.

Registered Physiotherapist