PELVIC PAIN

PELVIC PAIN TREATMENT

Pelvic pain is a very broad name and can have many contributing factors. Generally it refers to any pain in the pelvic girdle and the surrounding muscles, tendons, and ligaments.

All of these diagnoses have some aspect of dysfunction or muscle spasm of the pelvic floor muscles. While medical management is needed, a pelvic floor physical therapist should absolutely be a primary part of the team in order to decrease muscle spasm and trigger points in the pelvic floor and educate on lifestyle modifications.

Some different diagnoses that fall under this category include:

 Endometriosis – Endometriosis is the growth of endometrial tissue outside of the uterus, most commonly in the abdomino-pelvic cavity. This results in pain in the pelvis and abdomen which worsens during menstruation. The gold standard for treatment of endometriosis is excision surgery, not hysterectomy. While this is a primary visceral pathology, the pain from endometriosis often leads to increased muscle tension and trigger points in the muscles of the abdomen and pelvic floor which can exacerbate pain.

Vaginismus – Vaginismus is a spasm of muscles surrounding the vaginal canal. This can result in pain with gynecological exam, inability to insert a tampon, pain with sexual activity, and pain with sitting.

Dyspareunia – Dyspareunia means pain with intercourse. This can be due to hormonal changes, tightness in the pelvic floor muscles, or painful scar from child birth.

Interstitial Cystitis/Painful Bladder Syndrome – IC/PBS is a diagnosis of exclusion characterized by pelvic pain and urinary urgency and frequency.

Pudendal Neuralgia – Pudendal neuralgia is irritation of the pudendal nerve, a nerve that innervates structures in the pelvic floor. This nerve can get irritated as a result of spasm in the surrounding pelvic floor muscles or constriction from other structures through which it passes.