Pelvic Pain FAQs: Part 1

I see 40 patients a week, with roughly 50% of my patient’s coming to PT for some version of pelvic pain. Their pain varies wildly. Some have been in pain for years, some for months, some for weeks. Some have had a long history of surgeries, procedures and physicians visits while others have had very few or none. Some have vaginal pain, rectal pain or perineal pain while others have low back pain, abdominal pain or hip pain. I see men, women and a patients ranging in age from teenagers to nonagenarians.

My point is, they are all different. However, somehow, the same questions are on all of their minds. Below you will find the top three questions people ask me during a PT visit and my best effort to answer them. FAQ’s: Part 2 with questions four through seven to come next week!

  1. So, how long is this going to take?

This is the million dollar question. It’s on everyone’s mind at the start of physical therapy and I completely understand. The most honest way I can answer this question is this: it depends. I know that can be frustrating, but let me elaborate on what it may depend on.

When it comes to pain, recovery depends on many factors. It depends on how long you have been in pain, what your pain was originally caused by, what you have done to manage your pain in the past, how significantly your pain has impacted your life, how you’ve adapted to your pain and even how you feel about your pain.

Science has informed us how long we can expect tissue healing to take, bone healing and even how long nerves take to regrow. But often times pelvic pain is different. Sometimes we don’t know what caused it or what perpetuates it. Because of that, treating pelvic pain becomes a multifactorial process including everything from stretching and exercise to modifying diet, fluid intake, sleep and stress management.

Here is my attempt at giving you something more concrete: By the 4th-6th week of pelvic floor physical therapy, you should notice a change of some sort. It may be small, it may be incremental, but you and your physical therapist should be able to see some signs that your symptoms are moving in the right direction. This may differ from person to person, depending on any setbacks you experience or inconsistencies in your care, but that’s my attempt at a benchmark. If you go to PT at the interval your therapist determines is best and diligently follow your home exercise program, this should be enough time to notice some change. After that, you and your PT should be able to start setting some realistic goals for your particular case and your particular body.

2. What can even be done for this type of pain?

This is a big one on people’s minds when they start PT. It usually comes from a place of feeling like they have already tried everything: medication, surgery, diet, exercise, physical therapy, injections, etc. The one place they usually have not looked at or addressed yet is the pelvic floor.

Your pelvic floor muscles assist in controlling your bladder, bowels and sexual function. If these muscles are tight or weak, they can affect any or all of these symptoms, and they can cause pain. That’s where pelvic floor PT comes in. A pelvic floor physical therapist can use a physical exam including internal and external techniques to determine if your pelvic floor falls into the tense or weak category, or maybe both. Once they determine which muscles are affected, they can begin teaching you exercises to manage these impairments at home while providing manual therapy and other treatment tools in clinic.

Additionally, there are a number of changes in habit that can help reduce bowel, bladder or pelvic pain. For instance, ideal positioning when sitting on a toilet for bowel movements can help decrease pain while trying to empty, or decrease the need for pushing and straining which can also decrease pain. Knowledge is power. The more you know about your body and how these systems are meant to work together, the faster you can start helping your body heal.

3. How in the world did I develop a trigger point in my X?

X = vagina, rectum, abdomen, muscles surrounding tailbone, anal opening, vaginal opening,etc.

So many reasons. There are so many reasons you can develop a tense muscle in your vagina or rectum. You could ask the same question regarding how you’ve developed tension in your neck or back. Our pelvic floor is full of muscles, just like our back is.

Let me start by listing some reasons:

  • You had an infection at some point that caused your muscles to guard because of pain caused by the infection, and now they don’t know how to relax.
  • You had surgery and now the scar tissue is affecting the way your muscles function and move.
  • You and your body have been experiencing a lot of stress due to work or personal life and you’re not realizing how tense you are holding your glutes and pelvic floor.
  • You injured yourself at the gym and while you knew how to rest, ice, stretch and mobilize your knee, hip or back, you know very little about your pelvic floor and haven’t been able to give it the attention it needs to calm down and return to normal.
  • You have chronic ankle, knee, hip or back pain and don’t realize how your compensations during movement have affected your pelvis.
  • You took a 12 hour flight, fell asleep in a weird position, didn’t get up once, and don’t know how to stretch the right muscles.
  • You delivered a baby and your muscles haven’t returned to normal strength or length.

I can continue, but you see my point. Our muscles respond to injury, even if that injury is minor. When we wake up with inexplicable knee pain, we throw some ice on it, ask a friend what to do, and avoid going on a long run that day. When we wake up with inexplicable pelvic pain, we often don’t know what to do, and are most certainly not going to call up a friend and say hey my X (use X substitutes listed above) hurts.

When we add on that we also don’t know where these muscles are, how to activate them or what they do, it can leave people crossing their fingers and hoping it goes away until the pain gets strong enough that they decide to see a doctor. At that point, they’ve been in pain for quite some time and they’ve felt anxious about why there X is hurting for just as long. Pain is a cycle, and it needs to be broken. Understanding our bodies and what can contribute to this pain is an extremely important part of breaking that cycle.

-Rebecca Maidansky, PT, DPT

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