The “Evil Triplets” of Chronic Pelvic Pain

The “Evil Triplets” of chronic pelvic pain include endometriosis, interstitial cystitis/painful bladder syndrome, and pudendal/levator neuralgia which are called triplets because they frequently can occur together.
Endometriosis is a condition where the endometrial lining of the uterus grows outside the uterus. This abnormal tissue growth occurs most commonly in the tissue lining the pelvis. This condition can cause chronic pelvic pain, dyspareunia, scar tissue formation, and fertility issues.
Interstitial cystitis/painful bladder syndrome is often characterized by pelvic pain, pain with intercourse, urinary frequency, and urinary urgency that is not associated with an active infection.
Pudendal/levator neuralgia is frequently associated with tenderness and pain to tissues about the pudendal nerve, changes to tissue texture, decreased tissue blood supply, and muscle weakness and atrophy.
What can be done about the “Evil Triplets?” Physical therapy treatment of pelvic pain frequently includes an assessment of a variety of structures including the spine, pelvis, abdomen, and lower extremities. Alignment, range of motion, muscle strength, muscle extensibility, and connective tissue mobility is frequently assessed. Physical therapy treatment may include manual treatment such as trigger point release, neuromuscular re-education, relaxation techniques, therapeutic exercise, and physical therapy modalities. Patient care for this population frequently involves a cross-disciplinary approach.

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