• Danielle Khoury, DPT

A Deeper Look into Pelvic Pain


May is pelvic pain awareness month. Pelvic pain is a huge umbrella encompassing all genders and ages. Chronic pelvic pain (CPP) is defined as “intermittent or constant pain in the lower abdomen or pelvis of at least 6 months, not occuring exclusively with menstruation or intercourse and not associated with pregnancy.” Chronic pelvic pain does not affect just women, but men as well. Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) accounts for 90% of prostatitis cases in outpatient clinics. CP/CPPS has a worldwide prevalence between 2 and 16% and is the most common urologic disease in men below 50 years old. The prevalence for women in reproductive ages is between 14% – 24% and about 14% of women experience CPP at least for one time during their life. It is reported that this disease accounts for up to 10% to 15% of referrals to gynecologists, with greater than 40% of all diagnostic gynecological laparoscopies being done for this reason. It is well appreciated that from 25% to 40% or more of all patients who have hysterectomies done for CPP continue to have pain after the procedure. This would suggest the origin of pain is not always due to the uterus as often as it is thought. In the past, it was suggested that the major causes of pain of a chronic nature were due to gynecological problems, including endometriosis, adhesions, pelvic inflammatory disease (PID), adenomyosis; gastrointestinal disease; skeletal disorders (myofascial pain); and genitourinary problems.

Did you know that physical therapy addressing pelvic floor rehabilitation is the only therapy given an evidence grade of ‘A’ by the American Urological Association and recommended in the first line of medical treatment.

“Only a fraction of patients with the key symptoms of IC/BPS – urinary frequency, urgency, and pelvic pain – have ulcers within the bladder. And many of the patients who are diagnosed with IC/BPS are found not to have bladder pathology as the name implies, but rather pelvic floor dysfunction.”

– Dr. Kenneth Peters, Chair of Urology at Beaumont Hospital, MI

In another study found on endometriosis.org. The authors found a correlation of 91-94% of women in the study diagnosed with endometriosis were found to also have myofascial trigger points and referral pain from the pelvic floor. If you have been diagnosed with any of the following conditions you may benefit from pelvic floor physical therapy:

  • Endometriosis

  • Pudendal neuralgia

  • Vulvodynia

  • Dyspareunia (pain with intercourse) and Vaginismus (pain with penetration)

  • Interstitial Cystitis / Painful bladder syndrome

  • Post surgical pains

  • Pain with erections, ejaculation, prostate pain

  • Persistent abdominal pain and bowel conditions

References:

1. Paulson, J. D., & Delgado, M. (2005). Chronic pelvic pain: the occurrence of interstitial cystitis in a gynecological population. JSLS : Journal of the Society of Laparoendoscopic Surgeons, 9(4), 426–430.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3015651/

2. Prevalence of Chronic Pelvic Pain Among Women: An Updated Review. Alebtekin Ahangari, BSc. PT. ww.painphysicianjournal.com. Pain Physician 2014; 17:E141-E147 • ISSN 2150-1149

3. Smith C. P. (2016). Male chronic pelvic pain: An update. Indian journal of urology : IJU : journal of the Urological Society of India, 32(1), 34–39. doi:10.4103/0970-1591.173105

4. Image retrieved from www.pelvicguru.com

#PelvicHealth

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