Pelvic Pain

Physiotherapy For Pelvic Pain

Pelvic pain is one of the common conditions yet a complex problem that can affect both men and women. Pelvic pain is a pain or discomfort that is present between your lower abdomen from the belly button to the groin area. They could be symptoms of pain arising from the reproductive, urinary, digestive, and musculoskeletal systems.

Pelvic pain is part of Pelvic Floor Dysfunction, which is usually caused by tight pelvic floor muscles. If the muscles are tight, it can cause pelvic pain, urinary/fecal urgency and frequency issues.

Learning about the layers of the pelvic floor,  Pelvic floor muscles and fascial connections that envelope the deep pelvic area helps understand more on the pelvic pain.

Layers of Pelvic Floor and Perineum: there are known to be three layers which include

Pelvic Floor Muscles
Pelvic Floor Muscles

Layer 1: Superficial perineal muscle layer – urogenital triangle  – It stabilizes the perineal body, supports the pelvic floor and propels semen expulsion, influences penile rigidity in males and voluntary sphincteric action of the anal canal in both men and women

Layer 2: Deep perineal muscle layer the Urogenital Diaphragm – is essential for maintaining a continence mechanism.

Layer 3: Pelvic Diaphragm – includes Levator ani (PFM), coccygeus, piriformis, obturator internus muscles. These support the internal pelvic organs, provide voluntary control of sphincteric action of the anal canal, helps and supports tail bone, hip lateral rotation movement

Pelvic floor muscles (PFM) that are also known as Levator Ani muscles are essential in supporting and protecting the connective tissues that lay in your pelvic region from excessive load. The connective tissues include bone, tendons, ligaments cartilage, and fat tissues. The Pelvic Floor muscles can be exercised to strengthen if weak or to lengthen if it is tight.

Fascial Connections of pelvic Floor:

Fascia is the lining of the internal organs and muscles that are made of smooth muscle fibers, ligaments, blood vessels and connective tissue. Fascia covers and supports the inner organs like bladder, intestines and uterus. Some of the ligaments connect to the lumbar spine and pubic symphysis. This fascial layer cannot be exercised.

The pelvic diaphragm and the urogenital triangle are all supplied by the Pudendal nerve. The only nerve that has both sensory, motor fibers and autonomic fibers is the Pudendal nerve. The sensory fibers of the pudendal nerve can lead to perineal and pelvic pain.

5 Important Pelvic Floor Muscle Functions:

Pelvic floor muscles provide various functions that help maintain pelvic integrity and harmony

  • Support: PFM provides internal pelvic organs like uterus, bladder, rectum support against gravity and intra-abdominal pressure
  • Sphincteric: pelvic floor functions to control the continence mechanisms coordinating between bladder, urethra (pee hole) and muscles
  • Sexual: pelvic floor muscles help react to sexual stimuli by providing tone in vaginal and rectal canals and increased blood circulation to sexual organs and involuntary contractions during orgasm in both men and women.
  • Stability: provides stability to Si joint, pubic Symphysis, pelvic, lumbar, and hip joints, and functions to unload the spine (Hodges 2007).
  • Sump- Pump: helping with venous and lymphatic circulation.

Acute and Chronic Pelvic Pain:

Acute Pelvic pain:

Acute pelvic pain is the lower abdominal or pelvic pain that is of sudden acute onset and can be less than three months. It is challenging to evaluate due to broad differential diagnosis and has different signs and symptoms that can be non-specific.

  • Idiopathic pelvic pain
  • Pelvic inflammatory disease
  • Acute appendicitis
  • Ovarian cysts,
  • Ectopic pregnancy
  • Endometriosis
  • Cancer among postmenopausal women

These require medical attention and intervention ( Amit et al. 2016 ).

Chronic Pelvic pain:

Chronic pelvic pain is pain and inflammation in the pelvic organs for more than six months. Chronic pelvic pain represents a chronic pain syndrome that combines dysfunction of the pelvic floor muscles with the malfunction of pain perception linked with psychological and cognitive factors. ( Grinberg et al. 2020) These conditions can be helped by a physiotherapist.

Chronic Pelvic pain
  • Vulvodynia
  • Vestibulodynia
  • Dyspareunia
  • Vaginismus
  • Chronic urological pain syndromes – include interstitial cystitis and Bladder pain syndrome
  • Dysmenorrhea
  • Pelvic congestion Syndrome
  • Coccydynia
  • Anal fissures
  • Chronic prostatitis
  • Pudendal Neuralgia

Chronic Pelvic Pain: Most common causes

  • Tight pelvic floor muscles or fascial tension
  • Connective tissue dysfunction
  • Neural tension along the nerve pathway
  • Increase tension in the internal organs of the lower abdomen including the bladder, prostate, uterus and ovaries
  • Pelvic congestion from varicose veins and poor circulation in the pelvic floor muscles
  • SI joint /Sacroiliac joint dysfunction
  • Genitourinary syndrome of Menopause due to hormonal changes
  • Upregulation of sympathetic nervous system from chronic stress, anxiety, catastrophization  or depression leading to Pelvic Persistent pain in the absence of actual tissue dysfunction or persistent pain states with a blend of tissue dysfunction

What does the research say about Physiotherapy Treatment for Pelvic pain:

Pelvic floor physiotherapy is useful in training the pelvic floor muscles increases the support of bladder and uterus and decreases the strain on fascial connections which in turn can improve your pelvic pain

Pelvic Pain Stretches

Releasing the pelvic floor and the fascia layers through pelvic support physiotherapy can help with non-mechanical back pain that can be caused by tight pelvic floor muscles and that the therapeutic interventions in chronic pelvic pain should  follow a multidisciplinary approach( Grinberg et al. 2020)

Recent quality studies noted significant clinical effects of physiotherapy for chronic pelvic pain and female sexual dysfunction. The experts advocate a holistic and multidisciplinary approach that includes physiotherapy ( Bergman’s B 2018 )

Pelvic Floor Physiotherapist Can help:

A physiotherapist specializing in pelvic floor problems and pelvic pain can help you to understand your problem and identify the appropriate solution.

Physiotherapy treatment involves a biopsychosocial approach to your problems that begins with effective interviewing to understand your problem/ condition. Physical bio mechanical evaluation that includes both external and internal myofascial assessment, providing neurophysiology based pain education to the condition. Therapeutic interventions can range from exercises , relaxation training , movement practice, myofascial release and connective tissue mobilization. Self-care/self-management and lifestyle modification approach to better assist with the treatment.

Physiotherapist at Opal physiotherapy can help you in your journey towards recovery by setting a realistic short and long term goals that involve you being an active participant.

If you think you have pelvic pain and are diagnosed by your health care provider with having any of the pelvic pain conditions, do contact our clinic at 604-532-7887 or email at [email protected] to get assessed and to start your recovery process.

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