Women’s Health: You Have Pain WHERE?!

It is as common as low back pain, migraines and asthma, yet many suffer in silence with pelvic pain.¹

According to the National Institute for Health, up to 32 percent of women of childbearing age have pelvic pain that is severe enough to cause them to miss work.² Pelvic pain can be felt anywhere in the abdomen, pelvis, genitals, rectum, hips, or even the inner thighs and back. It can be dull or sharp, localized or generalized. Because pelvic pain is closely associated with so many diagnoses, it is often misdiagnosed and not properly treated.

Pelvic pain can be caused by endometriosis, pregnancy, tailbone pain, hormone dysregulation, IBS, Crohn’s disease, bladder dysfunction, scar tissue, hip pathology, chronic constipation, interstitial cystitis, pelvic organ prolapse or visceral problems. It is also present with fibromyalgia, pudendal neuralgia, vulvodynia, and vaginismus. It can cause incontinence, rectal or vaginal spasms, painful intercourse, abnormal bowel or bladder habits, frequent urination and fertility issues. The pain can greatly inhibit a person’s ability to participate in work, social activities, sports and intimacy. Pelvic pain is not often recognized by general practitioners as a treatable problem, but it is very effectively treated with physical therapy.

Physical therapists are skilled at dealing with issues related to the musculoskeletal system, so why would they deal with issues that seem related to the bowel, bladder and reproductive system?  

I am so glad you asked. Women’s health physical therapists are specialized in the treatment of the pelvic floor. The pelvic floor is a sling-like group of muscles that lies at the bottom of the pelvis.

These muscles are responsible for closing three openings: the urethra, the vagina and the rectum. If these muscles sense pain or problem in a nearby structure (such as the bladder, colon, tailbone, hip, or uterus), their job is to protect and splint that area. Chronic contraction of those muscles over a long period of time creates pain and trigger points within the pelvic floor. This pain then creates more guarding of the muscles, so they remain in a constant state of protection and don’t ever fully relax. Just like any other muscle, the pelvic floor can be retrained to relax, and the trigger points can be released through very specialized techniques.

Patients who have had abdominal surgeries may have scar tissue that can create pain and reduced mobility of the abdomen. In my experience, I have seen patients with endometriosis that have had ten or more laparoscopies and have significant scar tissue within the abdomen and viscera. Cesarian section scars are also a contributor to pelvic pain and tightness. Physical therapists are skilled at myofascial release and scar mobilization to reduce adhesions and improve mobility of the connective tissue, thereby reducing pain. Your physical therapist may also utilize special techniques, such as ultrasound or cupping, to help improve your outcome.

Another issue that Women’s Health Physical Therapists regularly treat is pelvic floor weakness.

Chronic constipation, pregnancy, high-impact sports and chronic coughing can create a huge strain on the pelvic floor. The forceful, prolonged downward pressure exerted on these muscles can make it hard to create closure of the urethra, vagina and rectum. This can result in embarrassing leaks, pelvic organ prolapse (“my bladder has fallen!”), and abdominal pain due to strained ligaments. Poor pelvic floor strength can also manifest as low back and hip pain, because the pelvic floor is the core of the core. If these muscles aren’t strong, the core is sloppy and unstable, increasing the risk of injury. Physical therapy is the key to learning how to target and strengthen these often-ignored, deep core muscles.

Choose Physical Therapy

If you struggle with pain “down there,” you are not alone, and physical therapy can help you return to a healthy and active lifestyle! Talk to your doctor if you have abdominal or pelvic pain, problems with your bowel or bladder, or have a history of endometriosis or abdominal scar tissue. Tell them about Women’s Health Physical Therapy! You will be so glad you did!

Request a Free Assessment

Physical therapy is usually the thing you are told to do after medication, x-rays or surgery. The best way to fix your pain is to start where you normally finish – with physical therapy at Athletico. Schedule a free assessment in-clinic or virtually through a secure online video chat where our team can assess your pain and provide recommended treatment options.

The Athletico blog is an educational resource written by Athletico employees. Athletico bloggers are licensed professionals who abide by the code of ethics outlined by their respective professional associations. The content published in blog posts represents the opinion of the individual author based on their expertise and experience. The content provided in this blog is for informational purposes only, does not constitute medical advice and should not be relied on for making personal health decisions.

References:
1. Prendergast S, Rummer E. Pelvic Pain Explained. Lanham:Rohmann and Littlefield; 2016.
2. Ahangari, A. Prevalence of chronic pelvic pain among women: an updated review. Pain Physician 2014; 17:E141-E147.