Let’s Talk Chronic Overlapping Pain Conditions

In Pelvic Pain by Stephanie Prendergast

By Stephanie Prendergast, MPT, Cofounder, PHRC Pasadena

 

Pelvic pain knowledge is improving, but not as quickly as desired by suffering patients. Many of our page followers might have some or all conditions shown. Researchers and NIH now term them Chronic Overlapping Pain Conditions (COPCs).

Imagine if these symptoms and diagnoses were interconnected. Endometriosis, diagnosed via surgery biopsy, often overlaps with:

 Vulvodynia

 Interstitial Cystitis/Bladder Pain Syndrome

 Irritable Bowel Syndrome (IBS)

…and Pelvic Floor Dysfunction (PFD)

 

Emerging neuroscience research is showing patients with COPCs exhibit brain changes making certain people more susceptible to increasing pain. Other COPCs include: migraines, Tempromantipular Joint Disorder (TMJ), low back pain (LBP), and chronic fatigue syndrome CFS).

Whether or not you have chronic pain, pelvic pain, or anyone of the diagnoses mentioned, we want you to know that help is out there! Now, let’s dive into discussing each of the different pelvic pain conditions that were mentioned above.

 

Vulvodynia

Simply put, Vulvodynia is persistent pain in the vulva. Many people are incorrectly told there is no cause or cure by general providers who are not qualified to diagnose or treat vulvar pain conditions.  ⠀⁣

We’re here to tell you THAT’S NOT TRUE!! Vulvodynia is a treatable syndrome with known and associated causes that affects 1 in 4 women that are premenopausal. This condition is more commonly associated with hormonal deficiencies from birth control or oral contraceptives. And, over 90% of those with vulvar pain have pelvic floor dysfunction as a cause or an effect of vulvodynia.⠀ 

Managing vulvodynia symptoms may feel like an uphill battle, but with the right approach and knowledge, it is possible to find relief. Remember, everybody is unique and what works for one person may not work for another. The key to success is working with clinicians that can help you understand why you developed vulvodynia and how they are going to help you restore your pelvic health.  It’s crucial to remain patient, open-minded, and proactive in your journey towards pain management.

We have a lot to say on this topic, for more information check out our e-book all about Vulvodynia, Vaginismus & Vestibulodynia!

Interstitial Cystitis/Bladder Pain Syndrome

Interstitial Cystitis/Bladder Pain Syndrome is defined as “An unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms of more than six weeks duration, in the absence of infection or other identifiable causes.”

Despite its prevalence, the causes of Interstitial Cystitis/Bladder Pain Syndrome are multifaceted, and the general lack of knowledge about this condition and the potential causes makes navigating this diagnosis challenging. Recent studies have identified a number of phenotypes to help characterize the different causes of irritative bladder symptoms which is leading to more effective treatment. The majority of patients with irritative bladder symptoms have pelvic floor dysfunction and all should undergo a pelvic floor evaluation with a skilled therapist.

Get more information via our recent blog on the topic.

 

Irritable Bowel Syndrome (IBS)

IBS plagues millions of Americans. Chronic constipation and straining to evacuate can be a cause and effect of pelvic floor dysfunction. It is important to work with both a medical and pelvic floor team to help restore easy comfortable bowel movements.

 

UTI or PFD 

The symptoms of urinary tract infections and pelvic floor dysfunction are similar, which can lead to misdiagnosis, unnecessary and overuse of antibiotics. People are frustrated and suffering with symptoms. Symptoms of PFD and UTIs include urinary urgency, frequency, and pain.

We strongly recommend undergoing urinalysis with a physician to know if there is an infection or not and if so what medications are effective treatments.

UTIs may come with urinary odor, cloudy urine, and even a fever. Over-the-counter test strips are available and are often used to help people decide if they need to contact their doctor or not. We warn that there can be ‘false negatives’ with these test results. If you suspect you have a UTI please contact your doctor, get tested and get treated if necessary.

If you have these symptoms in the absence of a UTI, pelvic floor physical therapy can likely help! Tight and painful pelvic floor muscles cause urinary hesitancy, urgency, frequency, pain and incomplete voiding. The solution is manual therapy, neuro-muscular reeducation and a home exercise program!

 

Pelvic Floor Dysfunction (PFD)

Pelvic Floor Dysfunction spans a range of neuromuscular deviations which can include weakness, poor endurance, altered neuromuscular control – both voluntary and involuntary, myalgia, and tightness. Pelvic floor dysfunction is associated with urinary, bowel and sexual dysfunction and pelvic, low back and hip pain. 

There are many causes of pelvic floor dysfunction as illustrated above. The good news is that pelvic floor physical therapy is the answer!

 

Chronic Overlapping Pain Conditions

Improved understanding of neuroscience drives advancements in new technologies and treatments. For more information on this topic, check out the iCarebetter: Endometriosis Unplugged Podcast, where Jandra Mueller and Stephanie Prendergast talk with Jason Kutch, PhD about his groundbreaking research and own experience with pelvic pain. You can listen on both Apple Podcasts or Spotify.

Check it out for more information and please share your questions, we are happy to help answer them! 

Understanding Chronic Overlapping Pain Conditions (COPCs) is an ongoing and crucial part of the field of pelvic pain. The more research that is available, the more we will be able to unravel the intricate and complicated connections between these conditions. Healthcare providers can help offer more comprehensive care strategies when they are able to consider the interconnected nature of COPCs. These care strategies can be more effectives when then address the root causes of pain rather than symptoms alone.  This is possible by staying up to date on current advancements in neuroscience and pain management (for both practitioners and patients).

 

Resources

Pelvic Pain Explained: Endometriosis + Resource List

Interstitial Cystitis/Bladder Pain Syndrome: Diagnosis and Subtypes

Vulvodynia: Do’s, Don’ts, + Symptom Management

6 Unexpected Reasons to See a Pelvic Floor Physical Therapist

 

How to find informed medical providers

Need to find a specialist? Check out iCarebetter’s ‘Find a Specialist’

International Pelvic Pain Society Find a Provider

American Physical Therapy Association’s Section on Women’s Health PT Locator

Herman and Wallace Find a Provider

Pelvic Guru Provider Directory

 

Useful Websites/groups

Endofound.org

iCareBetter

Tight Lipped

 

Frequently Asked Questions

What do the pelvic floor muscles actually do or control?

To start, there are various functions we can thank our pelvic floor, but the functions: Part of core muscles, Supports pelvic organs, Urinary and bowel control and comfort, and Involved with sexual function and pleasure. Check out our blog on the Biomechanical Evaluation for Pelvic Floor Dysfunction & PF Functions for more information!

I think I have Interstitial Cystitis/Bladder Pain Syndrome. It seems like there is so much to know about this, where can I start?

You can check out the linked blog below that dives into everything you need to know about Interstitial Cystitis/Bladder Pain Syndrome.

How is pelvic pain treated? I have chronic pelvic pain and want to know how to seek a diagnosis. It was acute pelvic pain but with the menstrual cramps and the ability for symptoms to mimic symptoms related urinary tract infections- I just want the pelvic pain diagnosed!

We understand your frustration. Pelvic pain can be treated in a variety of ways; the treatment plan is dependent on the cause of pelvic pain! We recommend finding a pelvic floor physical therapist near you in order to be evaluated. An evaluation will be able to set you up on a treatment plan for your chronic pelvic pain! Regardless of the cause of pelvic pain, help is out there. In the resources of this blog you will find links in order to locate a provider in your area.

What is pelvic floor physical therapy?

Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.

What happens at pelvic floor therapy?

During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.

______________________________________________________________________________________________________________________________________

Check out our recently published e-book titled “Vulvodynia, Vestibulodynia, and Vaginismus,” designed to empower and inform individuals on their journey towards healing and understanding.

Did you know we opened our 11th location in Columbus, OH? Now scheduling new patients- call (510) 922-9836 to book! 

Are you unable to come see us in person in the Bay Area, Southern California or New England?  We offer virtual physical therapy appointments too!

Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.

Do you enjoy or blog and want more content from PHRC? Please head over to social media!

Facebook, YouTube Channel, Twitter, Instagram, Tik Tok