By Elizabeth Akincilar, MSPT, Cofounder, PHRC Lexington
Did You Know…
- An estimated sixty-one percent of women with bladder pain syndrome have comorbid chronic pelvic pain, while almost fifty percent of women with endometriosis suffer from chronic pelvic pain.1
- Seventy percent of women with a previous diagnosis of endometriosis are diagnosed with chronic pelvic pain.2,3
- Women with a past medical history significant for pelvic trauma or surgery are at a much higher risk of developing chronic pelvic pain compared to the general population. Twenty-eight percent of women develop persistent pelvic pain following an elective cesarean delivery, three months postoperatively, while twenty percent of women continue to have persistent pain six months postoperatively.4
- Myofascial pelvic pain in women may be the underlying cause of chronic pelvic pain in 14% to 23% of cases and up to 78% of cases of interstitial cystitis.5
- Pain scores significantly improved proportional to the number of physical therapy visits completed, with 63% of patients reporting significant pain improvement, concluding that transvaginal physical therapy is an effective treatment for chronic pelvic pain resulting from myofascial pelvic pain.6
Pelvic Floor Dysfunction and Female Pelvic Pain
Female pelvic pain generally refers to burning, itching, aching, or other types of pain in the vulva, vagina, perineum and/or anal area. These pain symptoms may be constant or intermittent. Symptoms can be provoked, such as with intercourse or tampon insertion, or unprovoked and spontaneous.
Women with pelvic pain can also experience other symptoms such as:
- Pain with intercourse
- Hypersensitivity to underwear or other tight-fitting clothing
- Pain with sitting
- An exacerbation of pain with exercise
- Urinary urgency, frequency and/or hesitancy
- Abdominal bloating and/or abdominal pain
- Gastrointestinal distress
Diagnoses associated with pelvic pain include:
- Interstitial Cystitis/Painful Bladder Syndrome
- Pudendal Neuralgia
- Irritable Bowel Syndrome
- Lichens Sclerosis and Lichens Planus
Women can develop pelvic pain for a number of reasons. Causes of pelvic pain include:
- Pelvic floor dysfunction
- Recurrent or chronic vaginal or urologic infections such as yeast infections or urinary tract infections
- Chronic gastrointestinal or dermatologic conditions
- Prescription medications such as oral contraceptive medications, acne medications, or hormonal suppressive therapies commonly used for conditions such as Endometriosis or Polycystic Ovarian Syndrome
- Oral contraceptive pills decrease the availability of sex hormones, including both estrogen and testosterone. In 2015 an International Consensus Conference on Vulvar Pain decided that hormonal insufficiencies can cause vulvar pain.
- Surgical trauma such as a Cesarean section or hysterectomy
- Orthopedic injuries or trauma
- Biomechanical or structural dysfunction such as sacroiliac joint dysfunction, hip dysfunction or scoliosis
- Vaginal childbirth
- Genital cutting or mutilation
Challenges to diagnosis and treatment
Women face many challenges when it comes to diagnosing pelvic pain as well as receiving effective treatment. Research reveals that it can take women suffering with pelvic pain five years to get a diagnosis and up to 11 years for a woman with endometriosis. One of the reasons women are often misdiagnosed is that many of these symptoms mimic other pathologies such as a yeast infection, urinary tract infection, or sexually transmitted infections. Other times the symptoms may be mistaken for primary dysmenorrhea (recurrent menstrual cramps). At the end of the day many medical providers are unaware that pelvic floor dysfunction can be the culprit for many symptoms of pelvic pain leading to misdiagnosis and delay of proper treatment.
What is Pelvic Floor Physical Therapy and how it can help Pelvic Pain
Pelvic floor physical therapists specialize in the treatment of pelvic pain and pelvic floor disorders. Pelvic floor physical therapy is often an integral component of the treatment plan for anyone experiencing pelvic pain. Women experiencing pelvic pain will almost certainly benefit from a pelvic floor physical therapy evaluation. During the evaluation the physical therapist takes a comprehensive history to understand exactly how and when the symptoms began, the nature of the symptoms, the woman’s complete medical history, including previous diagnoses and treatments and the effectiveness of those treatments. During the physical examination the physical therapist evaluates the muscles, tissues, joints, nerves and movement patterns. After the examination, the physical therapist reviews and explains their findings and develops a comprehensive treatment plan that is carried out over the next, approximately, 8-12 weeks. Additionally, the physical therapist develops a home exercise program to facilitate the in-person treatment. Importantly, the physical therapist coordinates their care with the other members of the treatment team to ensure the most comprehensive treatment plan.
PHRC YouTube Videos
- Vulvodynia, Vestibulodynia, Vaginismus…What’s the Difference???
- Getting to Know Your Vulva
- What is Vulvodynia?
- Everything You NEED to Know About Endometriosis
- The truth about the birth control pill
- Sex Hormones: YES They’re important
- New Perspectives on Endo: Gut-Immune Link & IG Live w/ Dr. Orbuch
- Healing Female Sexual Pain, and IG Live with Dr. Irwin Goldstein
- Vestibulodynia Explained with Follow Up Q&A
- Lj Powerhouse and Jandra Mueller of PHRC: IG Live Endometriosis Q&A
- Tirlapur SA, Kuhrt K, Chaliha C, Ball E, Meads C, Khan KS. The ‘evil twin syndrome’ in chronic pelvic pain: a systematic review of prevalence studies of bladder pain syndrome and endometriosis. Int J Surg. 2013;11(3):233-7.
- Laufer MR, Goitein L, Bush M, Cramer DW, Emans SJ. Prevalence of endometriosis in adolescent girls with chronic pelvic pain not responding to conventional therapy. J Pediatr Adolesc Gynecol. 1997 Nov;10(4):199-202.
- Mowers EL, Lim CS, Skinner B, Mahnert N, Kamdar N, Morgan DM, As-Sanie S. Prevalence of Endometriosis During Abdominal or Laparoscopic Hysterectomy for Chronic Pelvic Pain. Obstet Gynecol. 2016 Jun;127(6):1045-1053.
- Richez B, Ouchchane L, Guttmann A, Mirault F, Bonnin M, Noudem Y, Cognet V, Dalmas AF, Brisebrat L, Andant N, Soule-Sonneville S, Dubray C, Dualé C, Schoeffler P. The Role of Psychological Factors in Persistent Pain After Cesarean Delivery. J Pain. 2015 Nov;16(11):1136-46.
- Pastore EA, Katzman WB. Recognizing myofascial pelvic pain in the female patient with chronic pelvic pain. J Obstet Gynecol Neonatal Nurs. 2012;41(5):680-691. doi:10.1111/j.1552-6909.2012.01404.x
- Bedaiwy MA, Patterson B, Mahajan S. Prevalence of myofascial chronic pelvic pain and the effectiveness of pelvic floor physical therapy. J Reprod Med. 2013 Nov-Dec;58(11-12):504-10.
Are you unable to come see us in person? We offer virtual physical therapy appointments too!
Due to COVID-19, we understand people may prefer to utilize our services from their homes. We also understand that many people do not have access to pelvic floor physical therapy and we are here to help! The Pelvic Health and Rehabilitation Center is a multi-city company of highly trained and specialized pelvic floor physical therapists committed to helping people optimize their pelvic health and eliminate pelvic pain and dysfunction. We are here for you and ready to help, whether it is in-person or online.
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.
In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page.
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