Persistent (Chronic) Pelvic Pain
Chronic, or persistent pain, is very complex and has a variety of contributing factors. Often, patients with pelvic pain see many doctors before someone gives them a diagnosis, and once given, the treatment options are often disappointing for the person experiencing symptoms. Sometimes, after going through a medical work up and imaging studies, the patient is told that there is nothing medically wrong, despite their ongoing symptoms. This can be distressing and frustrating for the patient, because though there is nothing medically wrong, the symptoms are undeniable.
There are many misunderstandings with regards to chronic pain, in general. The pelvis is an especially difficult area, as there are also many misconceptions about pain in the pelvis and the genitals. Much of the research in this area is new - and many medical professionals are not familiar with the most recent scientific and clinical advances. There are many barriers to accessing treatment for chronic pelvic pain, including sexual health issues, cultural expectations, financial issues, privacy, and religious issues.
Many physicians are not familiar about the role of physiotherapy in the treatment of pelvic pain. In the foreword for Healing Pelvic Pain Naturally by Amy Stein a gynecologist explains that "...despite completing nearly 20,000 hours on internship and residency in obstetrics and gynecology, I heard only one hour-long lecture on vulvar pain and sexual dysfunction. I was taught that pain during sex was the result of "vaginismus", an involuntary contraction of the vaginal muscles during attempted penetration. I was further taught that vaginismus was a psychological issue resulting from trauma or abuse, and it was to be treated through psychotherapy and sex therapy. Physical therapy was never mentioned. Other types of vulvar pain were thought to be caused by nerve injury and were treated- as much as possible- with drugs. Again, physical therapy was never discussed as a treatment for women suffering this pain..." If a gynecologist who works with patients with pelvic pain has had this experience, imagine the challenge for a family physician!
So, what are the factors that impact pelvic pain that can be addressed by a physiotherapist? Some of the most common factors are: altered pain processing in the central nervous system, increased pelvic floor muscle tone and tension, altered lumbopelvic and hip muscle control, irritated nerves in the pelvic region, and posture, among other factors.
Many of the pelvic pain syndromes doctors and patients have struggled with for years derive (at least in part) from myofascial disorders. For example, women are often diagnosed with irritable bowel syndrome or interstitial cystitis when in fact their pain may be myofascial in origin.
With careful, detailed assessment and treatment planning - many of these problems can be addressed. In some cases the problem can be completely resolved or at least managed much more successfully. Treatment for chronic conditions is rarely a "quick fix" - usually it takes time to unravel the problem and address all of the issues that may be contributing to the problem in consultation with your medical team. In our clinic, Cara Humphreys treats clients with persistent pelvic pain disorders using a multifaceted approach.