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Persistent Pelvic Pain

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Persistent Pelvic Pain

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Created OnSeptember 19, 2019
byPHS Team

Persistent Pelvic Pain

You get a variety of answers when you ask a patient with persistent pelvic pain, “What do you believe is driving your pain?” or “Why do you think it persists, despite all you have done to try and heal the pain?”

Many of these answers are not consistent with what we understand about tissue injury and function, and reveal underlying fear, as well as a lack of understanding regarding changes and sensitivity of the nervous system during chronic pain states.

Persistent (chronic) pelvic pain is complex. For more detail on the complexity of persistent pain, see the YouTube video, Understanding Pain: What To Do About It In Less Than Five Minutes. When patients with persistent pelvic pain seek medical attention, they see many doctors before someone can give them a diagnosis, and once given, the diagnosis may not be helpful from a treatment perspective. Contributing to the general misunderstanding of chronic pain are the common mysteries and misconceptions about pain throughout the pelvis and genitals. Social challenges can further limit the medical system’s ability to make a clear assessment of a person with chronic pelvic pain, including sexual health issues, social stigmas, cultural expectations, privacy, and religious issues.

In the foreword for Healing Pelvic Pain Naturally by Amy Stein (2008), Dr. Andrew Goldstein recounts that even gynaecologists have very little training in pelvic pain. He reports that, “…despite completing nearly 20,000 hours on internship and residency in obstetrics and gynaecology, 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, nor was I ever taught anything about pelvic disorders in men!”

As explained in Amy Stein’s book, pelvic pain is a result of the muscles having tightened and shortened. The tightening decreases the blood flow, and therefore the supply of oxygen to the affected muscles. As a result, lactic acid builds up, irritating the nerves that pass through the muscles. Because the brain perceives pain as being located in the end organ reached by the affected nerve, the person feels vulvar pain.

In addition, the irritation of the nerve typically gives rise to an inflammation that produces redness and swelling, which like the pain, show up in the “endpoint” organ reached by the irritated nerve: namely, the vulva. Many of these pain syndromes that doctors and patients have struggled with for years now turn out to derive from myofascial disorders. For example, women are frequently diagnosed with irritable bowel syndrome or interstitial cystitis, when in fact, Stein believes all of their pain may be myofascial in origin.

“We live in a somewhat puritanical society, where the issues of pelvic floor disorders are not discussed openly , if at all. What’s more, our culture’s attitudes toward health care often encourages the quick fix (make an appointment and get a prescription) and certainly, our current system of health-care insurance favours such efficiency…We also tend to believe that there’s so much health-care information available, in newspapers and magazines and all over the Internet, that we should be in charge of our medical treatment, even to the point of self-diagnosis and self-medication” (Stein, 2008).

People with pelvic pain need to address Pelvic Tissue Dysfunction, Connective Tissue Dysfunction and the Sensitive Nervous System in order to successfully address their pelvic pain. A physiotherapist specializing in pelvic pain, specifically using non-painful internal treatment techniques for the pelvic floor muscles, connective tissues and nerves, needs to be consulted in order to address their particular problems.

Pelvic Health Solutions provides a tool to help people with pelvic pain find a physiotherapist who has met the high standards of this organization to provide pelvic health in Ontario. In addition, this resource is a great place for people to start their healing journey by helping them understand the importance of addressing the central nervous system through:

  • Understanding the need for shifting people’s thoughts and beliefs about persistent pain.
  • Understanding the Neurophysiology of pain (the functioning of the nervous system).
  • Understanding and addressing people’s sleeping difficulties as they relate to persistent pain.
  • Understanding the role of nutrition as it relates to persistent pain.
  • Training people to think positively and mindfully, using healing imagery and guided relaxation.
  • Learning to induce a state of relaxation daily to reduce overall muscle tension and stress.
  • Learning how to choose one activity that can help decrease the sensitivity of people’s nervous systems and practicing it daily.
  • For the Patient
    • For The Patient
  • What is Pelvic Floor Health Physiotherapy?
    • What is Pelvic Floor Health Physiotherapy
  • Why Do We Do an Internal Exam?
    • Why Do We Do an Internal Exam?
  • The Biopsychosocial Approach
    • The Biopsychosocial Approach
  • Incontinence – Urinary and Fecal
    • Incontinence: Urinary and Fecal
    • Facts and Myths About Pelvic Floor Dysfunction
    • Pelvic Floor Muscle Weakness
    • Pelvic Floor Muscle Strengthening (Kegels) for Females (Or If You Have a Vulva/Vagina)
    • Pelvic Floor Muscle Strengthening (Kegels) for Males (or if you have a Penis)
    • The Knack
    • Pelvic Floor Muscle Tightness
    • Bladder Irritants
  • Overactive Bladder (OAB)
    • Overactive Bladder
    • Bladder Irritants
    • Nocturia
  • Pelvic Organ Prolapse (POP)
    • What is Pelvic Organ Prolapse (POP)?
    • Pelvic Floor Muscle Weakness
    • Pelvic Floor Muscle Strengthening (Kegels) for Females (Or If You Have a Vulva/Vagina)
    • The Knack
    • Constipation
    • Pessary
  • Bowel Dysfunction
    • Bowel Dysfunction
    • Pelvic Floor Muscle Weakness
    • Pelvic Floor Muscle Strengthening (Kegels) for Females (Or If You Have a Vulva/Vagina)
    • Pelvic Floor Muscle Strengthening (Kegels) for Males (or if you have a Penis)
    • Pelvic Floor Muscle Tightness
    • Constipation
    • Deep Breathing Exercises
    • Reverse Kegels (Pelvic Floor Drops)
  • Pelvic Floor Muscle Weakness
    • Pelvic Floor Muscle Weakness
    • Pelvic Floor Muscle Strengthening (Kegels) for Females (Or If You Have a Vulva/Vagina)
    • Pelvic Floor Muscle Strengthening (Kegels) for Males (or if you have a Penis)
    • The Knack
  • Pelvic Floor Tightness
    • Pelvic Floor Muscle Tightness
    • Deep Breathing Exercises
    • Reverse Kegels (Pelvic Floor Drops)
  • Persistent Pelvic Pain
    • Persistent Pelvic Pain
    • Pelvic Tissue Dysfunction
    • Pelvic Floor Muscle Tightness
    • Deep Breathing Exercises
    • Reverse Kegels (Pelvic Floor Drops)
    • Sensitive Nervous System
    • Types of Pain
    • Understanding Pain Better
    • Laughter
    • Sleep
    • Nutrition and Persistent Pain
    • Connective Tissue Dysfunction
    • What Are My Myofascial Tender Points?
    • Pudendal Nerve Irritation
    • Self-Treatment Techniques for Foam Rolling
    • Pain Education in a Nutshell
    • Catastrophization
  • Endometriosis
    • Endometriosis
    • Pelvic Tissue Dysfunction
    • Pelvic Floor Muscle Tightness
    • Deep Breathing Exercises
    • Reverse Kegels (Pelvic Floor Drops)
    • Sensitive Nervous System
    • Types of Pain
    • Understanding Pain Better
    • Laughter
    • Sleep
    • Nutrition and Persistent Pain
    • Connective Tissue Dysfunction
    • What Are My Myofascial Tender Points?
    • Self-Treatment Techniques for Foam Rolling
    • Pain Education in a Nutshell
    • Catastrophization
  • Dysmenorrhea (Painful Periods)
    • Dysmenorrhea (Painful Periods)
    • Pelvic Tissue Dysfunction
    • Pelvic Floor Muscle Tightness
    • Deep Breathing Exercises
    • Reverse Kegels (Pelvic Floor Drops)
    • Sensitive Nervous System
    • Types of Pain
    • Understanding Pain Better
    • Laughter
    • Sleep
    • Nutrition and Persistent Pain
    • Connective Tissue Dysfunction
    • What Are My Myofascial Tender Points?
    • Self-Treatment Techniques for Foam Rolling
    • Pain Education in a Nutshell
    • Catastrophization
  • Vaginismus
    • Vaginismus
    • Accommodators and Dilators
    • Pelvic Floor Muscle Tightness
    • Lubricants and Moisturizers
    • Vulvar Care
    • Pelvic Tissue Dysfunction
    • Deep Breathing Exercises
    • Reverse Kegels (Pelvic Floor Drops)
    • Sensitive Nervous System
    • Sleep
    • Types of Pain
    • Understanding Pain Better
    • Laughter
    • Nutrition and Persistent Pain
    • Connective Tissue Dysfunction
    • What Are My Myofascial Tender Points?
    • Self-Treatment Techniques for Foam Rolling
    • Pain Education in a Nutshell
    • Catastrophization
  • Vulvodynia
    • Vulvodynia
    • Vulvar Care
    • Pelvic Tissue Dysfunction
    • Deep Breathing Exercises
    • Pelvic Floor Muscle Tightness
    • Reverse Kegels (Pelvic Floor Drops)
    • Sensitive Nervous System
    • Types of Pain
    • Understanding Pain Better
    • Laughter
    • Sleep
    • Nutrition and Persistent Pain
    • Connective Tissue Dysfunction
    • What Are My Myofascial Tender Points?
    • Self-Treatment Techniques for Foam Rolling
    • Pain Education in a Nutshell
    • Catastrophization
  • Dyspareunia (Painful Penetration)
    • Dyspareunia
    • Vulvar Care
    • Accommodators and Dilators
    • Lubricants and Moisturizers
    • Pelvic Tissue Dysfunction
    • Pelvic Floor Muscle Tightness
    • Deep Breathing Exercises
    • Reverse Kegels (Pelvic Floor Drops)
    • Sensitive Nervous System
    • Types of Pain
    • Understanding Pain Better
    • Laughter
    • Sleep
    • Nutrition and Persistent Pain
    • Connective Tissue Dysfunction
    • What Are My Myofascial Tender Points?
    • Self-Treatment Techniques for Foam Rolling
    • Pain Education in a Nutshell
    • Catastrophization
  • Interstitial Cystitis and Bladder Pain Syndrome
    • Interstitial Cystitis (IC) and Bladder Pain Syndrome (BPS)
    • Diet Modification for IC/BPS
    • Pelvic Tissue Dysfunction
    • Pelvic Floor Muscle Tightness
    • Deep Breathing Exercises
    • Reverse Kegels (Pelvic Floor Drops)
    • Sensitive Nervous System
    • Types of Pain
    • Understanding Pain Better
    • Laughter
    • Sleep
    • Nutrition and Persistent Pain
    • Connective Tissue Dysfunction
    • What Are My Myofascial Tender Points?
    • Self-Treatment Techniques for Foam Rolling
    • Pain Education in a Nutshell
    • Catastrophization
  • Pudendal Nerve Irritation
    • Pudendal Nerve Irritation
    • Pelvic Tissue Dysfunction
    • Pelvic Floor Muscle Tightness
    • Deep Breathing Exercises
    • Reverse Kegels (Pelvic Floor Drops)
    • Sensitive Nervous System
    • Types of Pain
    • Understanding Pain Better
    • Laughter
    • Sleep
    • Nutrition and Persistent Pain
    • Connective Tissue Dysfunction
    • What Are My Myofascial Tender Points?
    • Self-Treatment Techniques for Foam Rolling
    • Pain Education in a Nutshell
    • Catastrophization
  • Pregnancy
    • Pregnancy
    • Postpartum
    • Breastfeeding
  • Rectus Diastasis
    • Diastasis
  • Pelvic Girdle Pain (PGP)
    • Pelvic Girdle Pain
  • Tailbone (Coccyx) Pain
    • Tailbone (Coccyx) Pain
    • Pelvic Tissue Dysfunction
    • Pelvic Floor Muscle Tightness
    • Deep Breathing Exercises
    • Reverse Kegels (Pelvic Floor Drops)
    • Sensitive Nervous System
    • Types of Pain
    • Understanding Pain Better
    • Sleep
    • Connective Tissue Dysfunction
    • What Are My Myofascial Tender Points?
    • Pain Education in a Nutshell
    • Catastrophization
  • Persistent Genital Arousal Disorder (PGAD)
    • Persistent Genital Arousal Disorder (PGAD)
    • Pelvic Tissue Dysfunction
    • Pelvic Floor Muscle Tightness
    • Deep Breathing Exercises
    • Reverse Kegels (Pelvic Floor Drops)
    • Sensitive Nervous System
    • Types of Pain
    • Understanding Pain Better
    • Sleep
    • Connective Tissue Dysfunction
    • What Are My Myofascial Tender Points?
    • Pain Education in a Nutshell
    • Catastrophization
  • Menopause
    • Menopause
    • Vulvar Care
    • Lubricants and Moisturizers
    • Dyspareunia
  • Lubricants vs Moisturizers
    • Lubricants and Moisturizers
  • Chronic Non-Bacterial Prostatitis
    • Chronic Nonbacterial Prostatitis
    • Bladder Irritants
    • Pelvic Tissue Dysfunction
    • Pelvic Floor Muscle Tightness
    • Deep Breathing Exercises
    • Reverse Kegels (Pelvic Floor Drops)
    • Sensitive Nervous System
    • Types of Pain
    • Understanding Pain Better
    • Laughter
    • Sleep
    • Nutrition and Persistent Pain
    • Connective Tissue Dysfunction
    • What Are My Myofascial Tender Points?
    • Self-Treatment Techniques for Foam Rolling
    • Pain Education in a Nutshell
    • Catastrophization
  • Prostatectomy
    • Prostatectomy
  • Paediatrics Pelvic Health
    • Pediatric Pelvic Physiotherapy
  • Transition Related Surgeries
    • Ways a Physiotherapist Can Help With Preparation and Rehabilitation for Transition-Related Surgeries
  • Preparing for Pelvic Surgery
    • Preparing for Pelvic Surgery
  • Post Pelvic Cancer Rehab
    • Post Pelvic Cancer Rehab
  • Post Breast Surgery Rehab
    • Articles coming soon
  • Lichen Simplex, Sclerosis, and Planus
    • Lichen Simplex, Sclerosis, and Planus
    • Accommodators and Dilators
    • Lubricants and Moisturizers
    • Vulvar Care
    • Pelvic Tissue Dysfunction
    • Pelvic Floor Muscle Tightness
    • Deep Breathing Exercises
    • Reverse Kegels (Pelvic Floor Drops)
    • Sensitive Nervous System
    • Types of Pain
    • Understanding Pain Better
    • Laughter
    • Sleep
    • Nutrition and Persistent Pain
    • Connective Tissue Dysfunction
    • What Are My Myofascial Tender Points?
    • Pain Education in a Nutshell
    • Catastrophization
  • Breastfeeding
    • Breastfeeding
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