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.