Female Dysfunctions: Chronic Pelvic Pain

Chronic Pelvic Pain refers to pain in the lower part of the abdomen, pelvis or pelvic floor. It is pain that has lasted for six months or longer. It can be a symptom of another disease, or a condition in its own right. The cause can often be hard to find.

WHAT CAUSES IT?

There are many excellent websites dedicated to providing information on the various causes of chronic pelvic pain. Some of these causes and the websites are listed below.

Pudental Neuralgia, Neuropathy and Nerve Entrapment

Disorders that involve compression or restriction in mobility of the pudendal nerve along its pathway and causing pain may be called pudendal neuralgia or where the nerve is truly entrapped it may be diagnosed as an entrapment. These are quite rare. Sometimes the pudendal nerve is involved in chronic pelvic pain conditions and sometimes it is diagnosed as being involved where it is not the main cause of the pain.

Vulvodynia

It is a term used to describe vulval pain. It is a generic term and there is a further sub-classification depending on how the pain in the vulva is provoked. This depends on whether it is with provocation or is permanently present. Typically the skin is very sensitised. There may or may not be involvement of the pudendal nerve as well and the two conditions are often confused and need to be evaluated differently.

Vaginismus

Vaginismus is a condition where the pelvic floor muscles have become so tense that penetration with intercourse or even the use of a tampons are impossible or at least very painful. It can be associated with vulvodynia (vestibulodynia) and or pudendal nerve conditions but can also present on its own. The cause is often unknown. It can take a long time for the muscle tension to ease out and dilators are often recommended as a treatment. They may or may not be helpful.

It is important to know that assessment with an experienced physiotherapist may help in finding specific areas of restriction and therefore accelerate the process.

Interstitial Cystitis (IC) - Bladder Pain Syndrome

There is no definitive test for IC. The diagnosis is based on the presence of pain related to the bladder, usually accompanied by frequency and urgency of urine and in the absence of other diseases that could cause the symptoms.

In response to the pain, urgency and frequency the pelvic floor muscles and abdomen become tense going into a holding pattern. The tension becomes part of the problem further feeding into the holding patterns and pain cycle. The pelvic floor muscles need to be able to control at the neck of the bladder.

More about IC at www.ichelp.org

OUR TREATMENT: Manual Therapy & Exercises

Pelvic floor manual therapy and release exercises are a key part of treatment for pain conditions prior to any strengthening program. It is important to note that a multidisciplinary team approach is essential with chronic pain conditions.

You can follow the pelvic floor release exercises on this website – they will apply to everyone. If you are still struggling after a few weeks then you need the help of a physiotherapist who specialises in this area.

Female pelvic floor disorder: Chronic Pelvic Pain

USEFUL INFORMATION

Health Organization for Pudendal Education
www.pudendalhope.info

Vulval Pain Society, UK
www.vulvalpainsociety.org

National Vulvodynia Association (NVA)
www.nva.org

Global Thinking for Women’s Wellness
www.issvd.org