Introduction to Pelvic Pain

The institute estimates that about one-third of Americans will experience some form of chronic pelvic pain over the course of their lives. It is important to understand that chronic pelvic pain is a symptom and may be the result of a number of different diseases or muscular imbalances.Symptoms can manifest in a wide variety of ways, depending on the source of the patient’s pain. Commonly reported symptoms include, but are not limited to, urinary urgency, pain while sitting, urethral discomfort, anal numbness, pain during sex, and throbbing aches or burning pain after intercourse. (Note: Some of these symptoms can also occur because of sexually transmitted diseases; we recommend getting screened to determine STD status to ascertain if such an illness is a contributing factor.) Sex and sitting are two common activities that can potentially contribute to pelvic pain. Others include bike riding, tight clothing, and weight lifting. If the source is bladder-related, dietary choices may have an influence as well. Stress and anxiety can make some pelvic pain conditions worse, creating a self-defeating cycle.

While the conditions that cause pelvic pain vary widely, the actual physical discomfort is almost always deeply unnerving and scary, especially before there is a diagnosis and a course of treatment has been reached. Many patients describe feelings of hopelessness, isolation, and a tendency towards “catastrophic thinking.” Some fear they will be afflicted with pain forever and that it will ruin their ability to carry on romantic and sexual relationships. Because of the location of the pain, often in and around the genitalia and buttocks, many people have a hard time talking about it with their friends, family and even their doctors, which can deepen feelings of isolation. Men are believed to have a stronger tendency towards not discussing their pelvic pain (multiple studies have shown that they seek medical assistance less frequently), which may account for the higher reported incidence rates among women. Many pelvic pain conditions cause intermittent discomfort, so the symptoms may “flare up” at periods of higher stress, for example. Lack of constant pain can provide relief, but if and when the pain returns, the effects can be quite demoralizing. It is essential that patients learn to take these setbacks in stride, always remembering that the pendulum swings the other way as well! Flare ups do end!

Chronic pelvic pain can have significant life impacts depending on the conditions behind it, its intensity and the psychological and social state of the individual patient. The pain itself is, of course, often very discomforting. In some cases, it can be eased by changing certain lifestyle choices, like the amount of time spent sitting over the course of a day. Patients have reported changing their social, sexual, workplace, recreational and household habits due to pelvic pain. While this is sometimes necessary, the emotional toll of such changes can be great and if, for example, a patient abandons social outings for fear of pain or shame, the toll will only be more devastating. One 1996 study by X Mathias showed that 15 percent of pelvic pain sufferers lost time from paid work and 45 percent reported reduced productivity. These alterations can be demoralizing as well. No one likes to feel as though they are changing their life because of an illness.

The various conditions that can cause pelvic pain are too numerous to list in this limited space but in general, there are two types of diagnoses. Overt medical reasons for pelvic pain, such as sexually transmitted illnesses, urinary tract infections and reactions to certain kind of food or drink can often be dealt with by simple alterations of diet and pharmaceutical regimens. The other type of condition associated with pelvic pain relates to muscle hypertonicity, which means overly active muscles are being tightened subconsciously and habitually. These ailments are sometimes unknown to urologists and other doctors who are untrained in physical therapy. This accounts for the unusually high number of physicians many patients see five and seven before the treatment is properly assessed and treated. In these cases, medical interventions with medications, trigger point injections, and, on rare occasions, surgery can be useful. Outcomes will likely be greatly improved if paired with a frequent appointments with a physical therapist, who can both perform interventions and train the patient how to do the stretches, breathing exercises and other practices that can calm overworked and hyper-tense muscles. For patients who are struggling with the emotional turmoil that often accompanies pelvic pain, psychiatric treatment can be useful.