May is Pelvic Pain Awareness Month! The International Pelvic Pain Society made this designation to help create more awareness of those living with chronic pelvic pain, as these individuals often go unnoticed and the treatment of which can be very multifactorial and complex. Due to this complexity, the prevalence and epidemiology of these conditions is not well known, but it is more common in women than men and often occurs in individuals aged 36-50 (1).
As a pelvic physiotherapist, I assess and treat conditions that arise in the area of the pelvis including the pelvic girdle, pelvic floor, abdomen, low back, hips and buttocks. As such, I treat clients pelvic pain conditions on a daily basis suffering from both acute (0-3mo) and chronic (>3mo) pelvic conditions. Examples of chronic conditions include endometriosis, interstitial cystitis/bladder pain syndrome, dysmenorrhea (painful periods), pain with intercourse, low back pain, tailbone pain and gastrointestinal issues such as IBS.
Pelvic floor physiotherapists take a holistic approach to treatment of chronic pain conditions. This may include both an exam and treatment of tissue dysfunction in the pelvic floor and nearby soft tissue, but will often extend to education about pain and your pain system, as well as lifestyle and psychological concerns such as high levels of stress, poor sleep, and fear of movement.
Top Tips for Managing Chronic Pain
- Breathe with your diaphragm: Your diaphragm is your main breathing muscle. Learning to breathe with this muscle can release tension in the pelvis and calm your nervous system which will help to reduce your overall pain experience. Lie in your back with your knees bent and feet on the floor. Place your hands around the bottom of the ribcage and take a slow inhale through your nose and into your hands. Exhale slowly as though you are blowing out a candle. Repeat for 5 minutes each day.
- Stretch muscles around the pelvis: Try combining diaphragmatic breathing with hip and spine opening movements such as childs pose, cat-cow, happy baby and butterfly pose.
- Good bowel habits: Aim to consume 0.5 oz for each lb of body weight in water daily, assess your eating habits and prioritize fiber (typically 25-35g/day for an adult), incorporate movement into every day and sit on the toilet with your feet on a stool so that your knees are higher than your hips
On the pain system...
According to the International Association for the Study of Pain, pain is defined as: “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” (2) Important to note in this definition is that pain includes both sensory and emotional experiences and it is associated with actual or potential tissue damage – meaning, you don’t need any injury to feel pain. Think of your pain system as your body’s ‘alarm system’. When our brain interprets that we are in danger, it ensures that we feel pain which motivates us to take notice and make a change (e.g. don’t hold your finger on a hot stovetop). But, when pain goes on longer than what is reasonable for normal tissues to heal (typically 3mo), we need to dig deeper into the emotional, social, immunological, and cognitive aspects of an individual person and determine why our brain is continuing to send danger signals. For example, are you experiencing a high level of stress? Are you scared to move? Have you experienced a trauma? All of these things can make your alarm system more sensitive. As physios, we call this taking a biopsychosocial approach to treatment or considering the whole person.
- Alappattu MJ, Bishop MD. Psychological factors in chronic pelvic pain in women: relevance and application of the fear-avoidance model of pain. Physical therapy. 2011 Oct 1;91(10):1542-50.