How Physical Therapy Helps Pelvic Pain

Pelvic pain affects up to 20 percent of the population in the United States, including women and men. It is pain felt in the abdomen, pelvis, buttocks, vaginal and rectal area, and can refer to hips or back of thighs. Pelvic pain is considered chronic when it lasts for more than six months. It is usually treated with a multidisciplinary approach with physical therapists, urogynecologists, physiatrists and gynecologists usually involved in diagnoses and treatment.

Pelvic pain can be complex and can be caused by many different injuries or events, such as:

• Pregnancy and childbirth.
• Orthopedic problems in the joints of the pelvis such as the SI joint and pubic symphysis.
• Muscle weakness or tightness in the muscles of the vagina, rectum, pelvis and abdomen.
• Pressure on the nerves in the pelvis.
• Weakness in the muscles of the pelvis and pelvic floor.
• Scar tissue after childbirth, abdominal or pelvic surgery.
• Disease.

Symptoms of pelvic pain can vary  

Pelvic pain can be achy, sharp, burning or stabbing and usually felt in the lower abdomen, pelvis, buttocks and back of thighs. Some patients report pain in tailbone, and that it usually comes on when sitting. Others people report a heavy pressure feeling in the pelvis area or they feel like there is an object in the vagina or rectum.

 Pelvic pain can affect your mobility and function

• Difficulty with standing and sitting for long periods of time.
• Difficulty with walking, sleeping, driving or doing household chores.
• Pain with exercise, biking or running.
• Pain with sex.
• Urinary leaking, having to go constantly and getting sudden, strong bladder urges.
• Constipation or straining with bowel movements, or pain during bowel movements.
• Difficulty using tampons.

Pelvic pain can be diagnosed by your primary care provider, urogynecologist, gynecologist and physical therapist.

Your healthcare provider can run tests to rule out medical issues such as cancer or pelvic disease. A urogynecologist will look for prolapse of pelvic organs, and/or muscle weakness or tightness. A physical therapist will complete a thorough review of your medical history and perform a physical examination to identify the causes of your pelvic pain and any joint issues, muscle tightness or weakness, or nerve involvement.

Pelvic pain can be treated conservatively with physical therapy

The international pelvic pain society (IPPS) identifies physical therapy as a first-line of treatment for pelvic pain.  

Based on the examination results, your physical therapist will design an individualized treatment program to meet your specific needs and goals.

Your physical therapist will:

• Show you how to identify the appropriate muscles, such as the pelvic floor, deep abdominals and diaphragm.
• Work on your tight or weak muscles with massage and manual therapy techniques to correct to reduce muscle pain, correct alignment in joints, and relax and re-educate muscles to work correctly.
• Educate you on how to use these muscles correctly for activities like exercise, posture correction, getting up from a chair, or squatting to pick up a child or pick something up from the floor.
• Teach you exercises to stretch and strengthen the affected muscles and retrain them, so they work together normally.
• Teach you techniques to improve blood flow and tissue function in the pelvic area.
• Teach you appropriate pelvic floor muscle exercises.

Case study

The case of Angie (not her real name) illustrates how a woman might experience pelvic pain and the various treatment approaches used to resolve her pain.

At the age of 22, Angie noticed she had pain with intercourse with her partner. She was diagnosed with vaginismus, which is a type of pelvic pain where women have pain in the vagina only when trying to use a tampon or engage in intercourse. She was referred to physical therapy at Overlake and was treated with muscle relaxation training, manual therapy, dilator work and working with her partner to allow her to meet her goals of pain-free intercourse. She was able to overcome vaginismus and successfully engage in sexual intimacy.

Five years later, I saw Angie again after she had a baby. She had been experiencing severe pain with intercourse, painful bowel movements and bladder urgency/frequency.

This time she had muscle tightness and spasms in her pelvic floor muscles after she sustained a tear to her vaginal muscles during childbirth. She was treated with pelvic floor muscle relaxation/training, massage to the vaginal scar, muscle strengthening, use of biofeedback and electrical stimulation to relax and strengthen the pelvic muscles. She was given extensive training in use of fiber, water intake, and correctly emptying bladder and bowels.

Angie had complete resolution of her symptoms including pain-free intercourse, normal and regular bowel movements and resolution of bladder leaks.

This is a common case we see here at Overlake. We treat women of all ages with various pelvic floor complaints and are able to help them meet their lifestyle goals. Pelvic pain is successfully treated when correctly diagnosed and addressed with a combination of conservative treatments and medical management.

If you are experiencing pelvic pain, schedule an appointment for an evaluation from your healthcare provider.