Pain is no doubt part of the human experience. We have all stubbed a toe or fallen and scraped a knee. That type of pain makes sense. It hurts. You may rub it, look at it, and after a day or two it settles down and is no longer sore. Sometimes this pain might linger longer than you think it should. You would certainly talk to someone about it. Show them your toe, how it looks fine, but is still bothering you quite a bit. Once you convinced yourself nothing was really wrong, the pain in the toe will go away. What if your pain was pelvic pain? Suppose it came on after a long bout of sitting on a hard surface? Or worse, with no injury at all. Would you look at it? Inspect it? Talk to someone about it?
Pain and Perception
What makes pelvic pain so troublesome is that most humans aren’t very comfortable with their genitalia. They aren’t comfortable talking to anyone about it, even their healthcare provider. This causes a lot of worry, anxiety and fear associated with the pain. On top of that it may limit intimacy in relationships, causing a large emotional burden on the patient. All of these feelings increase the amplification of the nervous system. Turning it up to become more sensitive, meaning more signals reach the brain. The more fear and worry, the more these signals are perceived as pain. Many healthcare providers are not even informed enough about pelvic pain to provide the correct guidance or terminology, inciting more fear and worry in patients.
Chronic pelvic pain can be confusing. It is often accompanied by many tests and procedures that come back without any diagnosis. Many different medications may be prescribed, without much relief. Healthcare providers shrugging their shoulders. All of these negative experiences without real answers further drives the fear and worry. This increases the pain experience.
Pain and the Brain
There are hundreds of nerves in your body that transmit information to the limbs, hands, feet, organs, muscles and joints. They also receive information from these structures and bring it back to the spinal cord, which then shares it with the brain. In a system that has not been amplified, the spinal cord often decides what is important enough to be passed along to the brain. For example, your pants touching your inner thigh is not worth the attention of the brain. However, in someone whose volume is turned up, that stimulus is allowed to reach the brain. The brain is concerned, “why do my pants cause pain?” The more that stimulus is perceived as a threat to our systems, the more pain we feel.
Many people with chronic pelvic pain have been given any number of diagnoses. Endometriosis, pudendal neuralgia, vulvodynia, chronic prostatitis, vaginismus, interstitial cystitis, irritable bowel syndrome, the list goes on. The truth is, although they may all be different causes of the pain, they share common characteristics regarding how the pain developed, and how it can be treated. Pain is produced by the brain when we feel danger or fear about a sensation. It doesn’t matter if the sensation is from the colon, bladder or muscles, the body’s response to danger is protection. Pain is a very big part of protection for our body.
Treating Pelvic Pain
Chronic pelvic pain can produce pain in any part of the abdomen, spine, pelvis, hips, groin and more. There are postural and muscular changes that occur when pain persists and these need to be addressed. The primary goal of treatment needs to be working to turn down the amplification of the nervous system, while working with the tissues to regain improved function and movement. A physical therapist trained in pelvic dysfunction, but who is also knowledgeable about chronic pelvic pain management, is very important in treatment. It is also very important that they work alongside a medical provider who has experience in chronic pain management, and a mental health provider who can help turn down the nervous system as well.
At Foundational Concepts, Specialty Physical Therapy you will find empathetic, knowledgeable providers who can help educate you about your chronic pelvic pain, and work to improve your function and movement while decreasing the fear and danger that have been driving your pain and your life.
-Sarah Dominguez, PT, MSPT, CLT, WCS, CMTPT