What is Pelvic Pain?

Our Family had dinner over the weekend with several other families. One of the guys asked how my new business was going. As I was discussing this and mentioned our specialty practice in pelvic dysfunction, he looked at me quizzically, pointed to his backside and said, “you mean here?”.  I had to giggle, and he defensively laughed a little, and said, “well I have no idea what that means”.  I realized that most people don’t really know what pelvic dysfunction is, and when you say the word pelvic or pelvis people squirm in their seats a little. I decided a blog on pelvic pain would be a good topic to get specific on what symptoms define it, and how to find a practitioner who understands the complexity of pelvic pain.

Pelvic pain can be defined by pain in the lowest part of your abdomen and pelvis. Sounds simple, right?  The truth is that the pelvis is a very complicated region with many organs, nerves, muscles, and connective tissue. It is an emotional center where very intimate experiences happen that are wonderful, pleasurable experiences for most, but can also be very painful experiences when they are unwanted or injured.  There are a myriad of things that can cause pelvic pain. The purpose of this post is not to go into the many problems that can happen, but to just discuss the common signs and symptoms of pelvic pain.  And provide some questions you can ask yourself to determine if you need to seek help for your pelvic pain and where to find a practitioner who knows about it.

Structures of the pelvis can cause pain in a variety of areas. You may experience pain in the lumbar spine (lower back), rectal pain, pain in the lower abdomen, groin pain, pain in the tailbone, and pain in the back or inner thirgh.  For women there can be pain that feels like burning in the vulvar or clitoral area, the tissues around the vagina, or deep in the vagina.  Men may have scrotal, penile or testicular pain.  Both sexes may have pain with intercourse, urination or bowel movements.  Symptoms of incontinence (leaking urine) or trouble emptying your bladder (urinary retention) or bowels (constipation) is also common. The pelvis is a large network of nerves and pain from the organs, muscles and tissues here can refer pain to may locations.

Here are some good questions to ask yourself to determine if you have pelvic muscle dysfunction that may be contributing to your pelvic pain. If you answer yes to any of these it may be time to see a practitioner who can help you with your dysfunction.

• Do you leak urine or stool?
• Do you have trouble emptying your bladder or do you strain to start the stream?
• Are you constipated or do you strain significantly to empty your bowels?
• Do you have pain with prolonged sitting?
• Do you have pain with sexual intercourse, vaginal or rectal exams?
• Do you have trouble being aroused during sexual activity?
• Do you have trouble reaching orgasm during sexual activity or is it painful?

Identifying that you have pelvic pain is the first step. The next step is finding the right practitioner.  Too often health care practitioners are not educated in pelvic pain and do not know what the gold standard for treatment is. Pelvic pain is complex and requires a multidisciplinary approach with good communication between practitioners. Finding a physician who has special training in pelvic pain is not easy, but you should not hesitate to call and ask what type of training the doctor has, how much experience they have with treating this population, and what other practitioners they have whom they work closely with. A physical therapist who is specially trained and has experience treating pelvic pain is another provider that you will need.  Ask the therapist where they were trained and how many courses or continuing education hours they have specifically related to pelvic pain/dysfunction. Ask them how many years they have worked in the field of pelvic floor dysfunction.  You should also have a psychologist on board who is familiar with chronic pain syndromes and  sexual dysfunction.  It is important that you be your own healthcare advocate. Don’t shy away from asking these questions of your care providers, and do not shy away from asking your doctor, physical therapist, or chiropractor for a referral to a pelvic physical therapist and psychologist to help you with your pain.  Providers often don’t know what they don’t know. Your simple question may spark something and they may learn from it, saving others from timely and costly treatments that do not work for pelvic pain.

–Sarah Dominguez, PT, MSPT, CLT

This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you.  If you enjoyed this blog, check out our website at foundationalconcepts.net for more blog entries and to learn more about our specialty PT practice, Foundational Concepts.  Follow us on Twitter @SarahpelvicPT or @Jenn_pelvic_PT and like us on Facebook at Foundational Concepts for updates.