Helping with Pelvic Girdle Pain
Pelvic Girdle Pain: Management & Solutions
Do you…
– Experience pain with pelvic exams at the doctor’s office?
– Have difficulty or have never been able to insert a tampon because of feeling pain or blocking?
– Have painful or uncomfortable sex or intimacy.
– Dread intimacy with your partner, or maybe, you’ve never been able to be intimate?
In the United States, 1 in 7 women ages 18-50 have pelvic pain.
Common Physical Complaints include;
Pelvic Pain
Difficulty peeing (pain, hesitation, frequency)
Difficulty pooping (pain, constipation)
Difficulty with intercourse (pain)
Limited Sitting
Difficulty wearing tight clothing or jeans
What is pelvic girdle pain?
Chronic pelvic girdle pain is often defined as pain in the abdomen or pelvis that has lasted longer than 3 months, and not caused by diseases or conditions, such as painful intercouse, painful menstrual cramps or endometriosis.
Pain may be felt in these areas:
– Lower abdomen
– Vulva/Vagina
– Perineum
– Anus
– Tailbone
– Low back pain
Being in a chronic state of pain affects women not only physically, but mentally, as well. As stated in the introduction, you are not alone in this. Research shows 25% of women with chronic pelvic pain may spend 2-3 days per month in bed. More than 50% limit their daily activities 1-3 days/month, 90% have pain with intercourse, and nearly 50% feel sad or depressed.
There are some conditions that can be the cause of pelvic girdle pain, however pelvic pain can also be caused by pelvic muscle dysfunction. In most cases, pelvic pain can be improved or completely resolved with the help of a women’s pelvic health physiotherapist.
Conditions potentially causing pelvic girdle pain
- Endometriosis
- Pelvic congestion syndrome
- Pelvic inflammatory disease
- Radiation cystitis
- Interstitial cystitis
- Abdominal or pelvic trigger points
- Low back pain
- Nerve entrapment
- Depression
- Constipation
- Irritable bowel syndrome
- Peripartum pelvic syndrome
- Malignancies: bladder, colon, gynecologic
Causes of Pelvic Muscle Dysfunction
- Prior pelvic surgery
- Childbirth injury
- Low back pain
- Sexual injury
- Pelvic infection
- Pelvic inflammation
- Poor posture
- Sacroiliac (SI) joint pain
- Fall on tailbone
- Stress, tension
- Chronic holding (trying to avoid leakage)
- Chronic straining
- Muscle guarding
Your Core Foundation
- Diaphragm
- Transverse abdominis
- Pelvic Floor
- Multifidus
These are the key muscles that can help protect your core and pelvic girdle region. If there are issues in how these muscles are functioning then it can translate into problems in your pelvic region.
Role of the Core/Pelvic Floor
- Core (Multifidus, TrA, Diaphragm, and PF) stabilizes back, hips, pelvis
- Your pelvic floor muscles span from your pubic bone to your tailbone
- Pelvic floor acts as a sling to hold in our pelvic organs against gravity and increases in abdominal pressure (pregnancy, cough/sneeze/laugh, aging)
- Controls stop and start of urine and feces
- Improves sexual function (some of the muscles are involved in providing blood flow to the clitoris and some of the muscles must relax)
What is all this talk about Kegels?
You may have been told to keep your pelvic floor healthy, “do your kegels”! Or sometimes you’re worried that sex won’t feel as great to you or your partner unless your pelvic floor is “tight”. These things may be working against you if you are experiencing pelvic pain or pain with sex. If you are currently doing kegels while sitting at stop lights in your car or while you’re sitting at your desk or while you’re peeing, go ahead and stop now.
Our pelvic floor muscles are meant to be dynamic and support us when we are moving or sneezing or lifting. Our pelvic floor muscles need a rest or break just like all of our other muscles. So when you are sitting down, let your pelvic floor muscles relax.
Why does sex hurt?
Sex could be painful for a variety of reasons.
- Sometimes sex is painful because of poor lubrication. For women who are peri or postmenopausal, on hormonal birth control, and/or are breastfeeding, lubrication can be a challenge. A good, quality lubricant to use during intercourse is always important to have on-hand (no KY Jelly!). For some women, using lubricant during sex isn’t quite enough, lubrication can be helped by addressing vaginal tissue health. Some women need medications or specialized creams to help their vaginal tissue be more lubricated.
- Sex may be painful because of scar tissue. Some women have had vaginal surgeries that left behind some sensitive scar tissue. And some women have had tearing or an episiotomy from a vaginal delivery. Scar tissue isn’t naturally as flexible as our original tissue, but it can be more flexible and less sensitive with some scar work.
- Sex may be painful because of pelvic floor muscle tension. Sometimes your pelvic floor muscles may be so tense that it is making penetration during intercourse difficult, painful, or flat out impossible.
- Sex may be painful due to sexual or physical trauma in your past. If this is something you have experienced, we encourage you to speak with a mental health care provider. Pain is a very emotional and physical experience. Being sure to process these emotions with a professional is important and can pair very well with working through the physical aspect with your physical therapist.
Pelvic Health Physical Therapy Assessment for Pelvic Pain
Assessment with a women’s pelvic health physiotherapist may involve some or all of the following:
- A comprehensive history will be taken so we can understand your main concerns, what might be contributing to them and your goals for treatment
- You may be asked to complete questionnaires and bladder and bowel diaries
- Your pelvic health therapist will do a thorough physical assessment of your muscles, including your pelvic floor muscles. The internal pelvic examination will evaluate the function of your pelvic floor muscles and your ability to contract and relax these muscles.
- Real time ultrasound gives you immediate visual feedback so you will be able to see when you are contracting and relaxing the pelvic floor muscles. This will help you to be confident that you are doing your exercises properly.
- Talk to your doctor about your pelvic girdle pain in conjunction with your physiotherapist. There are a variety of tests that they may want to complete to help your management pathway. These may include a urine sample, ultrasound or urodynamic studies.
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Management of Pelvic Girdle Pain
Management of Pelvic Girdle Pain can be through conservative treatment, medicines, or surgery. Initial treatment should be conservative; this is done with a pelvic health physiotherapist.
A pelvic health physiotherapist is a qualified physiotherapist with extra qualifications and a specific interest in pelvic girdle health. They are best equipped to assess, treat, and manage pelvic pain.
Conservative management may involve:
Lifestyle Advice
After considering possible causes of pelvic pain, your pelvic health physiotherapist will give you advice on lifestyle changes you can make to help manage your pelvic girdle pain. The discussion may include, information about general exercise (what is helpful versus unhelpful), stress management, or encouragement to see your Primary Care Physician. You will be educated about good bladder and bowel habits. You will be advised to sit on the toilet with correct posture.
Downtraining
The importance of assessing your pelvic floor muscle tone and strength helps your physical therapist to understand if you’d benefit from relaxing and lengthening your muscles, strengthening your muscles, or both. Downtraining means to relax and lengthen your pelvic floor muscles. This can be done via diaphragmatic breathing, using various cues, the use of Real Time Ultrasound, stretches, and exercises.
Pelvic Floor Muscle Training
Once you’ve established relaxing and lenghthening your pelvic floor muscles, your physiotherapist will work on establishing a program specifically for you.
To activate your pelvic floor muscles, squeeze and draw in as if stopping the flow of urine. You should feel closure around the anus and urethra. Women will feel this in the vagina also. You don’t need to tighten your buttocks or abdominal muscles.
Once you have mastered this muscle activation with the guidance of your pelvic health physiotherapist, they will design you a pelvic floor muscle training program. The program will be reviewed and changed during subsequent treatment sessions. It takes time to alter the pelvic floor muscles and improve their function, so it’s important to follow their guidance.
General Exercise Advice
Maintaining your general fitness will help improve overall muscle tone in your body, including your pelvic floor. Daily physical activity will also keep your bowel emptying at regular intervals. Your pelvic health physiotherapist will help you establish an exercise program, taking into account your individual goals and preferred exercise.
Medical and Surgical Management
You can also talk to your doctor about pelvic pain. There are a variety of tests they may recommend, including analysis of a urine sample, an ultrasound, urodynamic study, hormone testing, or biopsies. Your doctor will advise you if medications or surgery might be appropriate. Medications help with some forms of pelvic pain. Injectable agents or surgery may be considered if conservative measures have failed or if the pelvic pain is severe.
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