May is pelvic pain awareness month, and pelvic pain is a topic I am asked about so frequently that it bears talking about from a variety of angles. So many women and men live day in and day out with pain in their pelvic region, buttocks, genitals, pubic area, tailbone, groin, bladder, genitals, rectum. It can get in the way of day to day activities like sitting, walking, sleeping, sexual activity, exercising, working, or child care. It can change your mood, your focus, your ability to engage with people you want to (or just need to) spend time with and pay attention to.
It's is a term that you may hear about and may have read a lot about. If you have pain somewhere in “that area” that is hard to describe, you have probably already done some research online to try to figure out what is wrong. You may have even found some possible suggestions as to how to solve this problem.
But how do you know whether what you have is Pelvic Pain?
When we say "pelvic pain", we’re talking about a number of different problems, with one term, so let’s break it down.
Physical therapists in all realms of treating the musculoskeletal system use a process of differential diagnosis to determine what is causing the client’s symptoms. This means simply that the problem must be correctly diagnosed, to the exclusion of other possible diagnoses, in order to be treated effectively. This diagnostic process allows the clinician to define the problem that is being treated, and to determine the needs of the client based on his or her individual presentation. Rehabilitation professionals must also consider symptoms and clinical examination findings that point to a need for other health care providers’ involvement. In pelvic rehabilitation, this can become a challenging process. Possible musculoskeletal causes of pelvic pain include abdominal wall or pelvic floor muscle trigger points, hip joint pain, coccyx pain, and irritation of the pudendal nerve. In addition, examples of other medical conditions that can cause pelvic pain are bladder, bowel, or gynecologic malignancies, endometriosis, pelvic congestion, interstitial cystitis, urethral syndrome, constipation, inflammatory or irritable bowel syndrome. (See this article in Canadian Family Physician for more.) It is common to find multiple sources of pain in our population of clients with chronic pelvic pain.
Within a multidisciplinary approach, which is most often the recommended approach to treating chronic pelvic pain, physical therapy will ideally work with other practitioners to develop the best course of care for the patient.
Helping health-oriented people overcome pelvic health problems, and live the life you love!
Deborah S. Cohen
Specialist Pelvic Health Physical Therapist