We all know the days of Midol and heating pads, curled up on the couch with a bag of fritos in our “fat pants” whining about PMS and the woes of having a uterus. Imagine having all of that, but having it be constant, unrelenting, and/or recurring—even between menstrual cycles. Many women suffer with something called “Chronic Pelvic Pain,” or CPP for short. Chronic pelvic pain is described as non-cyclical pain (not related to menstrual cycle) that lasts for up to 6 months or longer and is located below the belly button, including the lower stomach, low back, buttocks, groin and genital area. Sometimes the pain has certain triggers, such as intercourse or exercise. Other times, the pain randomly rears its ugly head and can make everyday activities torturous.
1 in 7 women live with chronic pelvic pain—worldwide the rates can range from 14 percent to 32 percent. One study shows the prevalence of pelvic pain as high as 39 percent! Costs associated with the condition are estimated at $881.5 million spent annually in the US and Britain, not including the 2 billion dollars associated with non-direct medical costs, such as women missing work due to pelvic pain.
Medical professionals love to label and differentiate pelvic pain, to wrap it into a nice little box with a bow. In my years of practice, I’ve realized it is not this simple. Most patients I meet have a complex amalgamation of symptoms, presenting in various ways that are specific to each individual. We must understand that the pelvis is a very busy place—housing huge blood vessels, nerves, organs, muscles and connective tissue. Dysfunction and pain does not discriminate and may manifest differently day to day, hour to hour. My advice would be to not get hung up on a diagnosis, but address your individualized and ever-evolving symptoms as they are, with the help of a specialist who understands your needs and can help plan a management strategy based solely on your particular situation.
That being said, you may have heard a few of these diagnoses related to pelvic pain. For more in-depth descriptions, please see the resources below:
- Pelvic floor dysfunction: Pelvic floor muscles deep in the bottom of your pelvis help maintain urinary and fecal continence. Dysfunction and pain occurs when you are not able to control these muscles. | voicesforpfd.org
- Vaginismus: Tightness or spasming of pelvic floor muscles causing discomfort, burning, pain, penetration problems, or complete inability to have vaginal intercourse. | Vaginismus.com
- Vulvodynia: Pain in and around the vulva, thought to be caused by injury to or inflammation of pelvic nerves. | nva.org
- Endometriosis: A condition where tissue similar to the lining of the uterus is found elsewhere in the pelvis and abdomen, and may cause scar tissue and adhesions. | Endometriosis.org
- Adenomyosis: Tissue that normally lines the uterus (endometrial tissue) grows into the muscular wall of the uterus. The displaced tissue continues to act normally—thickening, breaking down and bleeding—during each menstrual cycle. | mayoclinic.org/diseases-conditions/adenomyosis
- Polyps/cysts/fibroids: Benign tumors and growths, some fluid filled, which grow in and around the pelvic organs causing pressure, pain, urinary urgency, and other symptoms. | rmob.coloradowomenshealth.com/health/fibroids-polyps-cysts
- “The tissue issue”: Changing hormones throughout the lifespan may result in an unbalance of reproductive hormones, causing thinning of the tissues and thus fragility, dryness and pain. | menopause.org
- Pudendal neuralgia: Pain in the pelvis cause by damage or irritation of the one of the main nerves in the pelvis, the pudendal nerve. | www.pudendalhope.info
- Interstitial cystitis: Pain in the pelvis caused by inflammation of the bladder and urethra linings. | ichelp.org
Pelvic pain can occur at any time along the lifespan: adolescence, reproductive years, perimenopause and postmenopause. Injury or damage may result from pregnancy and/or childbirth, causing long-term repercussions if not treated appropriately at the time of injury. Highly active adults, such as cyclists, often experience symptoms associated with pudendal neuralgia, and high impact sports enthusiasts, such as gymnasts and dancers, often struggle with pelvic floor dysfunction. As we mature, our hormones change and we notice a thinning and drying of the tissues, which often causes discomfort with intercourse. Do not confuse commonality of these symptoms, however, with normality—because it is never normal to experience pain in the pelvis for any reason. Treatment can be simple and extremely effective, without having to go under the knife or expose your body to potentially harsh pharmaceuticals.
Chronic pain in cancer survivors is a frequent and underreported complication of cancer and its treatment. Unfortunately, chronic pelvic pain in survivors is severely under researched and we do not know how many of our super-humans suffer daily. We do know, however, the effects of treatment are physically and emotionally grueling. Patients are not told to expect changes in their sexual lives and are therefore not prepared for the tremendous evolution their body must traverse during surgery, chemo, and/or radiation. Many survivors have said, “I should be thankful I’m alive … I feel guilty for wanting more, wanting intimacy in my marriage.” Remember, chronic pelvic pain is never okay and is never normal. Please speak with your oncologist, gynecologist, or other medical provider about your options—because you have so many!
The Missing Puzzle Piece
Ever experience low back pain, intermittent lower abdominal pain or hip pain? Jaw clenching or teeth grinding? Well, surprise, surprise! Pelvic pain is correlated with low back pain, lower leg pain, abdominal pain—and yes—even jaw pain. If you’ve been visiting your chiropractor or dentist on a regular basis complaining of these issues, perhaps your next stop should be a pelvic physical therapist. Studies show a strong connection between the function of your pelvic floor muscles (which are part of your deep core stabilizers) and the presence of low back pain. If part of your core isn’t functioning correctly, you’d better believe the other muscles in that group will get pretty grumpy for having to do all the work! Other studies reveal similar overactivity in jaw muscles if pelvic floor muscles are overactive. Often, simple exercises—if done with persistence—can completely resolve the issue … No more bite guard at night or heating pads for your back!
Everyday Pelvic Health and Wellness Tips
- Hydration: The foundation of wellness! Ideal equation for your organs (including skin) to operate and function normally: Optimal body weight in pounds ÷ 2 = _____ ounces of unprocessed fluid daily. “Optimal body weight” meaning the weight best suited for your build and activity level, or when you felt at your best (best does not necessarily equal lowest weight in pounds.)
- Clean eating and nutrition choices: Processed, additive and preservative ridden foods have been shown to increase inflammation in the body. Sugar in the form of simple carbohydrates offer little nutrition and also contribute to inflammation. Eat clean and simple, in moderation, using seasonal foods to optimize your body’s ability to heal.
- Exercise: Aerobic exercise on a daily basis is so important when customizing your own “wellness” plan and will also contribute to your healing process by reducing inflammation, keeping blood sugars level and reducing your “stress hormones!” Start slow, gradually work up to 60 minutes of continuous cardio daily, at least 5 days per week.
- Moisturize: The tissues of the vulva and the vagina are similar to those of the rest of your body. There are times when these tissues become dry and fragile, which can lead to pain with intercourse, wearing certain clothing and even when having a bowel movement. There are special vaginal moisturizers over the counter which do not contain hormones and can be used on a daily basis or as needed.
- Massage: Massage can rejuvenate vaginal tissues by increasing blood flow and nutrients to the area and may also release tense muscles. Use lubrication and start externally, gently working the tissues and muscles, progressing internally as you are comfortable.
- Vibration: Very similar to massage, vibration brings blood flow to the area and helps to rejuvenate tissues. Many women are uncomfortable with the use of vibe therapy. However, if appropriate for you, your pelvic specialist will guide you with implementation. For help selecting a tool right for you, ask your medical provider, sex counselor, therapist, or Pelvic Physical Therapist.
How to Ask Your Medical Provider for Help
Don’t feel embarrassed! Speak up regarding your discomfort; your medical provider is ready and willing to help. If they seem caught off guard by your question, ask if they can lead you in the right direction to an informative resource or make a referral. Silence is the worst treatment. Keep a pain diary—where is it and what does it feel like? Note how intense pain is on a scale of 0-10, how long it lasts, if it comes and goes or is constant, how frequently it occurs, what makes it worse and what improves the pain. This information will make it easier for your provider to recommend treatment, or refer you to the appropriate specialist.
Conservative and non-surgical options for treatment
Good news! There are options for treatment … From conservative and organic to more high tech, focused solutions. Starting with hydration and nutrition, begin working your way through a plan individualized for you. Other options include: Pelvic physical therapy, prescriptions, hormone therapy, laser treatment, pain injections, pharmaceuticals (topical and oral) and counseling. Studies show in certain cases, talk therapy in conjunction with medical treatment shows better outcomes than medical treatment alone. Perhaps a little bit of this and a little bit of that is all you need.
Pain in your pelvis is never okay and is not normal! Yes, this includes pain with gynecologic exams. Please report any discomfort you experience to your medical professional. Request a pelvic physical therapy referral. Request a sexual medicine referral. You deserve to not experience pain in your vagina ... Or your pelvic area.
Written by Lily Dawson PT, DPT at Grand Rapids OB/GYN.