Did you know that May is Pelvic Pain Awareness month? That it’s also Mental Health Awareness month? I’d like to think that the two are not unrelated as so many women and men go through tremendous psychological stress when dealing with persistent pelvic pain – from a lack of awareness of differential diagnoses (‘I can’t find anything wrong therefore it must be in your head’) to delayed accurate treatment (the average women with endometriosis waits 6 years and sees multiple providers before getting an answer) to the ongoing stress and stigma associated with matters pertaining to bladder, bowel or sexual function (never mind being unable to sit if you have pudendal neuralgia!) No wonder the nervous system becomes wound up – inaccurate diagnoses usually lead to inaccurate treatments, including surgeries (no, hysterectomy is NOT an answer to undiagnosed pelvic pain) and medications (if a man with pelvic pain has no signs of infection, why keep putting him on antibiotics for ‘prostatitis’?) I’m hardly unbiased, but I do think this is where skilled physio assessment and interaction needs a bigger role….
For example: some questions to consider around pelvic pain….
Is the pain cyclical? Or maybe it was cyclical originally, now it is constant, with painful sex, abdominal bloating and fertility difficulties? Could it be endometriosis?
Is the pain worse after eating? Is there a pattern with constipation or diarrhoea? Is there a link between what you’re eating (your stress levels) and your abdominal discomfort? Could it be Irritable Bowel Syndrome?
Have you had pelvic pain lasting longer than six months? Does it get worse with bladder filling but eases with emptying? Do you have a persistent urger or increased frequency? Have infections of the bladder/urethra been ruled out? Could it be Bladder Pain Syndrome? (Interstitial Cystitis)
Do you have difficulty starting urination? Do you feel like you don’t empty completely when you’re having a bowel movement? Are you prone to constipation? Is penetrative intercourse painful? Could it be Pelvic Floor Muscle Dysfunction?
And of course sometimes it is a combination of all of the above!
Of course this is just a small example of possibilities when it comes to persistent pelvic pain – what they all have in common is that the brain goes into near constant high alert which encourage the pelvic floor muscles to follow suit. This makes the pain output system turned up, which affects the digestive system, mood, libido, fear of movement, general muscle dysfunction, social isolation, sleep disturbances…and it keeps spiraling until we learn how to gently stop the cycle – we need to address ALL of the players – brain, bowels, bladder, biomechanics and biopsychosocial…easy really!!
Comprehensive treatment of pelvic pain needs to include it all – stress management, mind body techniques (asking people what they do for FUN?) movement therapies, manual treatment – still very important for graded exposure and restoring a connection with the body, good sleep hygiene, eating well for pelvic health – the whole system has to be involved from brain to microbiome to elimination and of course sexual ergonomics and functional goal setting – in conjunction with the person who is sitting in front of you…it can be a long and perhaps overwhelming list, but looking at the whole person, not just the bladder or bowel or a set of muscles is essential if we are to help people live well.
If you’d like to take a deeper dive into pelvic health…I’ll be teaching Pudendal Neuralgia, Neuropathy or Entrapment? in New York next weekend, the Athlete and the Pelvic Floor in Chicago June 9/10 and PF1 in Washington DC June 22,23,24
In the meantime…I had the great pleasure of interviewing Sandy Hilton recently about our perspectives on pelvic pain, neuroscience, manual therapy and graded exposure, movement and the importance of pleasure hunts…Intrigued? Have a watch of this!
Until next time
Onwards & Upwards!