What’s the best way to treat persistent pelvic pain?
If you’ve had pelvic pain for more than a few months, the situation can begin to feel hopeless.
Having pelvic pain is never fun, but experiencing pain that persists for weeks or months on end can feel really scary.
But fear not!
Persistent pelvic pain is something that I treat a lot in my practice and there is hope!
In this blog, I’ll cover what persistent pain is, common causes of persistent pelvic pain, and different treatments I’ve found to be helpful for my patients.
I titled this post “What’s the best way to treat persistent pelvic pain?” because it’s a common question that I get but spoiler alert: there is no one best way to treat pain.
Pelvic pain is a little bit more complex than that. Different treatments work for different people and truthfully, most patients do best with a combination of treatments. So we’ll go over the best ways to treat pelvic pain.
What is pelvic pain?
First, let’s define what persistent pelvic pain is and identify some common causes.
Pelvic pain is pain in the lower abdomen, pubic bone, genital or tailbone region. I might even classify hip and low back pain as types of pelvic pain because the hips and low back do directly connect to the pelvis and there are many patients who experience pain in those regions as part of their overall pelvic pain.
Pain is considered persistent or chronic if it lasts longer than 3 months, as that’s typically the timeframe that it takes for an injury to heal. So when pain lasts longer than that, we can infer that there are many contributing factors and the pain is not due to an injury alone.
Causes of pelvic pain
So what causes pelvic pain? In no particular order, here are some things that can lead to pelvic pain:
Conditions such as endometriosis or PCOS
Pregnancy
Constipation or IBS
Tense abdominal, glute, lower back, or pelvic floor muscles
Muscle strength imbalances
Trauma (both physical and emotional)
Injuries, such as a fall or a vaginal tear (as during childbirth)
Repetitive postures or movements
Infections such as UTIs or STDs
And more. And if you’ve developed pain in your pelvis, it can then be influenced by:
Stress
Sleep (both amount and quality)
Feelings and beliefs about pain
Nutrition
Social support
And more.
With so many possible contributing factors, you can see how pain can very quickly become complex!
Treatment of Pelvic Pain
So how then can you treat pelvic pain? Here are five things that can help a ton!
Hands on work
Most people who have pelvic pain have tense pelvic muscles. As I wrote above, tense muscles can actually be a cause of pelvic pain! However, sometimes it’s a chicken and an egg scenario where the pelvic pain originated because of another reason and then the pain caused the muscles to tense up. Either way, using targeted interventions to release muscular tension is a big part of my practice. This can include massage or other hands-on techniques such as dry needling, myofascial release, visceral mobilization, etc.
If you do not currently have a physical therapist or another practitioner to help you release muscle tension, I love using self-massage tools such as cups or gua sha. Just be sure to be gentle, as the pelvic region usually does not respond well to deep or aggressive pressure.
Exercise
Exercise is so beneficial for many reasons, one of which is that exercise increases endorphins, the feel-good chemical in our body. Because of this, exercise has been shown to reduce pain.
Exercise can also help strengthen weak muscles, and stretches can help relax tense muscles, both of which can ease pain. (My patients are sometimes surprised when a session involves a workout but I tell them that it’s not named “physical” therapy for nothing!)
Stress management
Because stress can contribute to pain, managing stress can help to reduce pain. There are so many different ways to address stress (meditation, yoga, mental health therapy, hobbies, etc.) and to be honest, if you’re under a lot of stress, thinking about trying to reduce your stress can be stressful in itself! It can be a vicious cycle. What I like to tell my patients is to start by just taking a few deep breaths whenever you get the chance, whether that’s when standing in line at the grocery store or after laying down at night. Taking even 30 seconds to be intentional with your breath can help you to slow down. And then you can always add on yoga or whatever else helps you de-stress from there.
A support team
When you’re dealing with persistent pelvic pain, it can be so helpful to work with a pelvic health physical therapist! (Did you see that one coming?) Pelvic floor physical therapists help patients reduce their pain levels all time by using specific hands-on techniques and exercises to help address the root cause of pelvic pain.
However, if you have persistent pelvic pain, you would also benefit from a team approach so that different specialists can manage different aspects of your pain. For example, I as a physical therapist cannot prescribe medications, but there are some prescription medications that can provide a lot of relief! So we may need to have you see a MD to prescribe those. You might also benefit from a mental health therapist to help you manage the emotional effects of living in chronic pain, or you may even consult a surgeon if the root cause of your pain can be addressed with surgery. Having a team to support you will lead to the best outcome as no one provider is equipped to manage all aspects of a patient’s care. As a Pelvic Health Physical Therapist, I know that determining which specialists to seek out can sometimes be overwhelming so I love to help my patients build their team. If there’s another specialist who I’d recommend for you, I’m happy to help you find the best local provider for you and walk you through the process of initiating care with them.
Set realistic expectations
Finally, I want you to hear two messages.
People with persistent pelvic pain can get better so there is hope!
And it may take some time to find relief.
I realize the second one can be hard to hear when you’re hoping every day for relief, but it’s important to know for recovery. Too often I find that people wish for a quick fix and then are disappointed when it doesn’t happen. Wishing for fast relief is completely understandable, but you can get caught in a cycle of getting your hopes up high for one treatment to cure you, trying that treatment, maybe finding a small bit of relief but not a cure, and then feeling disappointed and giving up on treatment altogether. And the problem with that approach is that many times, the treatment would’ve helped more if you had continued it but because of frustrations, you don’t so then you’re stuck right back where you started. I get it. But I’m encouraging you to keep an open mind and adjust your expectations because when you do that, that’s when the magic truly happens!
Hopefully this blog post gave you some ideas of things to try to help with your pain. Remember that treating chronic pelvic pain is a marathon, not a sprint. If you need more guidance, I’d be happy to help.
I offer free 15-minute discovery calls where we can talk through your specific situation. You can schedule your 15-minute discovery call here.
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