Definitions and Classification of Chronic Pelvic Pain
Chronic Pelvic Pain is defined as “non-cancerous pain of the pelvis lasting more than 6 months”. The pain can be continuous or chronic. Once your physician rules out any acute causes of pain, then it is defined as chronic pelvic pain.
Another term commonly used is Pelvic Pain Syndrome. This is defined the “persistent of recurrent intermittent pain associated with the pelvic including the urinary tract, sexual, bowel, or gynecological dysfunction.” Infectious causes must be ruled out.
Conditions that cause Pelvic Pain Syndrome
- Painful bladder syndrome
- Urethral pain syndrome
- Vaginal pain syndrome
- Vulvar pain syndrom
- Anal Spasm
- Pudenal Pain syndrome
- Pelvic floor muscle pain syndrome
It is thought that 15% of women aged 18-50 years will have pelvic pain at some point in their lives. Some studies show that some pelvic pain symptoms like painful periods or painful intercourse may occur in up to 50% of women.
Causes of Chronic Pelvic Pain
Sudden onset of acute Pelvic Floor Muscle pain may be caused by new onset of exercise program. The reason for chronic pelvic pain is not clear. Some possible causes are:
- Abnormal pelvic floor muscle tone
- Pelvic floor muscle pain and overactivity
- Pelvic floor/myofascial trigger points
Impact of overactive Pelvic Floor Muscle on Bladder and Bowel function
The pelvic floor muscles are constantly contracting and relaxing which affect the urinary tract. Possible problems that may arise include hesitancy or difficulty urinating, slow urine flow, painful bladder emptying, incomplete bladder emptying (feeling of still being full), strong urge to urinate and fear of not making it on time, and the need to empty bladder frequently.
Patients with hyperactive pelvic floor muscles will feel the normal urge to have a bowel movement, but have a difficult time emptying their bowel or feel that there was incomplete emptying. This may result in constipation, which over time may cause hemorrhoids.
Treatments for Chronic Pelvic Pain
There are many solutions that are used in the treatment of chronic pelvic pain. After a thorough evaluation, you will be given a diagnosis, but more importantly a physical therapy plan that will help control or eliminate your pelvic pain.
Sitting in a bath tub with hot water has been shown to result in relaxation of the resting tone of the pelvic floor muscles in spasm. Long term success is not known, but this is a simple solution that can be started today and used whenever you are home. Ice packs on the other hand have not been shown to be helpful.
Use of vaginal dilators has been recommended for years. Unfortunately there are no good studies that have shown this to be beneficial for the treatment of pelvic floor muscle pain.
Our experience has shown that electrical stimulation has the best success rate. Estim causes a sustained contraction, which results in muscle fatigue. The fatigue can eventually result in relaxation of the spasm. It has also been shown that electrical stimulation can cause hypersensitive nerves to not send the pain signals and also to cause the nerves to release endorphins that reduce pain. This has been used as a form of treatment since 1982 with multiple studies showing success approaching 90%.
We do not recommend trying kegel exercises as a treatment for pelvic floor muscle spasms or trigger points. Unlike Estim, you will not be able to successfully contract your muscles long enough to cause the muscles to get tired. This may result in more spasm.