May is Pelvic Pain Awareness Month, a designation that came about in 2017, thanks to the International Pelvic Pain Society (IPPS) wanting to raise awareness about this often incapacitating condition.
As the IPPS notes, "chronic abdomino-pelvic pain can be a debilitating condition that can have significant consequences on an individual’s physical, mental, economic, and social well-being."
To help raise even more awareness, we asked Dr. Alicia Jeffrey-Thomas, one of our wonderful pelvic floor physical therapists, to talk about pelvic pain and how pelvic floor PT can potentially help alleviate symptoms.
Define pelvic pain. What are the symptoms?
DR. ALICIA JEFFREY-THOMAS: Pelvic pain is pain that exists in any of the areas surrounding the pelvis. Pelvic pain can present in a number of ways, including lower abdominal pain, back pain, tailbone pain, even hip pain.
You could also have things that then develop into urogynecological and GI problems. For example, you could have pain with bowel movements. You could have pain during intercourse or with speculum exams or with using tampons. You could have painful urination. You could have bladder pain. This list is seemingly endless.
Unfortunately, once one area of the pelvis experiences irritation and pain, the irritation and pain can spread. I often joke with my patients that once one muscle gets involved, all the other muscles want to come to the pain party. And so it's my job to work with the patient on shutting down that pain party.
Does pelvic pain affect women and men?
DR. ALICIA JEFFREY-THOMAS: Yes. All bodies have a pelvic floor. The only difference is that in cisgender male bodies, it's closed on the pelvic floor as opposed to being more open. But they can still develop pelvic floor trigger points and things like that. In men, you'll often see pelvic pain being blamed on the prostate, but really there's a whole sub-category of non-bacterial chronic prostatitis that ends up being pelvic floor dysfunction.
What causes pelvic pain?
DR. ALICIA JEFFREY-THOMAS: Let's start with the overarching umbrella: trauma. So that can be childbirth trauma. That can be falling on your tailbone trauma. That can be hurting your back. The problem with trauma is that it can cause a cascade of symptoms. You can also have sexual trauma, which would fall under this umbrella.
Infections can be another cause, like urinary tract infections (UTIs). And the patient might have the sense that, even though the infection has cleared, the symptoms—like the pelvic pain—never really go away. That's because the pelvic floor has kind of taken over and has continued to send those signals of pain or urgency or burning or things like that.
Sometimes pelvic pain can come from stress or anxiety. We all have that fight-or-flight response where our pelvic floor decides if it wants to 'guard up' in response to something stressful.
While other causes of pelvic pain do exist, trauma, infections, and stress/anxiety are the big ones.
Let's talk about how pelvic floor physical therapy can help treat pelvic pain.
DR. ALICIA JEFFREY-THOMAS: The treatment techniques that pelvic floor physical therapists use will range from external to internal. The reason we don't necessarily start with internal techniques is because sometimes somebody's system is already in such a state of fight or flight. We wouldn't want to go for internal pelvic floor releases because that might trigger that system more.
In those cases, we might start with doing gentle breathing exercises to kind of calm down the nervous system. We can do gentle stretches as well, where maybe we're stretching the abdomen or we're stretching the pelvic floor in a deep squat or a happy baby pose.
We might stretch your hip flexors or your glutes or different muscle groups that surround the pelvis. The goal is to create an overflow effect to the pelvic floor. And we can do trigger-point releases in those same areas as well.
When we get to the internal work, it's very gentle. If I can work on a muscle with extremely light pressure, then I'm going to do that. There's no reason for a patient to be in pain while we're doing internal releases. Patients might experience a little discomfort, simply because we're working in that area, but it shouldn't be something where you feel like you're disassociating or not able to withstand the pain or gritting your teeth.
We also teach patients how to do internal releases themselves. So whether that's with a pelvic wand or with dilators or different things like that. It really depends on the patient's goals. And it depends on what the patient is willing to do at home.
So who's a good candidate for pelvic floor physical therapy when it comes to pelvic pain?
DR. ALICIA JEFFREY-THOMAS: I think that it's good to have had a recent exam by a physician before coming to pelvic floor physical therapy, because they can rule out things like active infections. Your pelvic floor is going to be overactive when you have an active infection, like a UTI. So we'd want patients to address those things first.
I love the collaborative relationships that we have here at Greater Boston Urology. Because our urogynecologist (Dr. Angel Marie Johnson) or our urologists will say to patients, 'OK, we've ruled out X, Y, and Z. So now we're sending you to pelvic floor PT.'
If you know the cause of your pelvic pain—like you took a nasty spill and landed on your tailbone—you can usually come straight to PT. Or if you're a woman who's experiencing painful sex or you can't tolerate a speculum exam, coming to PT first can help you train your pelvic floor to tolerate those things.
Bottom line: If you're having any pelvic pain symptoms, talk to your doctor or—ideally—a pelvic health expert, like Dr. Angel Marie Johnson or someone like me. Because we're going to be screening for things that are different from what your primary care doctor is going to see you for.
Thanks, Dr. Jeffrey-Thomas!