Persistent Pelvic Pain

Written by: Dr. Lucy Hughes, PT, DPT

As a physical therapist who has the privilege of helping people with a variety of diagnoses, I can confidently say that pelvic health issues are some of the most commonly misunderstood. By the time a client with persistent pelvic pain reaches my treatment room, they have frequently gone through such a myriad of stressful experiences - numerous doctors' appointments, ER visits, tests, medications, even surgeries - that they have actually started to question themselves and their own experiences with their bodies. Oftentimes, clients will report that they had no idea that pelvic health PT could help with their longstanding pain and only booked the appointment at their doctor's suggestion after years of thinking there was nothing they could do. My clients typically have a number of questions for me at their first visit. These are some of the most common questions I hear:

What is persistent pelvic pain?

Pelvic pain is pain experienced in the region between the belly button and the knees and may include the lower abdomen, genitals, tailbone and the front and back of the thighs. Sometimes it is concurrent with back or hip pain. This is a pretty broad area of the body! When pelvic pain lasts for longer than six months, it is defined as persistent. Persistent pain can be debilitating as it can negatively affect your life in many ways, including interrupting your sleep, your work and your experiences of sexual intimacy. Some pelvic pain diagnoses include vaginismus, dyspareunia, vulvodynia, pudendal neuralgia, endometriosis, painful bladder syndrome and coccydynia.

What does persistent pelvic pain feel like?

Pelvic pain can be experienced as a fairly broad number of sensations, such as burning, stinging, pulling, stabbing, sharp, tingling, tight, gnawing, cramping or buzzing. Someone once even described their pain to me as "blue." Your pain can feel localized to one area, such as specifically on the tailbone when you are sitting down, or it can be broad, like a constant dull throbbing of the entire abdomen radiating down the thighs. You may experience pain during sexual intimacy, having a bowel movement, urinating, during your menstrual cycle or during recreational fitness activities. On the other hand, sometimes it may feel like your pain comes out of nowhere. Your pain experience is your own and may have any number of qualities, all of which are completely valid.

What is causing my persistent pain?

It can be frustrating to not know what is causing your pain, especially if your doctor has told you that they cannot find anything "wrong" and you do not have a diagnosis. While this is not always the case, oftentimes persistent pain is not connected to a current tissue injury. The body may have experienced trauma in the past which can result in lingering changes to local tissue metabolism, nerve irritability or an overall sensitized nervous system. The body's attempt to defend itself from a perceived constant threat can result in muscle guarding, weakness and pain even in response to light touch. Such traumatic experiences can include giving birth, undergoing abdominal surgery, falling on your tailbone, experiencing sexual assault or having a urinary tract or vaginal infection. Sometimes even a particularly emotionally stressful experience can give rise to persistent pain. That being said, even if you cannot identify the cause, your pain is real. Hearing providers, family members or friends tell you that your pain is "in your head" is neither accurate nor acceptable! Overcoming persistent pain requires a good support system, patience, open-mindedness and compassion for yourself.

What can I do to address my pain?

First, take a deep breath and give yourself credit for even asking this question. The most important step is acknowledging your experience and feeling comfortable enough to do something about it. You can contact your primary care provider or other trusted healthcare professional and ask about various treatment options. Pelvic health physical therapy is the preferred method of treatment for a number of persistent pain diagnoses. Additionally, sometimes treating persistent pelvic pain requires a multidisciplinary team, which may include your primary care provider, urologist, gynecologist, surgeon, occupational therapist, massage therapist, psychiatrist or mental health counselor. A good pelvic health physical therapist is always willing to be part of a multidisciplinary team to help support you in your goals.

What does a pelvic health physical therapist do?

Physical therapists are movement experts who strive to help people improve their quality of life by addressing movement dysfunction. Pelvic health therapists operate much the same, except that they specialize in the pelvic area. Your pelvic health physical therapist can work with you on managing your symptoms through manual therapy techniques, exercises, lifestyle modifications and other education. Your treatment sessions are always collaborative and tailored to your specific goals.

Battling persistent pelvic pain is challenging, but there are steps you can take to address your symptoms. Contact your healthcare provider and ask if a referral to physical therapy is right for you.