Studies show up to 25% of women experience some variation of chronic pelvic pain (CPP) at some point in their lives. That sure is a lot of ladies. The etiology can be gynecological in origin (endometrial adhesions, fibroids, adenomyosis), gastrological (irritable bowel syndrome, colitis), urological (cystitis, painful bladder syndrome) or musculoskeletal (pelvic floor hypertonicity, myofascial pelvic pain syndrome). A thorough history and physical can point the patient/provider team in the right direction to discover and treat the underlying cause or causes. Treatment is based on the source of pain with a goal of restoring function. Treatment may include medication, pelvic floor physical therapy, behavior modification and very rarely a referral for surgery. Unfortunately, many women are misdiagnosed and misunderstood for many years before appropriate care is found.
Types of pain include nociceptive, neuropathic and central pain. Nociceptive pain is often sharp and localized and is a result of injury or inflammation. Neuropathic pain results from specific nerve damage and is described as burning, numbness or tingling. Pelvic floor physical therapy can be life changing in these circumstances.
One of the trickiest situations is when, regardless of the initial reason for pain, the central nervous system becomes sensitized to pain signals and essentially “turns up the volume” without an actual increase in the source of pain. This phenomenon is considered “central pain” and the mechanism is thought to be similar to fibromyalgia. In these cases, one must consider the current level of pain in addition to the etiology. The chronic nature of central pain can be particularly challenging for patients and may present with comorbidities of depression, anxiety and addiction. Cognitive behavior therapy, medication and a home program of pelvic floor physical therapy exercises may all benefit the patient in this situation. Longer term situations require a longer healing period.
For some excellent resources on the topic of Pelvic Pain, check out the International Pelvic Pain Society website: https://pelvicpain.org/patients/patient-education-booklet.aspx
If you are someone you love suffers with pelvic pain, help is available! Please call us to set up an appointment today 503-287-4970
Linda Anzalone, WHNP at Nature Cures Clinic