Pelvic Pain: Causes, Symptoms & Physiotherapy Relief post thumbnail image

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What is Pelvic Pain ?

Pelvic pain is discomfort experienced in the area below your belly button and between your hips. It can be acute (sudden and severe) or chronic (lasting for six months or longer). Pelvic pain is a complex condition that can affect individuals of all genders and can stem from a wide range of issues, making diagnosis and treatment challenging.

Causes of Pelvic Pain

The pelvis contains various organs and structures, and pain can originate from any of them.

  • Gynecological (in individuals with female reproductive organs):
    • Menstrual Cramps (Dysmenorrhea): Common, often felt in the lower belly or back.
    • Endometriosis: Tissue similar to the uterine lining grows outside the uterus, causing pain, especially before and during periods, and sometimes with urination or sex.
    • Adenomyosis: Endometrial tissue grows into the muscular wall of the uterus, leading to severe menstrual cramps and heavy bleeding.
    • Ovarian Cysts: Fluid-filled sacs on the ovaries; some can rupture or twist, causing sudden, sharp pain.
    • Uterine Fibroids: Non-cancerous growths in the uterus; large ones can press on organs, causing pain.
    • Pelvic Inflammatory Disease (PID): An infection of the reproductive organs, often caused by STIs, leading to inflammation and scarring.
    • Ovulation Pain : Pain on one side during ovulation.
    • Ectopic Pregnancy: A pregnancy outside the uterus, a medical emergency.
    • Miscarriage or Threatened Miscarriage.
    • Vulvodynia: Chronic pain around the opening of the vagina without an identifiable cause.
    • Ovarian Remnant Syndrome: Painful cysts developing from ovarian tissue left behind after surgery.
  • Urological (Urinary System):
    • Urinary Tract Infections (UTIs): Bacterial infections causing pain in the lower pelvis, burning with urination, and frequent urination.
    • Interstitial Cystitis (Painful Bladder Syndrome): Chronic bladder pain and pressure, often relieved by urination.
    • Kidney Stones or Kidney Infection: Pain can radiate to the pelvis.
  • Gastrointestinal (Digestive System):
    • Irritable Bowel Syndrome (IBS): A group of symptoms including abdominal pain, bloating, constipation, and diarrhea.
    • Constipation: Chronic constipation can lead to pelvic discomfort.
    • Diverticulitis: Inflammation or infection of pouches in the digestive tract.
    • Appendicitis: Inflammation of the appendix, usually causing sudden, severe pain that migrates to the lower right abdomen.
    • Inflammatory Bowel Disease (IBD): Crohn’s disease or ulcerative colitis.
    • Intestinal Obstruction.
  • Musculoskeletal:
    • Myofascial Pelvic Pain Syndrome (MPPS): Pain arising from trigger points and tightness in the pelvic floor muscles and surrounding fascia.
    • Pelvic Girdle Dysfunction: Problems with the sacroiliac joints, pubic symphysis, or hip joints.
    • Coccydynia: Tailbone pain.
    • Fibromyalgia: Widespread musculoskeletal pain.
    • Hernias: Inguinal or femoral hernias can cause pain that radiates to the pelvis.
  • Neurological:
    • Pudendal Neuralgia: Chronic pain in the distribution of the pudendal nerve, often caused by nerve compression or irritation.
    • Nerve Entrapment: Other nerves in the pelvis or lower abdomen being compressed or irritated.
    • Nerve Injury: From surgery or trauma.
  • Psychological and Social Factors:
    • Stress and Anxiety: Can exacerbate pain and lead to muscle tension.
    • History of Trauma: Past physical or sexual abuse can contribute to chronic pelvic pain.
    • Depression: Often co-occurs with chronic pain.
  • Other:
    • Adhesions (Scar Tissue): Can form after surgery or infection, causing organs to stick together.
    • Cancers: Of the reproductive tract, colon, or bladder.
Symptoms of Pelvic Pain

Type of Pain:

    • Dull ache or heavy sensation.
    • Sharp, stabbing, or burning pain.
    • Cramping or throbbing.
    • Pressure or fullness.
    • Tingling or “pins and needles.”
  • Location: Can be localized to a specific spot (e.g., one ovary, the bladder) or spread throughout the lower abdomen, back, hips, inner thighs, or even down the legs.
  • Triggers:
    • Constant or intermittent.
    • Worsens with menstruation, ovulation, sexual activity (dyspareunia), urination, or bowel movements.
    • Triggered by certain movements, prolonged sitting or standing.
    • Pain during or after exercise.
  • Associated Symptoms:
    • Urinary urgency or frequency.
    • Difficulty with bowel movements (constipation, diarrhea).
    • Bloating, nausea.
    • Fatigue.
    • Sleep disturbances.
    • Pain with inserting a tampon (in females).
Advanced Physiotherapy for Pelvic Pain

Goals of Pelvic Physiotherapy:

  • Reduce pain and muscle spasm.
  • Improve pelvic floor muscle function (strength, coordination, relaxation).
  • Restore normal movement patterns and posture.
  • Address nerve irritation or compression.
  • Improve bladder and bowel function.
  • Enhance sexual function.
  • Empower the patient with self-management strategies.

Manual Therapy

    • Myofascial Release: Gentle, sustained pressure applied to tight fascia and muscles (internal or external) to release restrictions and reduce tension in the pelvic floor, abdomen, hips, and back.
    • Trigger Point Release: Direct pressure on painful knots (trigger points) in the pelvic floor and surrounding muscles to release tension and alleviate referred pain.
    • Soft Tissue Mobilization: Specific techniques to improve tissue mobility and reduce adhesions.
    • Nerve Glides/Neural Mobilization: Gentle exercises and techniques to improve the mobility of nerves (e.g., pudendal nerve) that may be entrapped or irritated.
    • Joint Mobilization: Addressing stiffness or dysfunction in the sacroiliac joints, pubic symphysis, or lumbar spine.
  • Pelvic Floor Muscle Retraining:
    • Relaxation Techniques: Crucial for hypertonic (overly tight) pelvic floor muscles, which are a common cause of pain. This includes diaphragmatic breathing, imagery, and specific stretches (e.g., child’s pose, deep squats).
    • Coordination Training: Teaching patients to effectively contract and relax their pelvic floor muscles in coordination with breathing and other movements. This often involves “reverse Kegels” to encourage release.
    • Strength Training (for hypotonic muscles, once pain is managed): Targeted exercises (e.g., Kegels) to improve muscle strength, endurance, and power, but only after ensuring the muscles can relax. Overtraining or incorrect Kegels can worsen pain if the muscles are already tight.
    • Electrical Stimulation: Low-level electrical currents can be used for pain modulation, muscle relaxation, or to facilitate muscle contraction for strengthening.
  • Therapeutic Exercise
    • Core Stability Exercises: Strengthening the deep abdominal and multifidus muscles to improve trunk stability and support the pelvis.
    • Hip and Gluteal Strengthening: Addressing weakness or imbalances in hip muscles (e.g., glutes, hip rotators) that can influence pelvic stability and contribute to pain.
    • Stretching: Addressing tightness in hip flexors, hamstrings, adductors, and piriformis, which can all affect pelvic alignment and muscle tension.
    • Postural Re-education: Correcting habits that contribute to pelvic strain (e.g., slumping, excessive arching).
    • Gait Training: Analyzing and correcting walking patterns that may contribute to pelvic pain.

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