Pelvic pain and sexual dysfunction

What is Pelvic Pain and Sexual Dysfunction?

Sylvia Farrell, Chartered Physiotherapist in Women’s & Men’s Health

Many women suffer from pelvic pain. Symptoms may include:

• Mild, severe or constant pain which may be described as burning, aching, stabbing or shooting type pain
• Pain may be diffuse throughout the pelvis or localized to one spot
• Pain in the vagina (vulvodynia), rectum, pelvis, groin, abdomen, hips, thighs or buttocks
• Tightness or spasm of the pelvic floor muscles making sexual intercourse/vaginal insertion either painful or impossible (vaginismus)
• Pain with exercising, cycling, sitting or wearing tight clothing
• Bladder symptoms including increased frequency, sudden urges and difficulty emptying
• Bowel symptoms including bloating and diarrhoea

Pelvic pain is often misunderstood; it is frequently associated with overactive pelvic floor muscles and the presence of trigger points and tension. The pelvic floor is a hammock of muscles, nerves, tissues and ligaments that stretch from the pubic bone at the front of the body to the bottom of the spine. They act as a sling to support the pelvic organs-the urinary tract, digestive tract, and reproductive organs-including the bladder, uterus and colon. With a mechanism so complex, it is common for dysfunction to occur. There are four primary causes of pelvic floor disorders:

1. Inflammation

Any type of chronic inflammatory condition in any of the pelvic organs can contribute to pelvic pain. This can include medical conditions such as interstitial cystitis, irritable bowel syndrome, endometriosis and pelvic inflammatory disease.

2. Infection

Any kind of infection can also contribute to pelvic pain. This can include urinary tract infections, yeast infection, bacterial infection or a sexually transmitted infection.

3. Trauma

A direct trauma to the pelvic floor from a fall or accident can cause pelvic pain. Injury to the sacrum or coccyx can also result in pelvic pain. Abdominal surgery (hysterectomy or a Caesarean section) can result in scar tissue or adhesion formation which can impact on surrounding tissues. Childbirth is not only a major life event but is also traumatic for your pelvic floor! An episiotomy or tearing of pelvic tissues, and even the birthing process can contribute to pelvic pain.

4. Mechanical Muscular conditions

Pelvic pain can stem from weakness or muscular imbalances in the trunk or pelvic stabilisers. This may be a result of poor posture, excessive strain from lifting or other heavy activities or working at a repetitive motion job. This can lead to over-activity of the pelvic floor muscles.

Pelvic pain may also be associated with other medical conditions such as fibromyalgia, chronic fatigue syndromes and chronic constipation. Any disorder within the pelvic floor can have an impact on any or all of the pelvic floors functions. In other words, one dysfunction may lead to another. You may even experience pain or dysfunction in other parts of the body. Pelvic pain can radiate downward or upward to affect other areas of the body.

What are Overactive Pelvic Floor Muscles?

We now know that one pelvic floor dysfunction may create another. This can result in a vicious cycle and worsening of symptoms. As the original dysfunction gets worse, it may cause the pelvic floor muscles to tighten and shorten. As this occurs the pelvic floor muscles get overloaded and grow weak. Now with a limited functioning pelvic floor the original dysfunction gets even worse.

We hear a lot about strengthening our pelvic floors. But with pelvic pain it is often necessary to release tense and tight pelvic floor muscles. In some cases, it may be both weak and tense and will need to be released before strengthening. Overactive pelvic floor muscles are common in women experiencing pelvic pain.

The muscle spasm is similar to spasm and tension people often get in the neck and shoulder muscles, but in that case, you are often aware of the tension, you can feel your muscles tightening and see the effect as your shoulders rise up towards your ears. You can then use techniques to reduce the tension, such as massage, exercises, relaxation techniques or just remind yourself to let go of the muscles. However, with the pelvic floor muscles, we are often unaware that they exist, let alone aware that they might be in spasm or particularly tight. If we are unaware of the muscles, then we are unlikely to be able to relax them or reduce the tension in them. This is where Women’s Health Physiotherapy is particularly effective.

What can we do about it?

To begin, we need to release the pelvic floor. This may need to be done manually by your Women’s Health Physiotherapist if there are specific tight spots and trigger points in your pelvic floor muscles. Your Women’s Health Physiotherapist can teach you to release your pelvic floor muscles yourself. Rehabilitation also involves learning how to reduce and control the tone in the pelvic floor muscles through specific exercises and controlled breathing. Ultimately the aim is to restore normal balance and function to the muscles and relieve pain.

It is important to be seen by a Women’s Health Physiotherapist who can complete a full assessment of the pelvis, the perineum, the pelvic floor, the abdomen and often the muscles and fascia of the thighs. Conditions that are left untreated will naturally deteriorate over time as muscles and other soft tissues shorten and tighten around the dysfunction.

If you have any of the following pelvic floor disorders, please make an appointment with our Women’s Health Physiotherapist – Sylvia Farrell for more information about treatment of the following:

–        Pelvic floor / perineal pain.

–        Urethral / vaginal / rectal pain.

–        Lower abdominal pain.

–        Vulvodynia.

–        Vaginismus.

–        Interstitial cystitis.

–        Pudendal neuralgia.

–        Coccydynia.

–        Manual therapy of the pelvis / back

Chronic Pelvic Pain and hypersensitivity

When pain lasts longer than six months it is called chronic pain. Chronic pelvic pain(CPP) can mean that the area becomes hypersensitive and that normal movements or pressures on the pelvis become extremely painful. You can read more about chronic pain and sensitivity and how it can be treated here. Chartered Physiotherapist Sylvia Farrell is experienced in dealing with chronic pain and hypersensitivity and will often integrate the more physical therapeutic interventions with other approaches that have been shown to help manage chronic pain.

Discreet and confidential service

At Evidence-Based Therapy Centre we understand that these issues can be difficult to talk about. We provide sensitive, professional and confidential treatment. Specialist Women’s Health physiotherapist – Sylvia Farrell is experienced in dealing with these problems and compliments her expertise and knowledge with a caring and empathic approach to treatment. We know how difficult it can be to tell someone about your sexual or pelvic pain. However, we urge you to break the silence, start talking, and take positive steps towards recovery.

If you would like to book an appointment with Chartered Physiotherapist, Sylvia Farrell, you can call the clinic on 091 727777 or get in touch via the contact page.