Pelvic Pain & Sexual Dysfunction
Most individuals who experience Pelvic Pain suffer in isolation. They are hesitant to disclose their concerns to their health care professionals for fear of the unknown or the likely pelvic examination. Individuals with pelvic pain are often reluctant to even speak to their partners out of embarrassment or concern about their partner’s reaction and how it may affect their relationship.
Pelvic Pain can have an explanation and is most often caused by dysfunctions, like tightening and or shortening of the pelvic floor muscle, fascia and ligaments.
When the pelvic floor muscles are functioning optimally they maintain urinary & fecal continence and allow for pain-free and pleasurable sexual intercourse. With Pelvic Pain, the muscle can be hypertonic (increased tension in the muscles and ligaments) or have trigger points, resulting in:
- Urinary symptoms including increased frequency, urgency, painful urination or incomplete emptying of the bladder
- Bowel dysfunction like constipation or diarrhea, a constant need to strain to achieve a bowel movement & incomplete emptying and pain with bowel movements
- Unexplained shooting and sporadic pain in your low back, pelvic region, hips and genital (vaginal and/or rectal) area
- Pain during or after intercourse, orgasm or sexual stimulation
Common Causes of Pelvic Pain
- Interstitial Cystitis/Painful Bladder Syndrome: Pain, frequency & urgency
- Endometriosis: The tissue that lines the uterus or womb grows outside of the uterus on other organs or structures in the body.
- Myofascial Trigger points(Hypertonic muscles): Pain in the pelvic floor region, as well as urinary urgency and frequency
- Vulvodynia: a broad category of pelvic pain that is often diagnosed as:
- Vestibulodynia: Pain at the vestibule or “front porch” of the vagina
- Vulvodynia: Pain in the superficial tissues of the vulva
- Clitordynia: Pain at the clitoris
- Dyspareunia and Vaginismus: Painful vaginal intercourse or inability to achieve penetration due to pain.
- Constipation: Can be a cause or effect of pelvic floor muscle dysfunction. Sacroiliac joint (SIJ) dysfunction: Leads to irritation in the lumbar spine & pelvic region
- Pudendal Neuralgia: The pudenal nerve supplies the rectum, vagina/penis, perineum and mons pubis. Irritation of this nerve can cause pain in the aforementioned areas. This nerve is often compromised during excessive sitting postures and activities like cycling
- Surgery: Surgical trauma can change the strength and integrity of the pelvic floor musculature and can lead to pain
- Psychological Factors: Stress, anxiety, depression, reduced self esteem and decreased quality of life can influence pain
Treatments to Improve your Health
Through our Path to Improved Health, we address the causes of your pelvic pain using:
- A Comprehensive Health History
- An internal and external assessment of your pelvic region including a pelvic floor muscle assessment to determine the muscle tone and your ability to contract and relax the pelvic floor muscles. This assessment will also include a biomechanical assessment of lower back, hips and sacro-iliac joints Your abdomen will also be assessed for soft tissue dysfunction including myofascial tightness and the presence of diastasis rectus abdominus (separation of rectus abdominus muscle)
- Hands on release or lengthening techniques to address the tissue health in the pelvic floor region. Once the tissue health has been addressed, strengthening exercise will be introduced
- Education including the specific progression of any strengthening and stretching exercises as well as education about activities that can exacerbate your symptoms
- Persistent pain education is also an important part of treatment since the pelvic area is where we often can hold our stress. By understanding how our pain system works, we can often reduce the threat of ongoing pelvic pain problems.
- Therapeutic modalities when indicated such as acupuncture, muscle stimulation and biofeedback.
The Path to Improved Health physiotherapy treatment will include a “home based” exercise program as a tool to maintain your well-being. Your physiotherapist will ensure that you are doing your home program correctly before you are discharged.
With your permission, your primary healthcare provider will also receive an overview of the treatment and progress that you made.
Occupational Therapy may be a fantastic addition to your treatment team. Your OT will help you to develop individualized strategies for
- managing your symptoms
- managing the emotions intertwined with them
- navigating your relationship with your symptoms, your body, and with movement
- re-engaging in the life activities, roles, and relationships that are important to you.
Individualized care plans may include nervous system regulation, somatic & sensory tools, Cognitive Behavioural Therapies, Graded Exposure, mindfulness techniques, and exploring day to day functioning, day to day demands, and life balance.
Discharge peak review
We want to you to remain at the peak of your Path to Improved Health and we will follow-up if necessary upon your discharge from the clinic. Sometimes regressions or reoccurrence occur after exacerbating events. Should you ever experience any reoccurrence or regression in your symptoms, we invite you to return to the clinic at your convenience.