PELVIC PAIN PHYSIOTHERAPY
Pelvic Floor Physiotherapy is now ONLY available at Northbridge and Liverpool.
Pelvic Pain Physiotherapy
Women that live with pelvic pain on a daily basis deserve the best help and support available from a multi- disciplinary team of health professionals. For many women this is a really difficult subject to talk to their GP about. They may not go to see their doctor for fear that he or she may need to do an internal examination, and this thought alone is terrifying for some women and puts them off…possibly for years! It is the GP’s job to help find the ‘cause’ of your pain and refer you for appropriate tests or consultation to other health professionals/specialists.
Currently Dyspareunia and Vaginismus still fall into the Diagnostic and Statistical Manual of Mental Health Disorders. S o the first referral is often to a sex therapist or psychologist. This may be necessary if there is significant emotional concerns for the patient. Many Pelvic conditions have ‘Musculoskeletal’ (muscle, ligament and joint) involvement. With careful, appropriate pelvic floor physiotherapy some women with pelvic pain can be helped tremendously. Pelvic floor physiotherapy is NOT just about strengthening the muscles!
‘Pelvic pain’ is a general term for pain in or around the pelvic area. It encompasses bone, muscle, fascia, organs, and vessels including blood vessels, nerves and nerve sheaths. CHRONIC PELVIC PAIN is generally described as pain in your pelvic region — the area below your belly button and between your hips — that lasts three months or longer. There are many, many sub-divisions of this topic and I have touched on some of them under the ‘pelvic floor’ page. My focus on this page will be the treatment for clients with chronic pelvic pain CPP.
There is also a substantial amount of information about understanding how Chronic Pain is constantly driven by connections from our spinal cord to our brain and then an’up- sensitising’ of pain in the brain…..The brain decides whether you are going to have pain or not!
Dyspareunia
Dyspareunia is pain at the entrance to; and/or inside the vagina, just before, during or after sexual intercourse. The vagina is a muscular tube providing a passage between your uterus and the outside of the body. It has three functions: admitting the penis during sexual intercourse, allowing menstrual blood to leave the body, and giving birth. The labia minora are folds of hairless skin containing sweat glands that make up part of your external genitalia. The clitoris is a pea-size sexual organ located in front of the urethra, close to where the labia minora meet. It is highly sensitive with over 8,000 nerve endings and functions for sexual pleasure.
The location and frequency of pain with dyspareunia may vary. Symptoms often include: Pain at the entrance of the vagina with initial penetration; even from penetration from a finger or tampon Deeper vaginal pain with movement of the penis Pain may be a sharp and burning, or deep and aching You may also experience an involuntary tightening of the pelvic floor muscles (vaginismus) during penetration. The tightening can be severe enough that the vagina is unable to be penetrated.
There are several causes of dyspareunia, these include:
Vaginal dryness
Inadequate lubrication can be due to a lack of sexual arousal, or a decrease in estrogen, which occurs after menopause, during and after pregnancy, and while breast feeding.
Side effects of medications
Certain medications can decrease sexual arousal and result in inadequate lubrication. These medications include antihistamines, antidepressants, birth control pills, breast cancer medication, high blood pressure medication, and some sedatives.
Infection
A bacterial or fungal infection of the vagina, genital area or urinary tract can cause pain.
Inflammation or skin problems Inflammation or severely dry skin such as eczema can lead to painful initial penetration. Skin diseases such as lichen sclerosis or lichen planus can affect the vaginal area and lead to pain. Check out this video for more info on painful sex after pregnancy.
Vulvar vestibulitis
A condition that can result in severe pain and sensitization on the area of the vestibule when touched or with initial penetration.
Allergic reaction
An allergic reaction to clothing, spermicides or douches can cause painful intercourse. It can be seen on the vuval area and or inside the vagina on the mucosal lining. referral to a dermatologist specialising in Vulvo-vaginal conditions is the ideal pathway.
STIs
Sexually transmitted infections s can cause blisters and sores that make intercourse painful. Uterine and other pelvic conditions
Certain conditions of the uterus can lead to painful intercourse. These conditions include retroverted uterus, endometriosis, pelvic inflammatory disease, fibroids, ovarian cysts, and interstitial cystitis.
Prolapses
A prolapse of the bladder (cystocele), uterus (uterine prolapse), rectum (rectocele), or intestine (enterocele) can cause a deep pain during intercourse.
Scarring
Previous surgeries to the pelvic area can cause scarring that may lead to painful intercourse.
Childbirth tearing of deep pelvic floor muscles or fascia; or an episiotomy during vaginal delivery may lead to painful intercourse. It is wise to delay sex until after your 6-week check-up and then only when you and your partner feel ready. I encourage my mums to talk about how they feel to me and to their partner. Often the partner is very anxious about penetration and causing ‘any pain’. take things slow, use lubrication and try being on top for this first time so that you can control the depth of penetration. Some women are not ready to have sex for a long while after a difficult vaginal delivery.
Come and see your Women’s health physio so that she can examine you and then discuss your concerns.
Treatments for cancer Chemotherapy and radiation to the pelvic area can lead to painful intercourse.
Other traumas from sport or road traffic accidents and injuries to the pelvic area can cause changes to joints and muscles around the hips and pelvis. Over time this may cause chronic muscle tensions ligament, tendon and fascial tightness in and around the pelvis. This can lead to painful intercourse. Women’s health Physios treat muscles, joints and tendons.
Emotional factors can also contribute to painful intercourse. Emotions and stress are important for sexual arousal and greatly affect the amount of lubrication and the tightness of the pelvic floor. Psychological issues such as anxiety, depression, and fear of intimacy can be a factor with dyspareunia. Additionally, any history of sexual abuse can lead to problems with dyspareunia. Women’s health physios with a special interest in treatment of this condition can, as part of a multi -disciplinary team do a great deal to help with musculoskeletal changes that impact on pain and function.
Vaginismus
An involuntary tightening of your superficial pelvic floor muscles during initial penetration. Primary vaginismus is a spasm or dysfunction of the superficial pelvic floor muscles that can be helped with specific pelvic floor physiotherapy. Specific skills in the treatment of internal and external trigger points in muscle and releasing techniques directed to fascial and scar tissue help in the rehabilitation of this condition. Education of pelvic anatomy and an understanding of the ‘central sensitization of pain’ will all help individual women to overcome CPP.
- Endometriosis Australia says “Endometriosis is a common disease in which the tissue that is similar to the lining of the womb grows outside it in other parts of the body. More than 730,000 (more than 10%) of Australian women suffer with endometriosis at some point in their life with the disease often starting in teenagers. Symptoms are variable and this may contribute to the 7 to 12-year delay in diagnosis. Common symptoms include pelvic pain that puts life on hold around or during a woman’s period. It can damage fertility. Whilst endometriosis most often affects the reproductive organs it is frequently found in the bowel and bladder and has been found in muscle, joints, the lungs and the brain. In an Australian government report, endometriosis is reported to cost Australian society $7.7 billion annually with two thirds of these costs attributed to loss in productivity with the remainder, approximately $2.5 billion being direct healthcare costs.
Endometriosis:
The Jean Hailes Foundation says:
“Studies suggest that endometriosis affects 1 in 10 women of reproductive age, with an estimated 176 million women worldwide having the condition.
The endometrial cells:
- are found on organs in the pelvis
- may start to grow and form patches or nodules on pelvic organs or on the peritoneum (the inside lining of the abdomen and pelvis; see image)
- have the same cyclical/menstrual changes outside the uterus as inside the uterus
- may bleed at the same time as your period (menstruation).
Endometrial cells found outside the uterus grow to form lesions or patches that bleed and leak fluid in response to your hormones at the time of the period. This leads to inflammation and scarring. These patches found outside the uterus cannot pass out of your body and remain in your pelvic cavity, on organs and other surfaces. On your ovaries, cysts called endometriomas can develop over time. These are sometimes called ‘chocolate cysts’ because of the darkish material they contain. On other surfaces the patches can form nodules.
What causes endometriosis?
We don’t really know what causes endometriosis, and possible associations or factors can be different from woman to woman. Factors that have a role in causing endometriosis include:
- Family history: Women who have a close relative with the condition are up to 7–10 times more likely to get endometriosis. Also, it is common with twins that both may get endometriosis, particularly if they are identical twins.
- Retrograde (backwards) menstruation: When a woman has a period, the blood flows out of the vagina but also backwards along the fallopian tubes into the pelvis (called retrograde menstruation). In 90% of women, the blood, which contains endometrial cells, is absorbed or broken down by the body and causes no symptoms. However, in women with endometriosis, this endometrial tissue starts to grow, which can cause a wide range of symptoms.
- Metaplasia: The conversion of the normal pelvic tissue into endometriosis.
Other possible factors that may have a role in causing endometriosis are:
- having first pregnancy at an older age
- heavy bleeding during periods, and periods lasting longer than five days
- first period before 11 years of age
- regularly having fewer than 27 days between periods, or having shorter regular cycles
- changes in the immune cells
- low body weight
- alcohol use
Can I prevent endometriosis?
Endometriosis can’t be prevented but is less likely to develop or progress if a woman reduces the number of menstrual cycles she experiences during her reproductive years. Factors that contribute to fewer menstrual cycles include:
- hormonal therapy such as the combined oral contraceptive pill or progestins (may be given as tablets, an implant, an injection or an intrauterine device (IUD))
- how many children you have – the chance of getting endometriosis may decrease with each pregnancy (this may be related to the hormone progesterone during pregnancy)
- younger age of first pregnancy
- breastfeeding for a longer period
- regular exercise of more than four hours per week (this may also help with pelvic pain for endometriosis).
There may be different forms or types of endometriosis
- Superficial endometriosis: here, superficial areas of disease appear on the lining of the pelvis and abdomen (called the peritoneum). These do not invade deeply into the tissues
- Deep-infiltrating endometriosis: endometriosis lesions do invade deeply (more than 5mm) into the tissues and can lead to scarring and nodules. These can grow into nearby organs, such as the bladder, bowel and ovary
- Ovarian disease: this may occur and is often considered a separate form of the disease. Here, burrowing lesions on and under the ovaries can lead to the development of ‘chocolate cysts’ or endometriomas
- Adenomyosis: the endometrial cells grow inside the muscle of the uterus
- Outside the pelvis: this is rare
- Upper abdomen, eg on the diaphragm
- In the liver, nose, eye
- Abdominal wall often associated with previous operation scarring.
How do you know if you have endometriosis?
The symptoms of endometriosis vary from woman to woman. Some women have many symptoms and severe pain, whereas others have no symptoms. The severity of the symptoms may not reflect the severity of the condition. The types of symptoms and their severity are likely to be related to the location of the endometrial tissue rather than the number of endometrial cells growing.
Due to the varied symptoms, endometriosis can take a long time to diagnose (the average time to diagnosis is seven years). About a third of women with endometriosis discover they have it because they have not been able to become pregnant, or because endometriosis is found during an operation for another reason.
About three out of four women with endometriosis have pelvic pain and/or painful periods.
How can Physio help?
Pelvic health physios experienced in treating pelvic pain can often help in conjunction with others to treat any muscle tensions and ‘up -sensitisation” of your pain.
Make an appointment online today to see one of our women’s pelvic physios.
