Chronic pelvic pain (CPP) is defined as pain in the pelvic area that lasts six months or longer.  

Just how common CPP is in the general population is hard to quantify, as it has a broad definition and can be difficult to diagnose.

However, estimates show between 39 and 61 percent of all U.S. women suffer from some form of pelvic pain. Among men the estimates are as high as 50 percent. 

Symptoms include: unexplained abdominal pain; pain in the buttocks or hips; aching or burning pain in the lower abdominal, lower pelvic or genital region; pain in the tailbone; painful bowel movements and bladder pain; limited sitting tolerance; and discomfort after sexual activity. 

What are the main causes and contributing factors of CPP?

Physical restrictions that play a factor include: back or pelvic injury; poor posture or walking patterns; muscle tightness and muscle weakness, as well as, broader emotional factors, such as high stress or anxiety. 

Underlying health conditions such as endometriosis, radiation therapy for pelvic area cancers and autoimmune conditions can be the root cause(s) of persistent pelvic area pain.

In males, pain may be associated with saddle paresthesia among cyclists (numbness and/or tingling along the inner thighs and lower groin), as well as another common condition often referred to as prostatitis, or spasms and imbalance of your pelvic floor muscles. 

With so much complexity in pain and tissue types (including joints, muscles, ligaments, organs and the nervous system), it is understandably difficult to establish a diagnosis. However, medical evaluation by a physician, nurse practitioner or physician’s assistant combined with a follow up evaluation and care by a specially-trained pelvic health physical therapist is a highly recommended approach. 

It may also be helpful to consider nutritional and counseling options to improve overall wellbeing.

What does physical therapy for CPP look like?

  

Physical therapists are the experts trained in assessing and treating muscle imbalances and joint dysfunction. PTs consider how symptoms impact daily function and recreation, guided by patient goals to help establish a plan of care.  

Rest assured, if you suffer from CPP, there are a diverse number of treatments to explore. 

After a thorough, individualized evaluation, treatments can include body work and manual therapy, posture and ergonomic counseling, muscle balancing (strength and mobility), and instruction and development of progressive, independent home and community-based exercise programs as appropriate. 

If I’m in too much pain, how do I start physical therapy? 

Discussing pelvic or genital pain and sexual relations can be difficult, but that is what your provider is there for. 

Know that all providers want to help you get the care you need to improve your quality of life. Patients may feel alone in their experience, or have been told to “live with it,” “‘it’s a normal part of aging,” or “normal after having a baby.” Know that pain is never normal. 

Accurate diagnosis and optimal treatment require honesty and clarity. 

Try to be as clear as possible with symptom explanation with your provider, including details like duration, severity, functional difficulties, location, and aggravating and relieving factors of pelvic pain. 

Though Colorado is a direct access state for physical therapy – which means you as a patient have total, unrestricted access to a PT – some therapists, health care organizations, referring providers and insurance companies may require a physician referral first. 

Services are provided by PTs with specialized training in pelvic health physical therapy. 

Insurance plans cover rehabilitation for pelvic area disorders under the same parameters of diagnoses more commonly associated with physical therapy.

As you contemplate this option, understand that physical therapy is conservative and non-invasive, and an evaluation doesn’t have to result in follow up if care is not deemed appropriate. 

Therapists collaborate closely with referring providers of multiple disciplines in a team approach, resulting in more comprehensive and effective care for you.

Sarah Hudelson, PT, DPT is a pelvic health specialist in the Rehabilitation department at Heart of the Rockies Regional Medical Center.

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