This is a question that can have a simple answer or a pretty complex one. Understanding the things that can cause pelvic pain allows you to address them in calm, focused manner. When I am referring to pelvic pain, it can mean pain over the bladder, the low back, and the pelvic floor – the muscles that support your organs as well as genitalia and rectum. Today I would like to focus on the pelvic floor as it is a highly discussed topic on blogs, websites and in small groups of moms and grandmothers. Men also can struggle with pelvic floor pain and search for answers everywhere. I want to give you some insight as to how a physical therapist would sort out the underlying causes of some types of pelvic pain.
For brevity, we will address with the most common reasons today.
Let’s start with the super flexible people! In the physical therapy world, we call them hypermobile. They are the folks whose elbows and knees look like they can go backwards when they straighten out their arms and legs. They can sometimes bend over and put the palms of their hands on the floor, may have flat feet, and super soft skin. They are usually (but not always) the dancers, yogis, and the gymnasts. If they are super flexible and are weak in their hips, back and abs, then their pelvic floor can go into incredibly high tone. In other words, it gets very tight – painfully so.
These women may say they have pain with intercourse, pain after or during orgasm, or pain just sitting down. They may leak urine as well or be constipated. The pelvic floor, needed for supporting your trunk in standing and walking, is holding on tight, but a lack of support from the other pelvic muscles puts too much strain on the pelvic floor, causing pain. Urination and bowel movements can be affected. Men may say it hurts to sit, that they have weak erections or ejaculation, and may be constipated.
There are people who carry their high stress levels in their muscles. They grit their teeth, hold their breath and clench their pelvic floor. They may or may not be strong throughout their hips, back and abs. But they do need to learn to relax their body. The therapist will note on examination that the client’s abs and breathing diaphragm are extremely tense and the pelvic floor follows suit! Think of it in 3 layers. If you are under stress, you are holding your breath, gritting your teeth and sucking in your abs, so your pelvic floor will respond in kind with high tone, more commonly known as tightness. This can result in digestive and bowel movement issues, sexual dysfunction, and pain.
A combination of both hypermobility and high stress can be most challenging as strengthening people who hold themselves in high tone means teaching them to differentiate between a gentle muscle contraction and release to help build core strength versus the sort of habitual gripping hold that stress behavior brings on.
One other problem I want to mention is more common than people think. People who sit too much can also sustain pelvic floor pain. The nerves that run from your low back through the pelvic floor can become irritated with prolonged sitting, eventually making it difficult to sit without exacerbating the pain. Think of this: if you sit for long periods of time, due to travel or your job or just out of habit, you lose muscle mass on your bottom from lack of use. This muscle is protective tissue that keeps your weight up and off your nerves when you do sit. Essentially, one starts to compress the nerves, resulting in pain and other sensations. People have noted burning, wetness, or sharp pain in their bottom, groin, or inner thighs. It is a compression injury and the nerves become highly responsive to further contact.
Finally, there is vulvodynia, defined as chronic, unexplained pain around the vagina. Women note they can’t sit, have sex, or wear certain clothes without irritation. The first thing I suggest is a food diary, because there is no one diet that fits everyone, and common foods and drinks that may not bother someone else could cause inflammation for you. In addition to this diary, take pH tests of your urine and keep a pH log. Yes, knowing what makes your urine too acidic or too alkaline can provide you with information about what may be irritating the skin around your vagina since the urethra is directly above it. When you urinate, it runs down over all that soft tissue. If what you are eating or drinking is inflammatory to you, then the tissue gets red, itchy and irritated. Checking your diet and your urine is definitely a study in self-care and takes discipline. It is also the easiest way to rule out other potential causes for your pain – before expensive tests and medications.
It is not unusual that it is the food you love and eat every day! You will read lists of what potentially causes vulvodynia but rarely do you see anything about food or the chemicals that are sprayed on it. Food that never bothered you as a child may be now an irritant to your body. Eating “just a little” dairy or gluten may be just enough to cause a problem for you now. Everyone is different, and we all have different food sensitivities, so it is worth checking out.
A pelvic floor physical therapist can help you figure out what factors are contributing to your pain and help you take action to resolve it. Posture, exercise, proper nutrition and relaxation are all essential to pelvic health. Best advice is this: Don’t think the worst! Yes, the pain affects a sensitive area of your body, but with proper information you can turn things around. Nobody knows your body better than you. Sometimes you need a partner to help figure it out.