What You Need To Know About Chronic Pelvic Pain

May is Pelvic Pain Awareness Month, thanks to the efforts of the International Pelvic Pain Society.

Because chronic pelvic pain (CPP) is a complex condition, sometimes it can take a long time to get diagnosed and start treatment. Read on to learn more about what to do if you have CPP.

What is chronic pelvic pain (CPP)?

CPP is pain experienced in the pelvic or abdominal area that lasts more than 6 months. It can come and go or be constant. Pain can be experienced across all genders and areas of pain can include the abdomen, perineum, bladder, rectum, uterus, vulva, vagina, prostate, testicles, penis, pelvic floor muscles, sacrum, and coccyx.

CPP is very different from acute pelvic pain. With acute pelvic pain, there is an obvious reason for the pain; for example an injury or infection. Chronic pain persists beyond the typical healing time frame of an acute problem or can even occur without a specific injury. 

Understanding the “why”

To understand CPP, it’s important to have a basic understanding of pain itself.  When the body gets injured, those tissues send signals to the spinal cord. Once at the spinal cord, the signals will either stop, get stronger, or get weaker before they’re sent to the brain for interpretation. Often, the signals will stop or get changed based on how YOU perceive the pain and can be influenced by other signals and messages (for example, was this a traumatic event or was it a little paper cut while opening an envelope). So, if the spinal cord is constantly letting signals go to the brain that there is pain and something wrong in the pelvis even after the tissue has healed and there is no tissue damage, this can then lead to chronic pelvic pain.

Some factors that can contribute to chronic pelvic pain include:
-Muscular and skeletal problems like pelvic floor muscle dysfunction
-Medical conditions (examples: recurrent bladder infections, interstitial cystitis, irritable bowel syndrome, endometriosis)
-Depression
-Anxiety
-History of trauma and/or abuse
-Poor sleep
-Poor nutrition

How is CPP diagnosed?

It’s important to seek help from a qualified healthcare provider, who will ask you a lot of questions about your symptoms, perform a physical exam, and may recommend other testing or imaging. Because pelvic pain can have many causes, sometimes it can be difficult to get a diagnosis. However, not finding the root cause of the pain does NOT mean that the pain is in your head or not real. Trust your body and what you’re feeling.

How is CPP treated?

At the end of the day, treatment will depend on your specific condition and situation. However, some treatments may include:
-Mental health support (counseling)
-Medications
-Medical procedures
-And of course, physical therapy!

Physical therapy treatments will again depend on your particular symptoms and presentation but will often include exercises like gentle stretches and mobility, pelvic floor muscle re-training, hands-on manual therapy, strategies for “down training” or quieting your nervous system, and education on behavioral changes like nutrition and sleep. Learn more about what to expect with pelvic health physical therapy in my blog post, “Pelvic Health Physical Therapy 101”. I promise it’s not as scary as you think it might be!

Be optimistic but realistic about your CPP

It’s important to remember that sometimes CPP can never be completely cured. Instead of aiming for complete pain relief, a more realistic goal may be to reduce your pain and increase your function. For example, if you cannot tolerate sitting for more than 30 minutes before the pain becomes unbearable, a goal could be to sit for at least 2 hours with minimal pain. Your healthcare provider will talk with you about realistic expectations and should also give you strategies for managing your pain after treatment is complete.

It will take time to improve CPP symptoms. Because CPP is defined as pain that lasts more than 6 months, you can’t expect it to get better after one visit, right? It takes time, consistency, and patience to see results. Make sure you are communicating with your provider about your progress; it’s not unusual to have setbacks. Just keep moving forward!