If Your Pelvic Pain Won’t Quit, Read on for 5 Tips to Help!
Here at Purple Mountain PT we have a heart for anyone who is experiencing pelvic pain that just won’t quit. We understand the despair you feel and the lack of answers when you go from provider to provider. Our Doctors of Physical Therapy have many years experience working with people who, unfortunately, have lengthy and frustrating journeys to finding us and getting the real help they need.
What are Some Common Things That Our Patients Tell Us? Here’s an example.
Sarah’s Story: Do You See Yourself in Her Story? Names have been changed for privacy.
Sarah is a 44 year old female who came to us with lower abdominal pain and vaginal/pelvic pressure that bothered her most days. It had been going on for the last six years or so, and developed around the time her last child was born. In those six years she thought her problem was an ovarian cyst, but when the doctor found a cyst she was told that it should simply be monitored and no further treatment was recommended. She found herself taking ibuprofen more often than she liked and this also caused some issues related to her migraines, rebound headaches. She developed some back pain and went to physical therapy for this; the PT didn’t help. At one appointment they had her sit in a chair and march in place and she thought it was a silly exercise that wouldn’t help her, so she stopped going. The pelvic pressure was worse around her menstrual cycle, but occurred throughout the entire month and was bad enough that she avoided jogging and intimacy.
She found us because one of her friends told her about us, but she had already been to physical therapy for her back and that PT told her that her pelvic floor was fine.
She was skeptical when calling Purple Mountain PT, but when her friend promised her that we were different and more effective, she scheduled an evaluation. At her evaluation we found that her pain was her main concern and was present just about everyday and often causing her to feel out of shape and unable to workout to get into shape. We also discovered that she experienced urinary leakage and sometimes urinary urgency. Her constipation was an ongoing problem, with bowel movements once every 2nd or 3rd day. Intimacy was not comfortable and was not enjoyable, her libido was gone.
Our examination found that she had a variety of things that we needed to address to help her pain:
- Myofascial restrictions in her abdominal wall including trigger points in numerous muscles that were contributing to daily pain.
- Tension and muscle guarding and tightness in her hip muscles, inner thighs and low back. These were a major source of her problem and needed to be effectively treated with myofascial release, trigger point release, joint mobilization and pelvic and low back alignment methods.
- Pelvic floor dysfunction characterized by high tone pelvic floor, meaning her pelvic floor muscles were stiff and painful. These were a big driver of her pain and her urinary urgency and leakage and likely contributing to her constipation, also.
- The presence of migraines plus the chronic pelvic pain render us suspicious for her having a ramped up nervous system that easily experiences pain. We use a validated questionnaire to find out if this is the case and it was for Sarah. Because of this we use a combination of education, neural calming techniques, heart rate variability training and myofascial release and muscle calming hands-on methods to calm down her sensitized nervous system.
- Inability to exercise is a big problem and something we needed to improve. We found she was quite weak & often tight in many major muscle groups including her glutes, quads, inner thighs, hamstrings, low back, postural stabilizers in her upper back, abdominals and calves. Her weakness was from a combination of being sedentary and also from her condition inhibiting the proper firing of her muscles; we needed to retrain the muscles and restore her capacity to exercises.
Because Sarah’s case is common and, if you are reading this blog, you likely share some characteristics with Sarah, we can offer five tips to help you today. These are things you can do today that we also suggested Sarah begin on her first day of treatment.
5 Tips To Ease Your Pelvic Pain that Won’t Go Away!
Tip 1: Practice Diaphragmatic Breathing
The diaphragm is a pathway to calming down high tone pelvic floor and chronic pain. Learning to effectively breathe with your diaphragm is a key skill that is usually dysfunctional when someone has chronic pain. This may seem like a simple, useless tip. But, take our word for it and our patients’ word for it: diaphragmatic breathing is an important skill to help nudge your body out of pain.
Tip 2: Lengthen Your Pelvic Floor Muscles
This is tricky to learn and, especially when someone has chronic pelvic pain, usually they have very limited capacity to let go of their pelvic floor muscles because these muscles are stiff and tight. For the most effective results, you truly need hands-on care from one of our Doctors of PT. But, please give this tip a good, solid try. Practice makes perfect, so you’ll have to work on it multiple times a day.
Here’s one way you can learn how to melt your pelvic floor muscles: lie down in a quiet location. Clear your mind. Soften your breathing. Relax your abdomen. Bring your awareness to your pelvic floor area. Relax your glutes. Let go of your tailbone, invite it to float back towards the floor. Soften and open the anus, let go of the back area. Drop your vagina by fully letting go of it. Simulate peeing and invite a release/opening of the area where you pee. Never push these muscles to get them to release.
Tip 3: Optimize your gut health
This is crucial when trying to resolve pelvic pain. You must have daily bowel movements that are well formed and without straining. Look closely at your nutrition and eliminate all foods that might constipate you and/or cause intestinal bloating or distress. Consider seeing a dietician for expert guidance. Aim to eat 30 grams of fiber a day, if you can tolerate fiber.
Tip 4: Optimize your water intake
Because Sarah had some issues with urinary control and urgency, she had slowly reduced her water intake. This actually worsens bladder wellbeing and can contribute to bladder spasms and ongoing pelvic pain. For your bladder to be happy you need optimal water intake. You should be urinating about every 2 to 4 hours and you want your urine color to be light yellow.
Tip 5: Movement is Needed
With chronic pelvic pain we know that movement is needed. You must move. The less you do, the more you hurt. The challenge is figuring out how much movement is well tolerated and which movements to do. In general, it is smart to begin with brisk walking and some light stretching. Think about stretching your hips, low back and legs. Be gentle with your movements, never forcing a stretch.
Bonus Tip 6: Prioritize Sleep, Relaxation and Meditation.
Sleep is how our body restores itself. You must prioritize sleep, address sleep apnea problems and keep a regular bedtime. By building relaxation and meditation into your daily routine, you will further nudge your nervous system towards a more balanced and less sensitized state and this will, in concert with everything else you are doing, help you have less pain. Research has shown us that individuals who have chronic pelvic pain experience higher rates of anxiety, depression and sleep disorders. We also know that multimodal (meaning a team of providers with various clinical expertise) care is best for you. For a link to an NIH article detailing some important findings related to chronic pelvic pain, click here. It is common that your team might consist of a physical therapist, counselor, psychologist, sleep specialist, gynecologist, physiotrist and other providers.
For our patient, Sarah, these 5 simple tips got her started with a plan for what she could do at home.
With our skilled therapy, which primarily comprised of hands-on treatments from her shoulders to her knees (because pelvic pain and fascia connections extend throughout the body), bladder calming treatments and parasympathetic nervous system activation, she was able to gradually increase her exercise and daily activities. We worked closely with her completing specific exercises to teach her how to reduce her pain while also building up better strength and function of her muscles, especially her core muscles, hips and thighs. While these tips have worked for many of our patients, please keep in mind that you are not our patient and, therefore, this is not medical advice for you. Everything here illustrates what worked for Sarah and other patients. Please, if you are having pelvic pain that won’t quit, give us a call so we can customize our recommendations for you.
Dr. Maureen O’Keefe, DPT and the Purple Mountain PT Team