Chronic Pelvic Pain

Chronic pelvic pain can be defined as pain in the lower abdomen or pelvis which may be constant or intermittent and lasting more than 6 months. It is more common in women and is often described as a symptom associated with other conditions such as vulvodynia and endometriosis among many others.

The ultimate cause of chronic pelvic pain is unknown and there are often several contributing factors.  The Royal College of Obstetricians and Gynaecologists (Green-top Guideline 41 – Chronic Pelvic Pain Management, 2012) have identified research that suggests Musculoskeletal Pain may be a primary source or contributing factor of pelvic pain. The guidelines include the following statements:-

• Pain may arise from the joints in the pelvis or from damage to the muscles in the abdominal wall or pelvic floor. Pelvic organ prolapse may also be a source of pain.

• Increasing interest is also being shown in trigger points – localised areas of deep tenderness in a tight band of muscle. It may relate to chronic contraction of the muscle, with the stimulus coming from misalignment of the pelvis or a discrete pain such as endometriosis. The pain from a trigger point may then become self-perpetuating.

• In a consecutive series of 26 women with laparoscopy-negative chronic pelvic pain, 20 were found to have injuries to the pelvic floor muscle.

• Spasm of the muscles of the pelvic floor is proposed as a cause of pelvic pain.

• A number of observational studies have demonstrated a high prevalence of primary or secondary musculoskeletal abnormalities in women with chronic pelvic pain.

• Nerve entrapment in scar tissue, fascia or a narrow foramen may result in pain and dysfunction in the distribution of the nerve. The incidence of nerve entrapment (defined as highly localised, sharp, stabbing or aching pain, exacerbated by particular movements) after one ‘bikini-line’ incision is 3.7%.

Physio for Women – Specialist Physiotherapy & Pilates