People suffering from pelvic pain are often reluctant to talk with their doctor, friends, or family. Signs and symptoms of pelvic pain are varied, however commonly pain can be located in the rectum, low abdomen, tailbone, groin, and low back.
People who have pelvic pain syndromes may have urinary symptoms associated with their pain such as hesitancy (difficulty initiating or continuing a urine stream), nocturia (having to urinate in the night), urinary frequency (urinating often), urinary urgency (a sudden strong urge to go to the bathroom that may or may not cause incontinence), a feeling of incomplete emptying of the bladder, as well as other symptoms. They may have pain with bowel movements, constipation, and pain before, during, or after orgasm. They may have anxiety, depression, reduced libido, decreased self-esteem, and/or social withdrawal.
Some symptoms are gender-specific. Men with pelvic pain may have penile pain. Signs of pelvic pain in women are clitoral pain or sensitivity, and/or pain with penetration.
Health care providers are sometimes unaware that a physical therapist specializing in pelvic floor conditions may help with incontinence issues.
How can therapy help? Physical therapists perform a thorough evaluation including joint alignment tests of the pelvis, hips, and lumbar spine; assess muscle length, strength, and coordination; internal and external muscle palpation to look for reproduction of symptoms; and internal rectal examination of the pelvic floor muscles. If you are not comfortable with internal examination, other assessments and treatments can be used to reduce pain symptoms.
Treatment involves education regarding postural changes needed, breathing patterns, relaxation, elimination of dietary irritants, and more. Biofeedback is used, when needed, to help you know when you are using the right muscles of the pelvic floor. Manual therapy techniques are used to realign the pelvis or spine, mobilize soft tissues, and eliminate internal and external muscle knots that may be the cause of your pain. Exercises are prescribed to enhance strength of the core and pelvic floor muscles, increase endurance, and flexibility. Modalities such as ice or heat, electrical stimulation, & ultrasound are several options available to help reduce pain and allow muscle relaxation.