Dr. Kelly Sammis, PT, CLT
Navigating Pelvic Pain
Pelvic pain has been associated with over 70 different diagnoses that often present with overlapping symptom presentation (1). Patients are often referred to physical therapy with medical diagnoses such as: chronic pelvic pain syndrome (CPPS), interstitial cystitis, irritable bowel syndrome, endometriosis, dyspareunia, pudendal neuralgia, bowel and urinary incontinence, and/or chronic prostatitis...to name a few. (2,3) Symptom presentation is quite variable in regards to pain, but often this pain is accompanied by dysfunctions of the bowel, bladder, and/or sexual systems.
Epidemiological data suggest that chronic, widespread, nonspecific musculoskeletal pain is on the rise and has doubled in the past 15 years, affecting approximately one third of the adult population in the US. A recent study also reports that the estimated lifetime occurrence of CPPS is 33%. (4,5) That's 1 in 3 individuals...while you might feel alone in this journey, I promise you are not. There is an entire community of support ready to help you navigate this.
OK, but nerdy data aside...why am I experiencing this pain?
This is the most common question that is asked by my clients. Understanding why this pain persists, what causes this pain and why previous treatment hasn't worked for you is integral for each client to begin the healing process and road to recovery. It is also often multifactorial and unique to each individual.
Let's start by saying, your pain is very real and how it is affecting your everyday life is very real. It is not "in your head" as you may have been told at some point during your experience. Your symptoms can be very debilitating and can certainly affect how well you function day to day, but they are also very treatable. While it can be a long and frustrating process at times, a life without pain is possible. Your countless visits with your medical team, varying trials of different medications and treatments, and at times an overwhelming feeling that there is no light at the end of the tunnel might make you feel otherwise, but I promise you, you are not alone and there is hope.
This is treatable.
What pain is...
The IASP defines pain as an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage (7). This brings forward a very important concept in regards to pain and that is that the sensory or emotional experience is very real; however, that doesn’t necessarily mean that the experience itself is equivalent to actual tissue damage.
Pain is designed to be a protective mechanism for our bodies and it helps us to prevent further injury and tissue damage. It's our alarm system to alert us that something isn't quite right and it tells us that we may be putting our bodies at risk. When our alarm system is in optimal condition, our brain will receive messages from our tissues and our environment. The brain will then process and interpret these messages. Last, our brain will send output back to our tissues and environment to stimulate an action or response. In short, pain is an outgoing message that is processed in our brain and expressed in our body.
What happens when our alarm system isn't working correctly? What if our alarm system has become sensitive, overactive, or upregulated? In this scenario, we will start to see activities that were once tolerable and completed without altered sensations become less and less tolerable and are potentially associated with a sensory or emotional experience. For example, prior to experiencing your pelvic pain you were able to sit through a work meeting without any issue, but now sitting for more than 3 minutes elicits a burning sensation around your sits bones. Sound familiar?
What pain isn't...
Pain is not necessarily equivalent to injury. Pain is not always directly correlated to the presence of tissue damage or the amount of tissue damage. Pain is not imaginary or unreal.
Your pain is real, but so is hope.
It's time to begin the journey of taking control of your pain to get back to the life you want to live. We will be expanding our knowledge on pain science and different diagnoses in pelvic health in upcoming blogs! Within these upcoming pieces we will discuss the diagnoses and how they present clinically, we will dive in to the common root causes that may contribute to the dysfunction and we will educate you on what you can do to start reducing your pain, alleviate your symptoms and return to optimal function!
Ask questions and send requests...
If you have questions or would like to see a specific clinical diagnosis highlighted sooner rather than later, connect with me!
To health + wellness for your pelvis,
1. Messelink et al. Standardization of terminology of pelvic floor muscle function and dysfunction: report from the pelvic floor clinical assessment group of the International Continence Society. Neurology and Urodynamics. 2005;24:374-380
2. Anderson R, Sawyer T, Wise D, Morey A and Nathanson B. Painful myofascial trigger points and pain sites in men with chronic prostatitis/Chronic Pelvic Pain Syndrome. The Journal of Urology. 2009;182:2753-2758
3. Hahn L. Chronic pelvic pain in women. Lakartidningen. 2001;98:1780-5
4. Kotarinos R. Myofascial pelvic pain. Curr Pain Headache Rep. 2012;16:433.438
5. Srinivasan A, Kaye J, Moldwin R. Myofascial dysfunction associated with chronic pelvic floor pain: management strategies. Current Pain and Headache Reports. 2007;11:359-364
6. Tantanatip A and Chang K-V. Myofascial pain syndrome. StatPearls Publishing, LLC. 2021. NCBI Bookshelf, https://ncbi.nlm.nih.gov/books/NBK499882
7. Raja SN, Carr DB, Cohen M, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161(9):1976-1982