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The Complicated Truth About Chronic Pelvic Pain

There’s no denying it: Pain is complicated. In the best-case scenario, pain is an accurate warning signal — alerting you of an injury or infection that needs your immediate attention. But chronic pain that occurs without injury and/or that sticks around after you've healed is anything but helpful.

Understanding and treating any type of chronic pain typically takes time, patience, and expert support. When pain occurs in the pelvis, an area of the body that's physically and emotionally complex, that's even more true.

If you're reading this because you have pelvic pain, know that it can get better. The info below will help you better understand the nature of chronic pain as well as what makes pelvic pain unique. If you have questions or need treatment, don't hesitate to book a visit or schedule a call with us.

Chronic Pain & Your Nervous System

As a rule, injured tissues will fully heal within 3-6 months. If pain persists beyond this timeline with no known medical cause, it's considered chronic. Even if you never had an injury, chronic pain is still very real — and has real impact on your day-to-day life.

Chronic pain is a lot like a broken fire alarm that goes off intermittently (even when there isn't a whiff of smoke) because its wires have gotten crossed. In the same way, your body can continue to produce pain signals because of wiring problems in your nervous system.

With chronic pain, your nervous system (which includes your brain) will begin to adapt to persistent pain signals, making changes that can contribute to and perpetuate pain. Eventually, what was once an accurate and efficient warning system in your body, can become exaggerated and confusing.

Signs your nervous system is changing in response to chronic pain:

  • Your pain becomes amplified: The signals going up to your brain get more intense, and more nerves become involved. This translates to an experience of even more pain. But what's important to note is that this does not mean more tissue damage. When a normally painful stimulus becomes more painful, this is known as hyperesthesia.
  • You feel new sources of pain: With chronic pain, movements that never used to be painful now are, and even light touch or pressure to your skin can start to become painful. When touch that is not ordinarily painful becomes painful, it is known as allodynia.
  • Your mind cannot focus or rest: With all of the excessive pain input, changes in your brain make it harder to focus, learn, or even rest and recover. It can seem like you never get a break from your pain.
  • It's difficult to locate the source of pain or move the affected body area: There are areas of our brain that are dedicated to the movement and sensation of different parts of our body. When we experience constant pain in a specific body part, the associated area of our brain can grow, shrink, and re-wire. These brain changes can make moving that area of the body and locating the source of pain difficult.

3 Reasons Pelvic Pain is More Complicated

Generally speaking, pain can be heavily influenced by what are known as biopsychosocial factors. This means that there are social, emotional, and physical influences that contribute to, and uniquely influence each individual’s pain story.

If your pain includes your pelvic or genital areas, these factors can come into play:

  • Increased muscle tension due to trauma: Whether it’s sexual trauma, birth trauma, or PTSD, it is common for pelvic pain to form around, or be exacerbated by trauma and threat. Our pelvic floor muscles often react to actual or perceived threats by holding tension. Pain is an example of a threat — the more pain we feel, the more tension can be held in the muscles and vice versa.
  • Cross talk and sensitization: The network of nerves that run to and from the pelvic area is uniquely complicated, as are the signals they send. Many of the nerves from the different pelvic organs join together and use one of only a few pathways up to the brain. In these pathways, the signals from the various pelvic organs are able to communicate and mix signals — this ability is extremely important so that bowel, bladder, and sexual function can work in concert. But this same cross-talk can contribute to the development of overlapping pelvic pain disorders.
  • Pudendal nerve complications: The pudendal nerve, which provides innervation to a significant amount of your pelvic floor structures, is known as a mixed nerve which means it provides sensation and function to the pelvic area. Most nerves to the body either provide motor or sensation, but not both. If the pudendal nerve is involved in pain signaling that is being amplified, it affects both how these muscles feel and how they function. As a result, things can get mixed up: Muscles that aren’t functioning properly can feel painful, and muscles that are painful might not function properly.
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Start Healing With Pelvic Floor Physical Therapy

The good news is that physical therapy can change how your body and brain respond to chronic pain, helping you to get relief over time. For example, a physical therapist can help you learn techniques such as progressive desensitization that can reduce allodynia, and adopt breathing and body mechanics strategies to manage and avoid pain.

With pelvic pain, it's also very important to work with a trained pelvic floor physical therapist who understands the biopsychosocial factors that come into play with this area of your body. If you had any kind of trauma (big or small), a pelvic floor PT can help you release pelvic floor tension that can create and exacerbate pelvic pain.

When it comes to solving chronic pain, a multidisciplinary approach is most effective. While your PT will address your musculoskeletal and nervous system — and provide you with education on how pain is affecting you — they'll also recommend other evidence-based treatments such as psychotherapy, medical management, or mindfulness practices like meditation. Every person and every pain story is different, so the most effective treatment will be unique to you.

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Dr. Ashley Rawlins, PT, DPT

Dr. Rawlins is a physical therapist at Origin who specializes in the treatment of pelvic floor muscle dysfunctions including pelvic pain, sexual dysfunction, pregnancy related pain, postpartum recovery, and bowel and bladder dysfunction. In addition to being a practicing clinician, she is a passionate educator and author.

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