Pelvic pain or tension is probably one of the most misunderstood and complex medical issues of our times. Very few practitioners have a full understanding of how to treat pelvic floor issues with respect to rehabilitation and other treatments outside of surgery. In this article, we will discuss disorders that may cause pelvic pain and also the social implications of pelvic pain.
For women, two of the most common problems I see in my practice are vaginimus (vaginal tightening or painful intercourse) and vaginal prolapse (especially after birth). For men, I commonly see erectile dysfunction and bowel incontinence. Sexual dysfunction or private body parts may be difficult to talk about for both women and men; nonetheless, they are an important part of our overall wellbeing. To understand pelvic pain, we need to understand the role nerves play in pelvic pain.
We know there are two facets to pelvic pain: the emotional and the physical. On the physical level of understanding pain we have visceral,somatic sources or both. Visceral pain is often defined as diffused pain and difficult to localize, especially with internal organs. Somatic pain refers to superficial structures such as skin and deep tissues.1 Both the visceral and somatic sources are connected by the nociceptors, pain-detecting nerves that send an impulse from the painful site up through the spinal cord and to the brain for interpretation and reaction. However, visceral and somatic sources often present pain very differently.
Another important aspect to understanding pelvic pain is understanding the different anatomical structure of the pelvic floor between men and women. Women tend to have a broader and shallower bony pelvis with greater ligamentous and muscle stiffness to provide joint stability for sacroiliac joints.3 Ligamentous laxity can be caused by hormones relaxing and estrogen. Most studies report symptomatic labral tears occurring more frequently in women than men. This is because there is a lower center of gravity for women compare to men.2 Another aspect of understanding anatomy is the position in which we sit or stand. Women tend to cross their legs, while men typically do not. Men have deeper hip sockets than women and tend to keep at their natural position in crossing at ankle to knee when sitting or keep both feet on the ground while sitting.
The body has an amazing ability to communicate when it comes to pain. In general, women have cluster headaches or tension headaches along with low back pain and pelvic pain.4 The reasoning behind this is related to the parasympathetic nervous system. Both the head/neck and lumbar/sacral (pelvic area) are supplied by the parasympathetic system. Therefore, both areas of the body are in direct communication with each other. If there is something going on up in the head, there is definitely something going on in the low back/pelvic region, and vise versa.
There is a tremendous need for understanding pelvic pain in both men and women. Do not hesitate to talk to your doctor about your issues. He or she may be able to provide resources and recommendations for specialists in your area. Be sure that your pelvic pain specialist treats both the internal as well as the external tissues, as it is important to treat both for optimal healing.
By Jill Ghormley, ND, MAMS, Portland, Oregon, Naturopathic Physician. Edited by Dr. Elise Schroeder
1. FitzGerald MP, Anderson RU, Potts J, et al; Urological Pelvic Pain Collaborative Research Network. Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes. J Urol. 2009;182(2):570-580.
2. Howard FM. Chronic pelvic pain. Obstet Gynecol. 2003;101(3):594-611.
3. Prather H, Spitznagle TM, Dugan SA. Recognizing and treating pelvic pain and pelvic floor dysfunction. Phys Med Rehabil Clin N Am. 2007;18(3):477-496, ix.
4. Zondervan KT, Yudkin PL, Vessey MP, Dawes MG, Barlow DH, Kennedy SH. Prevalence and incidence of chronic pelvic pain in primary care: evidence from a national general practice database. Br J Obstet Gynaecol. 1999;106(11):1149-1155.
About the Author:
Dr Jill Ghormley is a Naturopathic Doctor in Portland Oregon specializing in pelvic floor rehabilitation.