CHRONIC PELVIC PAIN

Chronic pelvic pain (CPP) is generally defined as pain in the pelvic region ongoing for at least 6 months. Distinct from acute pelvic pain, CPP often has a complex and multifactorial aetiology with numerous overlapping causes and associated diagnoses. As with other chronic pain conditions, the severity of CPP does not necessarily correlate with physical pathology, and standard medical and surgical treatments have limited success. The prevalence of CPP has been found to range from 6.4 to 25.4% worldwide

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    There is no one unifying aetiology for CPP—the primary pathology may be urological, gynaecological, gastrointestinal, dermatological, neurological, musculoskeletal or psychological, and often several of these systems are involved at once.

    Examples of commonly found causes are:

    Urological: Interstitial cystitis/painful bladder syndrome.

    Gynaecological: Endometriosis, Vulvodynia, Pelvic congestion syndrome

    Gastrointestinal: Irritable bowel syndrome

    Dermatological:  Lichen sclerosus, Lichen planus

    Neuromuscular: Pelvic floor myofascial pain, Sacroiliac joint pain/dysfunction,  Lumbosacral pain/lumbosacral radiculopathy,  Peripheral neuropathies including ilio-hypogastric, ilioinguinal, genitofemoral, and  pudenda nerves

    Psychological: Depression, anxiety, Physical, sexual or emotional abuse, Sleep disturbance

    How can physiotherapy help?

    Pelvic physiotherapy is appropriate in cases where there are demonstrated musculoskeletal or biomechanical abnormalities on examination, including pelvic floor dysfunction, sacroiliac (SI) joint dysfunction, and hip or lumbar spine pathology concurrent with the pelvic pain. Pelvic floor physiotherapy is invaluable in the treatment of pelvic floor muscle dysfunction, which can result in high tone, impaired coordination, trigger points, and myofascial pain that can contribute to the overall pain presentation. After performing a thorough assessment, pelvic physiotherapists can work to correct posture, restore muscle length, improve coordination including with the use of biofeedback, perform myofascial release, and provide desensitisation. In addition, pelvic physiotherapy can help greatly with bowel and bladder retraining.  It has been shown that this is an underutilised modality of treatment, as often the musculoskeletal components of pelvic pain are less likely to be recognised.

    Other modalities of treatment that may be used are acupuncture, electrotherapy including the PelviPower and  heat.

    Everybody with CPP presents with their own set of signs and symptoms and following a thorough initial assessment, personal treatment plans are devised in agreement with the patient.

    • Kumar L, Scott K. Chronic Pelvic Pain and the Chronic Overlapping Pain Conditions in Women. Current Physical Medicine and Rehabilitation Reports https://doi.org/10.1007/s40141-020-00267-3
    • George SE, Clinton SC, Borello-France DF. Physical therapy management of female chronic pelvic pain: anatomic considerations. Clin Anat. 2013;26(1):77–88. https://doi.org/10.1002/ca. 22187. 89.
    • Berghmans B. Physiotherapy for pelvic pain and female sexual dysfunction: an untapped resource. Int Urogynecol J. 2018;29(5): 631–8. https://doi.org/10.1007/s00192-017-3536-8.

    Female Pelvic Pain: Acupuncture can help to eliminate or significantly reduce the pain

    Chronic pelvic pain (CPP) is one of the most common pain conditions affecting women and can have a significant impact on quality of life. Chronic pelvic pain is a multi-system disorder when pain symptoms can manifest in many different ways for each women. There are also many root causes to pelvic pain ranging anywhere from trauma, muscle strain, emotional stress, and nutritional deficiencies. The pain in the pelvis can be defined as truly unique to each individual woman in the root cause and manifestation of it.

    How Acupuncture Helps to Relieve Female Pelvic Pain?

    Acupuncture provides a holistic approach to healing and is effective treatment to relieve the pain. The fundamental concept of acupuncture is the balanced flow of life energy, Qi through the body. The Qi flows in well-defined vessels – meridians, which already are identified and acknowledged by modern scientist research. When the flow of Qi is blocked by disease or injury, the symptoms of illness – pain, swellings, and tenderness manifest themselves. Acupuncture points are well- demarcated areas along the meridians, which “unblocks” the flow of Qi with the insertion of needle.

    One major hypothesis from Western researches is that acupuncture works through neurohormonal pathways: the needle in the body stimulates the nerves that send signals to the brain, and the brain releases neural hormones such as beta-Endorphins. By doing that, the patient may feel euphoric, or happy, and this increases the pain threshold and they feel less pain.

    The needles inserted locally, in pelvic area improve local blood flow and invigorate Qi/energy flow. This local needle insertion causes a local release of histamine and endorphins and facilitates local pain gate effects.

    Needles inserted more distally, on the legs and arms stimulate descending pain inhibition, as well as the production of endorphins and β-cortisol (anti-inflammatory).

    What types of Pelvic pain can be eliminated with Acupuncture?

    • Gynaecological pain
    • Endometriosis
    • Menstrual Pain
    • Uterine Fibroids
    • Ovarian and Dermoid Cysts
    • Childbirth Trauma/Anxiety
    • C-Section scar Adhesions
    • Adenomyosis
    • Vaginismus
    • Polycystic ovary syndrome (PCOS)

    Gastroenterological pain

    • Iritable bowel syndrome (IBS) pain is intermittent, with cramping in the left lower quadrant as well as flatulence, bloating and alternating diarrhoea and constipation. Pain is often improved after a bowel movement and is typically worse after eating, during stress and anxiety, and during the premenstrual and menstrual phases of the cycle.
    • Diverticular disease results in severe acute left quadrant pain with associated fever and tenderness.
    • Inflammatory bowel diseases such as ulcerative colitis manifests with acute pains and symptoms such as fever, vomiting and anorexia.

    Urological pain

    Chronic pain of urological origin is associated with bladder-related symptoms of urgency, frequency, hesitancy, incontinence, nocturia, dyspareunia and urinary tract problems such as:

    • Interstitial Cystitis (IC)
    • Bladder Pain
    • Bladder Syndrome
    • Prolapse of Uterus or Bladder

    Myofascial pain syndrome

    • It occurs as a result of muscle injury, overuse, repetitive strain or somatic influences on the sympathetic nervous system. Myofascial pain is generally described as dull, aching and poorly localised.
    • It may be affected by posture, stress and the menstrual cycle.
    • It is generally eased with rest, warmth and the reduction of postural and emotional stress.
    • Any fascia or muscle innervated by the twelfth thoracic to the fourth lumbar spinal segments can refer pain to the lower abdomen, especially the iliopsoas, quadratus lumborum, and piriformis muscles.
    • Any fascia or muscle innervated by the tenth thoracic to the fourth sacral segments can refer pain to the reproductive organs, abdominal wall, lower back, thighs and pelvic floor

    Psychological factors

    Studies of women with Chronic Pelvic Pain have documented a high incidence of psychological disturbance and sexual abuse. The role of unknown neurophysiological mechanisms within the enteric nervous system, spinal cord and supraspinal areas cannot be overestimated. Chronic pelvic pain without (or even with) inflammatory, mechanical or visceral pathology is likely to involve all levels of the Central Nervous system. In such cases the therapeutic approach should be directed at the physical, emotional and systemic levels.

    References

    Akimoto T, Nakahori C, Aizawa K (2003) Acupuncture and Responses of Immunologic and Endocrine Markers during Competition. Medicine & Science in Sports & Exercise 35(8): 1296-1302
    Heitkemper M, Jarrett M, Bond E (2003) Impact of Sex and Gender on Irritable Bowel Syndrome. Biological Research For Nursing 5 (1): 56-65

    Proctor M. L., Smith C. A., Farquhar C. M. & Stones R.W. (2002) Transcutaneous electrical nerve stimulation and acupuncture for primary dysmenorrhoea. Cochrane Database of Systematic Reviews 2002, Issue 1. Art. No.:CD002123. DOI: 10.1002/14651858.CD002123.

    Rankin AJ (2002) Chronic Pelvic Pain In: Textbook of Pain 4th Ed, Churchill Livingstone.
    Stones RW, Loesch A, Beard RW et al (1995) Substance P: endothelial localization and pharmacology in the human ovarian vein. Obstetrics and gynaecology 85(2): 273-278

    Practitioners

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    Rosemary Lillie

    Our Physiotherapy Clinic Services

    The West Wimbledon Physiotherapy Clinic aims to provide a selection of services to maintain and enhance health and wellbeing. Although primarily a physiotherapy clinic, a range of other treatments are available.