Have you been diagnosed with Chronic Pelvic Pain Syndrome, or are you experiencing pelvic pain and wondering if you have Chronic Pelvic Pain Syndrome?
This blog is going to talk about Chronic Pelvic Pain Syndrome specifically, but if you have symptoms like pelvic pain, aches, or any of the symptoms that are listed below, I would recommend you continue reading
What Is Chronic Pelvic Pain Syndrome (CPPS)?
Chronic pelvic pain is defined as persistent or recurrent pain in the lower abdomen or pelvis lasting longer than 6 months. In men, chronic pelvic pain is commonly diagnosed as chronic prostatitis or chronic pelvic pain syndrome (CP/CPPS).
This the presence of chronic pelvic pain and urinary symptoms without any signs of bacterial infection.
Common Symptoms of Chronic Pelvic Pain Syndrome
Chronic Pelvic Pain Syndrome comes with many different symptoms. Here are some of the most common ones that we treat at the clinic:
Pelvic pain
Painful periods
Urinary urgency or frequency
Pain with urination
Incomplete bowel and bladder emptying
Constipation
Pain with intercourse, gynecological exams, and/or tampons
Erectile pain or painful ejaculation
Pelvic Floor Muscle Dysfunction & CPPS
Upon manual assessment, it is common to find tension, impaired relaxation, and sensitivity of the pelvic floor muscles in those with chronic pelvic pain.
A self-perpetuating cycle of discomfort is created: initial pain causes protective muscle guarding and heightened tension in the pelvic floor, which ultimately intensifies the pain. The presence of pelvic floor tension and discoordination can contribute to other pelvic floor symptoms, such as urinary, bowel, or sexual dysfunction.
This is why chronic pelvic pain can become very complex and affect various systems beyond the musculoskeletal system.
Nerve Irritation and Sensitization
The pelvic floor and genitals can be an area of high alert for the brain and our central nervous system. As pain persists over time, our nervous system becomes increasingly sensitized.
That means that any stimuli to this area will cause the nervous system to respond in a protective and hypersensitive manner, leading to pain.
Our pelvis contains many neural pathways, any of which can become irritated.
Most commonly, the pudendal nerve is affected and results in pudendal neuralgia.
Pudendal neuralgia occurs because the pudendal nerve becomes entrapped along its path. This can be due to overactive pelvic floor muscles. Indirect trauma, such as viral infections, multiple sclerosis, or diabetes, can also contribute. Stress is a common aggravator, but not known to cause pudendal neuralgia.
The Role of Stress and the Nervous System in CPPS
There is a significant psychological aspect to chronic pelvic pain, especially for women with a history of trauma.
Women with pelvic pain are more likely to experience depression, anxiety, and sleep disorders. Increased stress can directly trigger a visceral response in the pelvic floor, exacerbating symptoms.
In men, research shows psychological stress can exacerbate CP. A complex case that involves various systems may require a longer course of care versus symptoms that remain very localized to the pelvic floor.
Bladder, Bowel, and Reproductive Factors
There are a few specific diagnoses that are known to be associated with CPPS.
Interstitial cystitis, or painful bladder syndrome, is classified as pain in addition to lower urinary tract symptoms. Pain is typically felt in the suprapubic region or at the bladder and worsens with bladder filling.
IBS has a high correlation with pelvic pain.
Rather than a cause for pelvic pain, IBS is linked to chronic pelvic pain via somatization and similar etiology. Those with IBS and CPP have higher rates of central sensitization (heightened nervous system) compared to those without these diagnoses.
Patients with IBS, especially IBS-C, often strain which can create tension in the pelvic floor and worsen pelvic pain.
Other comorbidities associated with chronic pelvic pain include endometriosis, adenomyosis, ovarian cysts, and uterine fibroids. Acute pain that results from endometriosis can become chronic by central sensitization. Any of these diagnoses can impact nerves, create scar tissue or adhesions, and cause inflammation in the pelvis.
Posture, Hip Mechanics, and Movement Habits
Our posture and how we move can significantly impact our pelvic floor. The pelvic floor sits at the bottom of the pelvis, in close proximity to our hips, core, and back.
Any tension, weakness, or laxity in these areas can directly cause tension in the pelvic floor.
Tightness, and even hypermobility, in the hips can cause pulling in certain parts of the pelvic girdle, changing how muscles react to movement and how force is absorbed.
How we sit for long periods, strike our foot while running, or lift a heavy box are all relevant to the pelvic floor.
Pelvic floor therapists are movement specialists, meaning we can examine beyond the pelvic floor to address other musculoskeletal contributors.
Why It Is Often Misdiagnosed
Pelvic pain is frequently misdiagnosed in women due to its extensive overlap with urinary, gynecologic, gastrointestinal, and musculoskeletal systems.
Each of these distinct systems is capable of giving rise to its own type of pelvic pain in addition to other symptoms.
Symptoms tend to go underreported for about 2 years until women seek care, so symptoms often become chronic and systemic. This can make it more challenging to find the source of the pain, resulting in misdiagnosis.
In men, pelvic pain can be accompanied by urinary or sexual dysfunction, leading to a diagnosis of bacterial prostatitis.
Despite negative tests for infection, they are prescribed antibiotics. If symptoms are unchanging, there is likely underlying pelvic floor dysfunction.
How Chronic Pelvic Pain Syndrome Is Treated
A multimodal approach is best for symptom relief. This can include pelvic floor physical therapy in addition to biopsychosocial approaches, such as cognitive behavioral therapy.
If you see a pelvic floor specialist, the course of care will include direct pelvic floor interventions, such as manual therapy, pelvic floor lengthening, and increasing pelvic floor awareness. Indirect interventions may include general relaxation and stress management strategies, lifestyle changes, and strengthening, when appropriate.
Less conservative treatment options include Botox, steroid injections, and medication.
Where to Find Pelvic Therapy for Chronic Pelvic Pain Syndrome
If you are located in Monterey or surrounding areas, we offer pelvic floor therapy and our clinicians can help you find relief from chronic pelvic pain syndrome.
Pelvic pain is one of our specialties in the clinic, and we see many patients who experience pelvic pain, either primarily or secondarily to another injury or diagnosis and we’d love to help you.
To get started, you can request an appointment by submitting our contact form or calling our clinic directly.