May is Pelvic Pain Awareness Month!
Updated: May 31
It is almost certain that someone in your life is suffering from pelvic pain (or dysfunction) and you are not aware! Or maybe you are yourself...
Pelvic pain is pain located in and around the pelvic girdle, including the pelvic floor, abdomen, low back, hips and buttocks.
Chronic pelvic pain (CPP) is non-menstrual pain lasting longer than 6 months, though often much longer.
In this post we will discuss some of the more common pelvic pain conditions in order to promote compassion and empathy for the 5.7%-26.6% of women, and many men, who experience CPP¹. Pelvic pain is marginalized such that there is even insufficient research statistics to draw from.
Dave B Weinstock, November 2020
The level of functional disability associated with different pelvic pain conditions is great and one's quality of life negatively impacted. CPP is under-discussed, thus under-researched, under-served, and mistreated.
We want to get those affected by CPP the multi-disciplinary, patient-centered, research-based, care they need!!!
Below is a list of conditions that can cause pelvic pain, the most common of which we will discuss (list is not comprehensive):
Interstitial Cystitis/Painful Bladder Syndrome
Pelvic Congestion Syndrome
Bladder, Gynecologic, or Colon Malignancies
Inflammatory bowel syndrome
In addition to their pelvic condition, between 25%–50% of people experience depression, 10%–20% anxiety, 20%–30% multi-psychological disorders, and 10%–20% somatic disorders. The mental and emotional toll of these conditions have an impact far beyond just pelvic pain.
If someone has Endometriosis, their uterine lining (which is normally produced on the inside of the uterus) occurs elsewhere in the pelvic cavity like the ovaries, fallopian tubes, or gastrointestinal and urinary tracts. This lining still thickens, breaks down and bleeds just the same as normal endometrium- therefore, it can be extremely painful. Overtime this cycle can cause lesions to form on the walls of the pelvic contents.
These lesions of tissue cause irritation, inflammation and scarring, which results in excessive pain during their menstrual cycle, intercourse, or seemingly random times.
Interstitial Cystitis/Painful Bladder Syndrome
Interstitial Cystitis (IC) or Painful Bladder Syndrome (PBS) affects the urinary bladder and surrounding structures.
Symptoms present similar to a Urinary Tract Infection although there is no infection; urgent sensation of having to urinate all the time while voiding small amounts of urine, pain before, with, or after urination.
The cause of IC/PBS is unknown although it is suspected that the bladder lining has undergone change and is more sensitive to irritants. Pain and inflammation fuel each other, increasing the sensitivity of the bladder and surrounding structures.
Meaning painful intercourse, dyspareunia can be primary or secondary.
Primary dyspareunia means that penetration has always been painful, while secondary dyspareunia is the development of pain overtime.
Often pain is acquired as our nervous system begins to ramp up in response to other stressors. These stressors can overlap, their sum resulting in a sensitized area and symptoms of dyspareunia (or either of the conditions listed above and below!)
For example, a person lives in a long term state of stress and anxiety (say, due to a global pandemic, stressful job, and improper management of said stress and anxiety.) They eat a largely inflammatory diet, and then happen to develop a bad UTI after having poorly lubricated intercourse. They may begin to experience mild symptoms of dyspareunia (or either of the conditions above or below!) The stress of experiencing these symptoms contributes to the nervous system ramping up,
Both Vulvo- and Vestibulodynia are either provoked or spontaneous pain, often described as burning (and many more uncomfortable adjectives.) "Vulvo" and "Vestibulo" refer to the location of the pain; whether is it experienced in the external anatomy called the vulva, or inside the vestibule of the vagina. Often associated with both of these conditions is, vaginismus.
Vaginismus is a reflexive response of the pelvic floor muscles by which they tense in anticipation of, or in response to, penetration of the vagina.
Jennifer Grey, 2020. https://www.naturalcycles.com/cyclematters/what-is-the-vulva
If ANY of these symptoms sound familiar, don't hesitate to seek help- it is out there! Be an advocate for your own health, and find the right health care team for you. Often involved practitioners are Gynaecologists, Urologists, Family Doctors, Psychologists, Physiotherapists and Pharmacists!
Pelvic floor physiotherapy is typically a component of evidence-based treatment for pelvic pain conditions... AND you do not need a referral to see a pelvic floor physiotherapist in Edmonton!
1-Ahangari A. Prevalence of chronic pelvic pain among women: an updated review. Pain Physician. 2014 Mar-Apr;17(2):E141-7. PMID: 24658485.
2-Bordman R, Jackson B. Below the belt: approach to chronic pelvic pain. Can Fam Physician. 2006 Dec;52(12):1556-62. PMID: 17279236; PMCID: PMC1783755.
3-Heim, Lori J., LTC, USAF, MC, Eglin Air Force Base, Florida, Am Fam Evaluation and Differential Diagnosis of Dyspareunia.Physician. 2001 Apr 15;63(8):1535-1545.
4-Lamont, J, Glob. libr. women's med.(ISSN: 1756-2228) 2011; DOI 10.3843/GLOWM.10430
5-Dr. Sukhbir Singh, et al. Prevalence, Symptomatic Burden, and Diagnosis of Endometriosis in Canada: Cross-Sectional Survey of 30 000 Women. http://www.jogc.com/article/S1701-2163(19)30980-6/fulltext. Accessed May 2020.
6-Witzeman K. Pelvic Pain: The Pain Problem with No Home. Pract Pain Manag. 2022;22(2).