Pelvic Pain: Explained
“Just relax!” or “use more lube”…
…are things you may have heard from your doctor when discussing pelvic pain. Unfortunately, pelvic pain goes misdiagnosed and underdiagnosed very often. Sometimes, healthcare providers are uninformed, unsure or just don’t have the right answer every time. If you have dealt with pain in the pelvic area or are currently dealing with it, tune in!
What is pelvic pain?
Pelvic pain is a type of pain that originates from pelvic floor tissues - muscles, nerves, ligaments, fascia, etc. The pelvic floor, being the base of the pelvis region, is chalk-full of these structures. The main function of those structures is to support & stabilize the joints and organs surrounding the pelvis throughout the anatomical changes in one’s life cycle.
Think about the changes your body goes through starting from childhood growth spurts, pregnancy, childbirth and all the way to menopause. Your pelvic floor anatomy alters during each transition, and all throughout it’s working to maintain bladder, bowel and sexual function.
Pelvic pain is usually caused by overactivity or tension in the pelvic floor muscles. Since it’s usually is not dealt with right away, these symptoms often progress and pull in surrounding body parts to compensate for its lack of full function.
This tends to be why pelvic pain typically brings along with bladder, bowel and/or sexual dysfunction.
This kind of pain can be… hard to pin-point.
Pelvic pain symptoms can present so differently for everyone. Here’s how many describe it:
burning, cramping, pinching, stabbing, tingling, aching, numbness, pressure/heaviness, discomfort, etc.
Location of these symptoms can widely range as well. For some, it stays localized to the pelvis region. For others, it can spread elsewhere up or down the chain. Common problem areas that arise with pelvic pain include:
low back, vaginal area, tailbone, pubic area, abdomen, anus, bladder, thighs/groin, hips
Here’s where the pelvic floor and it’s main functions can take a hit. Many women will mention the following issues:
Overactive bladder: urgency, frequency, feeling constant UTI-like sensation
Difficulty emptying bladder or bowels
Taking more time to initiate peeing
Pain with intercourse or orgasm
Constipation
Shifting on the toilet to fully empty
Any other culprits for this type of pain?
Pregnancy.
Pelvic pain during pregnancy is usually a result of the major hormonal changes that cause significant relaxation and potential instability of joints. Also, the shear weight of a growing fetus forces the pelvic floor muscles to make major adjustments throughout pregnancy. Common pelvic pains during pregnancy include:
Low back pain: up to 50% of women during pregnancy
Pain with intercourse: by the 3rd trimester, up to 70%!
Painful bowel movements: constipation & lots of gas build up
Endometriosis
“Endo” is an inflammatory condition where cells in the lining of the uterus, called the endometrium, are growing outside of the uterus. It’s a pain that is almost always chronic, and symptoms occur both during and outside of the normal menstrual period. This condition impacts about 1 in 10 women! Unfortunately is can take several years to pinpoint this to an official diagnosis due to the lack of overall awareness.
It can cause several painful symptoms, including:
Pelvic floor muscle spasms
Severe cramping
Difficulty or inability to engage in sexual activity
Bloating and constipation
Painful bowel movements
Irregular menstrual cycle with heavy bleeding
Sensation of not being able to fully empty bladder
Unexplained infertility issues
Gastrointestinal (GI) Issues
Because sometimes just taking fiber won’t make the problems go away. Here are common conditions that contribute to pelvic pain:
Irritable Bowel Syndrome (IBS)
Scar adhesions
Constipation
Diverticulitis
Inflammatory bowel conditions (Chron’s disease, Ulcerative Colitis)
Nerves.
This is called pudendal neuralgia, where there is persistent excruciating pain to the pelvic floor region, typically muscles, vulva and anus. This is caused by irritation or damage to the pudendal nerve, which brings major sensation and function to your pelvic floor.
People experiencing this type of pain having difficulty with:
Sitting, wearing tight clothes like jeans or leggings, engaging in sexual activity
Common causes for nerve-type pelvic pain include:
Surgery
Childbirth
Repetitive compression from specific activity (cycling!)
Direct trauma
Chronic constipation
Menopause.
With menopause, there is a major drop in estrogen that throws your body for a loop — and I’m not just talking about hot flashes. Low levels of estrogen directly decreased blood flow circulation to the pelvic floor and vulvar tissues, resulting in dryness and thinning. This is why many women with menopause can feel pain with intercourse. Similarly, the size of the clitoris decreases which can reduces overall arousal during sexual activity.
Why it’s not something you should just brush off.
Since pelvic pain tends to be chronic, complex, and builds up over time, it can feel life-altering. This can create a major negative impact on personal relationships, intimacy with your partner and your overall quality of life. Pelvic floor dysfunction from bladder, bowel or sexual impairments are important to recognize as possible contributions to this condition. Recognizing your symptoms and understanding potential causes of pelvic pain is crucial to get moving in the right direction towards treatment.
Your symptoms are treatable!
So, no more silent suffering. No more dealing with it because you don’t have enough answers. No more just believing what the doctor told you, especially when ‘just relaxing’ or ‘using more lubricant’ doesn’t do the trick.
It’s not worth ignoring. We are here to support you, hear you out, and get you out of pain.