Pelvic Pain Syndromes

Most of you at some point in life might have experienced pain around your pelvic region. But what does pelvic pain mean? How does it start and what does it do to your body? Let’s understand in depth.

Pelvic pain occurs in the lower part of the abdomen and pelvic bone, between the belly button and the groin region. It can affect both men and women and may arise from various structures, including the reproductive organs, urinary system, gastrointestinal system, muscles, and sometimes nerves within the pelvic region.

These pelvic pain syndromes are complex, presenting significant challenges in diagnosis and management. Pelvic pain can be acute or chronic, often involving musculoskeletal, neurological, and systemic organs.

So, how does a physiotherapist help you with the management of Pelvic pain? Physiotherapists play a key role in the management of pelvic pain, using evidence-based techniques to reduce symptoms, improve function, and enhance quality of life.

Classification of Pelvic Pain Syndromes

Pelvic pain syndromes are broadly classified into:

1. Acute Pelvic Pain

Sudden onset, lasting up to or less than 3 months, often linked to infections, trauma, or surgical complications.

2. Chronic Pelvic Pain (CPP)

Persistent pain lasting more than 3–6 months, most commonly seen in women more than men.

Common Types of Pelvic Pain Syndromes

• Chronic Pelvic Pain Syndrome – Nonspecific pelvic pain without known infection or pathology.

• Pelvic Floor Dysfunction – Resulting from abnormal tone (hypertonicity or hypotonicity) or poor coordination of pelvic floor muscles.

• Endometriosis-associated Pain – Caused by the presence of endometrial like tissue outside the uterus.

• Bladder Pain Syndrome – Associated with bladder wall inflammation and hypersensitivity.

• Pudendal Neuralgia – Pain along the distribution of the pudendal nerve.

• Prostatitis/Chronic Prostatitis – Non-bacterial inflammation of the prostate gland causing pelvic and perineal pain in men.

How does a Physiotherapist do Assessment of Pelvic Pain Syndromes?

A thorough assessment is important to identify the source of pain and contributing factors. These include:

Patient History

• Onset, duration, and nature of pain

• Associated symptoms (e.g, urinary, bowel, sexual dysfunction)

• History of trauma, surgery, or infections

Physical Examination

• Posture and Alignment – Assessment of pelvic alignment and lumbar spine mobility

• Pelvic Floor Muscle Evaluation – Internal and external palpation to assess tone, trigger points, and strength of pelvic floor muscles.

• Neural Assessment – Testing for pudendal nerve entrapment and referred pain patterns

• Functional Assessment – Impact on daily activities, sexual function, and quality of life

Management of Pelvic Pain Syndromes in Physiotherapy

Educating the patient about the condition and understanding the pain cycle and contributing factors plays a crucial role.

Neuromodulation Techniques

• Transcutaneous Electrical Nerve Stimulation (TENS) – Pain relief through nerve stimulation

• Peripheral Nerve Stimulation – Targeting the pudendal nerve and sacral nerve roots

Manual Therapy

• Myofascial Release – Targeting trigger points in pelvic floor and surrounding muscles.

• Joint Mobilization – Addressing sacroiliac joint, hip, and lumbar spine dysfunctions

• Visceral Manipulation – Improving organ mobility and relieving fascial restrictions

Pelvic Floor Muscle Training (PFMT)

• Relaxation Techniques – For hypertonic (tight) pelvic floor muscles

• Strengthening Exercises – For hypotonic (weak) pelvic floor muscles

• Biofeedback – Real-time feedback on muscle activation and relaxation patterns

Exercises

• Core Stability Exercise – Enhancing pelvic floor and lumbar control

• Stretching and Mobility Exercises – Improving flexibility of hip rotators, adductors, and lower back muscles

• Functional Movement Training – Restoring normal movement patterns 5. Breathing and Relaxation Techniques

• Diaphragmatic Breathing – Reducing tension in the pelvic floor and promoting parasympathetic activation

• Mindfulness and Meditation – Enhancing body awareness and reducing stress responses

  
  

Outcome Measures

• Pelvic Floor Distress Inventory (PFDI) – Tracking symptom severity and functional impairment

• Pain Catastrophizing Scale (PCS) – Assessing psychological impact of pain

• Functional Outcome Measures – Assessing improvements in mobility, strength, and daily function

  
  

Pelvic pain syndromes are complex conditions requiring a broad approach to management. Physiotherapists are uniquely positioned to provide effective treatment through a combination of manual therapy, exercise, neuromodulation, and patient education. A comprehensive, individualized treatment plan addressing both physical and psychological factors is essential for successful long-term management.