Chronic Pelvic Pain Can Be A Pain In The Booty
Chronic pain is defined as pain that persists for longer than 12 weeks and while today we will be focusing on chronic pelvic pain, this information can apply to any pain in the body including back, neck, joints or other soft tissue.
How common is chronic pain and why does it happen?
According to the National Library of Medicine, “the prevalence of chronic pelvic pain is between four to sixteen percent of women”. To better help us understand why pain becomes chronic, let’s take a look at how our pain system operates.
Brains are designed to keep us safe. They’re the central hub of the body through which all our information and sensations are processed. Our tissues are constantly sending signals to our brain alerting the brain to any changes around us, and our brains then decide what to do with that information.
Let’s explain pain using the example of stepping on a nail.
If you step on a nail, the tissues in your feet send a message through your nervous system up to your brain, letting your brain know that something has gone awry. With this information your brain recognizes the nail as a threat and creates a pain signal to bring your conscious attention to the affected tissue.
This pain signal is incredibly valuable and helps to keep us safe. It alerts you to look at your foot, to remove the nail, clean the wound, and take it easy for the next few days while your body gets to work healing those tissues.
In this situation, a pain signal is created at the same time as tissue damage. What we expect to see is over the next few weeks after you step on that nail is for the pain signal to decrease as your tissue heals until we return to baseline with healed tissue and no pain at all.
What can happen in about ⅓ of people is that, although the tissue has healed, our brain continues to create a pain signal alerting us to danger.
This pain signal is now no longer indicative of tissue injury or dysfunction, but rather tells us that the brain has become sensitized to stimulation.
What this can look like is that with less and less stimulation (think physical touch to the area), or less and less activity, the brain continues to create a pain signal. Activities that you enjoyed before are now painful, your endurance is decreased and you feel like this will never get better. This can become incredibly frustrating, depressing, confusing and overwhelming.
So what can we do about it? Since the pain signal dysfunction is coming from the nervous system rather than from the tissues, we need to treat the brain and the nervous system.
Here are 3 things our nervous system enjoys:
→ 8 hours of sleep
→ 10+ minutes of steady state cardiovascular activity
→ Graded exposure to “threatening” activities
By slowly de-sensitizing the nervous system we can build strength, endurance and mobility to return to previous activities pain free. This process can take several weeks, but the good news is that understanding where pain comes from can be an excellent first step to reducing the “threat” perceived by your brain when you feel your pain.
All of these principles hold true for postpartum and sexual pain, too. If you’re experiencing perineal pain following an episiotomy or perineal tear, read more here. For chronic pain following cesareans, read this to learn more. And if you’re having pain with sex, here’s an article outlining why and what you can do to address the three most common causes of sexual pain.
Since every body is so uniquely different, it is incredibly beneficial to meet with a licensed physical therapist who can help you to come up with a plan that is right for you based on your symptoms. Want to learn more about how we can help you manage chronic pain? Contact us to set up a free 15 minute phone consultation. Our PTs have over 25 years of collective experience treating chronic pain and are ready to work with you, today!
This post was written by Dr. Liz Cote, PT, DPT, OCS. Liz (she/her) earned her Bachelor of Science in Exercise and Movement Science at the University of Vermont in 2014. She went on to earn her doctorate in physical therapy from Northeastern University in Boston, Massachusetts in 2018.
Liz moved to Austin after graduating and never looked back. She earned a Manual Therapy Certification in 2019, and went on to become a board certified Orthopedic Clinical Specialist shortly thereafter. With four years of experience in treating a variety of orthopedic and pelvic health patients, Liz is excited to use her knowledge, experience and clinical brain to support folks through their pregnancies and postpartum recoveries.
When not rocking it as a physical therapist in the clinic, Liz enjoys exploring Austin, paddleboarding, trashy reality TV, spending time with friends and family and watching her favorite sports teams- the New England Patriots and Boston Bruins!