This is part 1 in a 3-part series on finding relief from pelvic pain through physical therapy, yoga, and other complementary therapies.
Question from Kate, a mother of two boys, ages 5 and 7:
I have pelvic pain due to a non-relaxing pelvic floor. I cannot even sit down without pain. I am already doing pelvic physical therapy and have had multiple therapies (see below). What can yoga do to help me find relief?
Note: Kate is also a physical therapist, a big plus for her. Otherwise, she may have not recognized the dysfunction as a diagnosis, or a real condition that is abnormal. Many women do not know pelvic physical therapy is an option. Fortunately, as a therapist, Kate was able to recognize the problem immediately and seek help.
Here is how you can recognize the signs of pelvic pain, and what you can do about it.
Pelvic pain (myalgia) can have many signs and symptoms. If you have pelvic myalgia or non-relaxing pelvic floor, you may experience the following:
- Pressure on the pudendal and obturator nerves, which makes stretching, walking, sitting, bending, or anything that puts tension on these nerves in the pelvic floor area very painful.
- Groin pain
- Difficulty with emptying the bowel or bladder or a feeling of incomplete emptying
- Bloating or constipation (bowel symptoms)
- Urinating frequently, hesitation during urination, painful urination, and/or urge incontinence (bladder symptoms)
- Dyspareunia or insertional pain with intercourse or after
- Pelvic pain unrelated to intercourse
“Symptoms of nonrelaxing pelvic floor dysfunction are associated with voiding dysfunction, anorectal dysfunction, sexual dysfunction, and pain.” – Mayo Clinic Proceedings 2012
Kate’s current treatment, since she recognized it and sought out physical therapy as soon as possible, gives her the best chance for recovery. Early referral to physical therapy is recommended by the Mayo Clinic Proceedings (2012). I take this a step further and am a strong advocate of physical therapy becoming a standard of care for every new mother. See my post on why every new mother needs physical therapy
Some conservative treatment(s) for pelvic myalgia could include:
*Note that conventional medicine such as trigger point or steroid injections, drugs, or surgery can be included as options; however, drugs and surgery should be considered a last resort because of the many side effects and limited long-term gains associated with them.
- Physical Therapy & Pelvic Physical Therapy
A physical therapist (PT) can identify any low back or sacroiliac issues that could be contributing to orthopaedic problems that would influence pelvic pain. A women’s health PT can also perform internal and external exams of the pelvic floor area, diagnose pelvic pain, and treat it with a range of options. PT can include biofeedback through electrical stimulation or monitoring, relaxation techniques, exercise and balance of the pelvic floor and surrounding musculature, biomechanical analysis, dry needling, and more.
- Behavioral psychology
Talk therapy can assist with types of biofeedback and even hypnotherapy to help release and relax the areas creating pain. Therapy can also include addressing or identifying past trauma or abuse that can often be associated with pelvic pain.
Prolotherapy is a series of injections designed to assist in stabilization of connective tissue, also known as regenerative injection therapy. It’s mechanism or effectiveness is currently undecided, but proponents of the therapy say it can strengthen weakened connective tissue and help alleviate pain. Several trials have shown benefits of prolotherapy outstrip, and are safer than, steroid injections. In Kate’s case, she was receiving injections into the sacral area to assist with stability and pain-relief that is perhaps contributing to her pelvic pain.
- Integrative Medicine
There are many options to pursue to find relief from pelvic pain using holistic techniques supported by science, including meditation for better hormonal regulation and cortisol regulation, which directly affect the body’s stress (and pain response). For example, my primary modality for treating women’s health issues is yoga.
Yoga offers a method for integrating medicine, physical therapy, and psychology into a single treatment session, which can be both a time and money saver. The techniques I use as a women’s health physical therapist are based around medical therapeutic yoga, but there are many other conservative (non-surgical and non-drug) interventions which can be incredibly beneficial and necessary.
In Part 2 we will address what questions you should ask your health care provider to get the care you need, which can include yoga.
1.Faubion SS, Shuster LT, Bharucha AE. Recognition and management of nonrelaxing pelvic floor dysfunction. Mayo Clin Proc. 2012;87(2):187-193. doi: 10.1016/j.mayocp.2011.09.004; 10.1016/j.mayocp.2011.09.004.
2.Cusi M, Saunders J, Hungerford B, Wisbey-Roth T, Lucas P, Wilson S. The use of prolotherapy in the sacroiliac joint. Br J Sports Med. 2010;44(2):100-104. doi: 10.1136/bjsm.2007.042044; 10.1136/bjsm.2007.042044.
3.Kim WM, Lee HG, Jeong CW, Kim CM, Yoon MH. A randomized controlled trial of intra-articular prolotherapy versus steroid injection for sacroiliac joint pain. J Altern Complement Med. 2010;16(12):1285-1290. doi: 10.1089/acm.2010.0031; 10.1089/acm.2010.0031.
4.Streeter CC, Gerbarg PL, Saper RB, Ciraulo DA, Brown RP. Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder. Med Hypotheses. 2012 May;78(5):571-9. doi: 10.1016/j.mehy.2012.01.021. Epub 2012 Feb 24.