If you’ve experienced pelvic pain, you know that it can affect every part of your life and make it difficult to function. It may also seem hard to tell if the pain or discomfort you’re experiencing is normal. While some describe pelvic pain as a dull ache or heaviness in the pelvis, others have cramping and sharper bouts of pain. However you experience it, it’s important to know that chronic pelvic pain – which lasts for at least six months – isn’t normal and can be treated.
If you have regular pain or discomfort in the pelvis, read on to learn more about the condition.
1. Pelvic pain isn’t always in the pelvis.
It makes sense that we would think that the pain is coming from where we feel it, but referred pain is common when it comes to pelvic pain. That’s because our abdomens do a poor job of localizing pain. Women may describe the pain as being in the abdominal wall, lower back and/or buttocks. However, a gynecological exam can reveal the pain is actually coming from the vagina. It’s not like having a paper cut on your finger, when you can tell the exact location with your eyes closed. That’s because the abdomen doesn’t have extraordinarily sensitive nerve endings like other parts of the body.
2. It may be a treatable condition called chronic pelvic pain syndrome.
The pain is present for six or more months and is non-cyclic, meaning while it may get worse during your period, it never entirely goes away. Conventional treatments like ibuprofen or acetaminophen just aren’t doing the trick. The pain is stronger than what you’d expect from the injury, surgery or condition that may have initially caused the pain. You’re having difficulty sleeping. You’re constipated. You’ve lost your appetite. You feel like you’re moving in slow motion. You’re depressed. You’re getting less physical activity and may be missing work due to the pain.
3. Sex should never be painful.
It’s common for some women to experience pain when they first become sexually active, but this usually resolves with continued intercourse over a few months. After that, sex should not be painful.
Yet, at least one in 10 women has pain during sex. And 90% of women with a history of chronic pelvic pain report pain during intercourse.3 Younger women may feel pain upon initial insertion, which can be related to the nerve fibers at the opening of the vagina. Menopausal or postmenopausal women may feel dry due to the lack of estrogen, when lubrication is lessened and the tissues of the vagina tend to thin.
Women of any age may feel deep pain with intercourse related to the pelvic floor muscles, which may be caused by pelvic floor myofascial pain. Myofascial pain – a common type of pain that’s often under-recognized and misdiagnosed – comes from the dysfunction, hypersensitivity or hypercontractivity of the muscles in the abdominal wall, pelvic floor and lower back. So painful sex may be common, but that doesn’t make it normal.
4. Kegels are not for everyone.
Kegels can help strengthen pelvic floor muscles, but they aren’t recommended for everyone, especially those with chronic pelvic pain.
Heather Wahl, MD, an OB/Gyn specializing in chronic pelvic pain with ProMedica Pelvic Health says, “Kegels are one of the worst exercises some women with chronic pelvic pain can do. That’s because if your muscles are already hypercontracted, doing a Kegel will only increase muscle contraction in muscles that actually need to be relaxed.”
Getting those muscles to relax and be better coordinated is key. Pelvic floor physical therapy can help those with hypercontractivity by relaxing the muscles that are causing pain. In short, don’t self-diagnose and self-treat with Kegels. It’s important to talk to a gynecologist who will listen and create a treatment plan.
5. Don’t stop exercising.
Often, when people feel chronic pain, they become less active. After all, who wants to go to the gym when you’re not feeling like yourself? But decreased activity can actually worsen chronic pelvic pain, because when you stop or decrease your activity, your muscles become deconditioned.
Strength training, cardio, stretching, yoga and walking are great activities to continue to enjoy if you can. Multiple studies have shown the benefits of exercise for improving chronic pelvic pain and pain with periods. This activity, along with pelvic floor physical therapy (done under the supervision of a professional), meditation, cognitive behavioral therapy and sleep, are common non-medical treatments for pelvic pain.