A fascial understanding of chronic pelvic pain

Exploring the fascial connections in the pelvis

About 10% of adults, men and women, develop chronic pelvic pain. It’s a difficult and sometimes embarrassing condition for many people as the symptoms can include rectal, genital or abdominal discomfort or pain; pain that gets worse with sitting or after sexual activity; and urinary frequency, urgency and hesitancy.

Because chronic pelvic pain is such a sensitive subject, people often take a long time to seek help. Common medical diagnoses for the symptoms include urinary tract infections (UTIs), non-bacterial prostatitis for men, and vaginismus or vulvodynia for women. Treatment typically starts with strong antibiotics, followed by rehabilitation exercises such as kegels to strengthen the pelvic floor.

If you think of the pelvis as a cereal bowl, the pelvic floor forms the bottom and supports the pelvic organs – the bladder, bowel, prostate in men, and uterus in women. The urethra (from the bladder), vagina and rectum all pass through the pelvic floor. The pelvic floor muscles also have a role in posture supporting your back to keep you upright and providing muscular stability when you move, hence their other name as the core muscles.

However, the pelvic floor does not work in isolation. Due to its central location it is intimately connected with the fascia of the whole body at many different levels from the skin to deep inside the body. If you imagine a cross section of the pelvis, the pelvic fascia wraps all the way round from the front to back creating several continuous layers of support, a bit like a girdle. This fascial wrapping is not just limited to the pelvic floor, but encompasses the abdominal wall, groin, bones and muscles of the pelvis and spine, internal organs, and extends to the muscles of the hips, back and thighs.

When working normally the pelvic fascia is mobile and balanced providing support and free body movement. If there are any changes to fascial function, however, this will affect not only the affected area but potentially also any other areas connected through the pelvic floor.

As an example, abdominal surgery to remove an infected appendix creates scar tissue which changes the function and tension of the abdominal muscles and fascia. Similarly, high intensity exercise such as long-distance cycling creates sustained pressure on the fascia of the pelvic floor while overworking the muscles of the buttocks and legs.

Either of these situations will create fascial restrictions that thicken over time until their altered tension affects sensitive structures such as the genitals, or organs such as the bladder.

As the pelvic floor is the conduit for internal pelvic tension, changes such as these can cause the pelvic floor muscles to go into a state of cramp which adds to the pain felt and stops effective function. This can lead to problems such as sexual dysfunction or urinary issues as the “tubes” that pass through the pelvic floor are no longer supported but instead held in spasm.

This fascial understanding of the pelvis differs from the commonly held medical belief that chronic pelvic pain is due to weak pelvic floor muscles. Instead, it is more likely that the problem is over-contracted pelvic floor muscles that need to be loosened, not strengthened.

It is also important to recognise that many pelvic pain symptoms come from imbalance or restrictions elsewhere in the body. This helps to explain why many diagnoses of pelvic pain conditions, such as non-bacterial prostatitis, are not correct as the symptoms are due to fascial restrictions not a problem with the prostate. It also explains why many people are told that there is no cure and they will just have to live with their symptoms when they fail to respond to standard medical treatments.

When you think from a fascial perspective, using myofascial self-care exercises to release restrictions in other areas such as the abdomen, buttocks, back and thighs, can be very effective in helping to alleviate symptoms. Regular exercises can gradually help to release restrictions that are causing the problem and return the pelvis to more normal pain-free balance.

Our Living Pain Free Self-Help Guide for Chronic Pelvic Pain includes useful background information about chronic pelvic pain as well as videos of myofascial self-care stretches and exercises and a mind-body relaxation audio.

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