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Chronic Pelvic Pain affects 1 in 10

Chronic pelvic pain is experienced by about one in ten adults. It is a catchall term for pain and other symptoms that last for more than three months and often the causes are not clear.

Common symptoms of chronic pelvic pain include a generalised feeling of pain which may be described as steady, intermittent, dull, sharp, cramping, or a heaviness deep within the pelvis. People may also experience pain in the genitals, pain during intercourse, when having a bowel movement or urinating, or pain on sitting or standing for prolonged periods of time. Other associated symptoms can include urinary frequency, urgency, hesitancy or incontinence.

In men the chronic pelvic pain catchall can also extend to a diagnosis of chronic non-bacterial prostatitis. This condition is usually neither an infection nor an ‘-itis’ or irritation of the prostate (other than a tightening of the fascia around it). Despite this many men are prescribed repeated courses of strong antibiotics which cause further unpleasant side effects.

Perhaps understandably many clients who come to us with chronic pelvic pain are at a loss about what is going on to cause their symptoms and why they are not getting much help medically. We explain things to them from our myofascial perspective.

Key to the function of the pelvic area is the function of the pelvic floor. If you think of the pelvis as a cereal bowl, the pelvic floor is an elastic muscular sling that forms the bottom of this structure and supports the pelvic organs. The ‘tubes’ from the internal organs all pass through the pelvic floor on their way out of the body. The pelvic floor muscles also have a role in posture supporting your back to keep the body upright and providing muscular stability in movement, 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. The pelvic fascia wraps all the way round the pelvis creating a girdle-like support that includes the abdominal wall, groin, bones and muscles of the pelvis and spine, the internal organs, and 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.

Such changes can happen for many reasons – for example, surgery such as an appendectomy creating internal scar tissue; sports injuries such as a groin strain; repetitive movement from walking or running; or lack of movement from desk work and driving; poor posture; and stress can all affect the function of the pelvic fascia and pelvic floor.

As a conduit for force transmission in movement (think of the rotational movement of your whole body as you walk), the pelvic floor is also very sensitive to any changes in pelvic tension and can 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 are not always accurate as the symptoms are due to fascial restrictions often elsewhere in the body.

At the Pain Care Clinic we specialise in treating chronic pelvic pain symptoms and we also encourage our clients to use regular self-help exercises to reduce their symptoms. We have developed a short Fascial Fix video of general hip exercises available on our YouTube channel:

 

and a more detailed All About Class specifically for Chronic Pelvic Pain available in our online shop:

Living Pain Free All About Classes – Chronic Pelvic Pain Syndrome (CPPS)

For therapists interested in learning more about how to treat chronic pelvic pain clients using exclusively myofascial techniques we also offer an accredited Fascial Pelvis course:

Practical Myofascial Release Fascial Pelvis

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