Pelvic pain and dysfunction part 2: The basis of management and treatment

Pelvic pain and dysfunction part 2: The basis of management and treatment

In part 1, we shared some of the causes and symptoms of pelvic dysfunction. In part 2, we discuss chronic pain (as compared to an acute condition) and why chronic pain can be so complicated to deal with effectively. It’s important to understand what’s going on in your body first, so that you can work out the steps you need to take in order to help heal yourself. It also helps you feel more confident in your approach and in the fact that improvement CAN happen, as well as give you motivation to keep going (healing has good and bad days and times when it feels like nothing is changing, then suddenly, but only after consistent action, things improve and you suddenly realise, the pain you “always” had is no longer there).

Pelvic dysfunction is a complicated subject, because:

  1. There are so many variations of pelvic dysfunctions and symptoms.
  2. There are multiple possible causes and a large number of associated factors and triggers.
  3. It’s a taboo subject so most people don’t want to talk about it.
  4. People don’t generally ask their GP or health practitioner for help for the above reason and don’t realise that there is anything that can be done to help.
  5. People don’t talk to their physical/manual therapists (such as their Osteopath, Chiropractor or Physiotherapist) as they don’t expect that lifestyle factors and muscle imbalances can be an easily treated part of the solution.

Because of these above issues, it often becomes a chronic pain condition. But what exactly is a chronic pain condition?

The definition of chronic pain is any pain that extends beyond the expected healing time for an injury. Generally, it’s accepted that most tissues have healed by 12 weeks. So, any pain that has continued for longer than 3 months is chronic pain. Conversely, acute pain is any pain condition that has resulted from a direct injury and is still within its expected tissue healing time (thus any pain less than 3 months old).

The brain is a pain modulating unit. That means that any pain stimulus, via nerves, alerts the brain to a potential issue and the brain then uses all the information it can gather before deciding if there is a problem or a potential problem and how dangerous it is. The intensity of the pain we feel is based on the brain’s interpretation of the level of injury or danger at hand. The information the brain uses to decide is vast and includes things like past experience, imminent danger in our surroundings (such as a car coming straight for you) and our fear levels.

Because of this, the brain is able to turn up or down the volume of pain you feel based on its need to keep you safe. Generally, the more threat there is to further harm, the louder the pain signals one feels. Yet, because the brain’s job is to keep us safe, it can turn down the level of pain to allow necessary action, hence the “apparent paradox” in stories you may have heard when for example a person has badly broken their leg, yet managed to walk many kilometres to get to help or run from an explosion etc.

However, when pain continues for extended periods, the wiring in the brain for that location begins to change. Just as a dirt path used over and over again gets deeper, so does the neural pathway. This means that the brain becomes hyper aware of that area of the body and is over sensitive to any nerve input that comes from that location, alerting us to potential injury, via pain, even if there is no risk.

Can you remember a time when you got a cut on your finger and it became inflamed? That area may have begun to feel painful even at the slightest touch such as the gentle swiping of fabric across it? In fact, even the adjacent finger sometimes feels painful, for no apparent reason. This is an example of sensitisation.

This is further intensified by our interpretation of the situation, such as how bad the injury is, our belief that any movement that causes pain is in fact worsening the injury and slowing or preventing healing, the level to which our injury has been affecting our daily life and functioning, and our fear that this situation will never end and might only get worse.

As you can see, the brain collects information from many places and can be influenced by many factors including our individual interpretation of what is happening to us. Thus, we feel increased pain when

  • our general levels of stress are high
  • we avoid all activities that hurt (including ones that help heal) because we believe they are damaging us
  • we fear having pain in general – because
    • it’s not nice
    • we believe that there is something wrong and we are making it worse
    • we don’t understand the biology of our situation
    • we fear that we’ll never improve and we catastrophise the worst about what that might mean for our future
    • we’re afraid that there is something seriously wrong with us.

These factors make treating chronic pain more difficult because in fact the tissues, while they may not be functioning correctly are not “damaged” anymore, so one cannot just deal with the “damaged” tissues nor just the musculoskeletal imbalances that are perpetuating the functional symptoms (such as reduced strength or movement).

Indeed effective management and treatment must therefore deal with as many of the above-mentioned types of psychological aspects as well as the physical factors. This requires education (about pain and the specific process happening in one’s own body), lifestyle modification, minimising triggers, reducing stress, increasing neural relaxation, education and techniques for learning to deal with always having pain (in some cases), rehabilitation exercises and more. Further, all of these components are unique to the individual, so body awareness, support and guidance, and some trial and error are required to build the correct plan of action. Given this complicated and individual nature of chronic pain, I hope the importance of a multi-factorial approach, starting with education and body awareness, is clear.

Once we understand the injury we have, the biology of pain and what is happening inside us, and which activities, if any, to avoid, our fear is reduced. We can also be confident in a stretching and strengthening program and doing activities that cause pain as we understand the difference between hurt and harm. This gives us control, piece of mind and discipline to continue the healing activities required to balance the tissues in the area and re-wire the brain to reduce its pain alert system. Further, we can understand the reason behind any lifestyle, habitual activity and postural modifications as well as stress reduction techniques required, making compliance easier.

Ok, so it’s complicated, where do I go for help?

 A practitioner who has some specific knowledge about pelvic pain and dysfunction is important (potentially an Osteopath, Chiropractor, Physiotherapist or even Acupuncturist – but you need to ask). A good practitioner can:

  • help you deal with the musculoskeletal imbalances and give you exercises
  • discuss and explain chronic pain with you and how you can use techniques and exercises to help re-wire your brain
  • assist with neuro-feedback, to ensure that you are using your pelvic floor correctly and give you both pelvic floor strengthening AND relaxation exercises
  • give advice on correct toileting techniques and support and training for lifestyle interventions to treat different types of incontinence issues (urge and stress)
  • assist with medicated creams, medications and referral to surgical (laser etc) interventions IF and only if necessary (generally a GP or gynaecologist – but you need to ask specifically, and I would recommend seeing a specialist gynaecologist for this type of thing as with a practitioner at Sydney’s WHRIA clinic who are researchers and leaders in this field and have minimal invasive and best results-based interventions).

If you would like to chat about your situation, drop us an email, call, or book an appointment with Alexis.

Stay tuned for part 3 where we share 7 simple tips to improve your situation NOW.


Read Part 1 now

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