What is Chronic Pelvic Pain?

The term "chronic pelvic pain" denotes pain that is either intermittent or continuous in the lower abdomen, pelvis, or intrapelvic structures, and persists for more than three months. Women's chronic pelvic pain is not exclusively associated with menstrual cycles, sexual interactions, or pregnancy and can be severe enough to lead to functional disabilities and/or medical care and intervention.

In terms of prevalence, (CPP) is more common in women than in men and primarily affects women between the ages of 36 and 50. Chronic pelvic pain may have a variety of causes. Diagnosing the cause of the pain can be difficult and complex.

Multiple organ systems or pathologies can lead to CPP, and it may stem from various factors. For example gastrointestinal, urinary, gynecological (endometriosis, adenomyosis, pelvic congestion syndrome, fibroids, and ovarian remnant after surgeries), musculoskeletal (for example tension of pelvic floor muscles, inflammation of the pubic symphysis).

Clinical Presentation:

Common symptoms include:

  • Constant severe pelvic pain
  • Intermittent pain
  • Sharp or cramping pain
  • Dull aching Pressure
  • Many women have difficulty doing non-strenuous exercises
  • difficulty sleeping
  • CPP can change the posture of a patient (for example marked lordosis, or/and kyphosis as well)

Medical Management of CCP:

  • Various analgesics are available to treat pain, including paracetamol, ibuprofen, aspirin, and naproxen.
  • Tizanidine can provide pain relief by improving the inhibition of central nervous system activity.

Physiotherapy management of Chronic Pelvic Pain:

A biopsychosocial model based on a multidisciplinary approach is considered the best treatment for CPP. This multidisciplinary treatment includes pain management, pelvic floor rehabilitation, nerve stimulation therapies, teaching cognitive coping strategies, education about the importance of planning and pacing exercise and activities.

Pelvic Floor Rehabilitation for Chronic Pelvic Pain:

Common treatment interventions include:

  • Manual therapy of the pelvic floor muscles
  • Biofeedback (EMG biofeedback and Kegel perineometer)
  • Electrical stimulation (Electro-Acupuncture, Percutaneous tibial nerve stimulation)
  • A myofascial release removes trigger points on the pelvic floor.
  • Relaxation techniques.
  • Pelvic floor muscles exercises and core stabilization
  • Stretches specific to certain muscles (pelvic floor muscles, adductors, or iliopsoas, for example)
  • Postural correction.

"Kegel" Exercises

When combined with other physiotherapy modalities, kegel exercises have been shown to be effective in treating CPP both in women and men with urinary incontinence as a symptom.