Why “Just Have a Glass of Wine” Isn’t The Answer to Your Chronic Pelvic Pain
If you are experiencing chronic pelvic pain, it can be confusing and scary. Oftentimes you have seen multiple medical providers who have told you that everything looks normal, “have a glass of wine”, or that it’s all in your head. It is true that pelvic pain is complex, and can have a psychological component, but that does not mean it is all in your head! Chronic pelvic pain is an interaction between the mind and the body and can be treated with great success in pelvic floor physical therapy; particularly when combined with an inter-professional approach which may consist of mental health therapists and pain management physicians. Read on to learn about what may be causing your chronic pelvic pain.
Pelvic pain can include things like pain in and around the genitals or rectum, pain with intimacy, low back or deep hip pain. Chronic pain means that you have had the symptoms for some time (greater than three months and not caused by identifiable diseases). The symptoms may have been brought on by a specific incident or injury or may have come out of nowhere. So why does your pelvis hurt even when all of the tests and images are telling you nothing is wrong? It comes down to the nervous system! First you will likely have some type of stressor (whether it be a physical or psychological stressor) which will bring on your symptoms. This is where your autonomic nervous system comes in (ANS) – which has two components 1) sympathetic (fight or flight) and 2) parasympathetic (rest and digest). Your body feels that there is some type of threat and enters fight or flight mode. Ideally, the body would come out of this heightened state once the threat is gone, but that does not always happen. With chronic pain, your body starts to be on high alert at all times, thinking that there is danger. When your body perceives danger, your muscles (in this case your pelvic floor muscles) will become tense and breathing will become shallow. The pelvic floor muscles need to be allowed to relax and actively lengthen in order to have adequate blood flow, nerve function, and bowel and bladder habits. So this state of perceived danger can keep your pelvic floor muscles in a tensed state - leading to pain and changes in function.
To recap – there is an injury or stressful event – your body reacts – your body continues to stay on high alert even after you are healed, or the stressful event is over which creates muscle tension and heightened sensations of pain. Over time this can actually change your brain to be more hypersensitive to pain or sensation, which is called central sensitization.
When you work with an experienced pelvic floor physical therapist, they should take the time to listen to your entire history, and work with you to figure out where this all started and if there are patterns or triggers to your symptoms. Other elements of treatment should involve education about your pelvic floor anatomy and function, manual-hands on treatment to help release tension in the body, breathwork, and gentle movement. It is important that you feel safe and comfortable with your therapist, and there is open communication in order to fully address your chronic pain.
We hope that reading this has brought some understanding to anyone suffering from chronic pelvic pain. Please reach out to us or a pelvic floor provider in your area to start your healing journey! If you do not have access to in person pelvic floor care, visit our PCPT Store to purchase our “Healing Pelvic Pain Program”.
If you are looking for more resources on this topic check out some books that we recommend:
Why Pelvic Pain Hurts?, Adriaan Louw, PT, PhD, CSMT - All genders
The Body Keeps The Score, Bessel van der Kolk, M.D. - All genders
You Are Not Broken, Dr. Kelly Casperson, MD - Geared towards individuals with a vulva and vagina
Pelvic Pain The Ultimate Cock Block, Susie Gronski, PT, DPT - Geared towards individuals with a penis
