Common Diagnoses Under the Chronic Pelvic Pain Umbrella

By Motion Physical Therapist: Dr. Alyssa George, PT, DPT, OCS

Chronic pelvic pain (CPP) can arise from a variety of different systems which often makes it difficult to diagnose. The musculoskeletal, gynecological, urogenital, gastrointestinal, and neurological systems, or some combination of these are often the culprits. Additionally, pain in the pelvic region tends to be different than pain in the low back, ankle, or shoulder because the pelvis is the area responsible for bowel, bladder, and sexual functions. Disturbance of any one of these functions can leave a person feeling even more impaired or disabled. There is a certain taboo around discussing pelvic issues, and may include elements of shame, religious and cultural influences, sex, and gender differences that can complicate the pelvic pain picture.

Some of the more common diagnoses under the umbrella of CPP include:

• Endometriosis
• Interstitial cystitis/painful bladder syndrome (IC/PBS)
• Irritable bowel syndrome (IBS)
• Levator ani syndrome
• Vulvodynia
• Dyspareunia (painful intercourse)
• Pudendal neuralgia
• Coccyx pain
• Sacroiliac joint pain

Many of these diagnoses have associated symptoms of bladder or bowel incontinence, constipation, bloating, urinary urgency or frequency, pain with intercourse, or sexual difficulties. 38-85% of patients with a diagnosis of chronic pelvic pain (CPP) will present with lower urinary tract symptoms (urgency, frequency, pain, nighttime urination, poor stream/hesitancy, retention, incomplete emptying).¹

Between 5.7% and 26.6% of women will experience pelvic pain at some time in their lives with direct medical costs estimated at $3 billion annually.^2,3 Recent studies have shown that approximately half of all patients with CPP also have musculoskeletal dysfunction as a primary or secondary contributor to their pain.^4,5 It is for this reason that a person with chronic pelvic pain may benefit from adding physical therapy to their treatment plan. Physical therapists are experts in treating musculoskeletal conditions and can apply treatments such as strengthening, stretching, and manual therapy to the pelvic region. We look at the entire body to determine a clear picture of the various components that may be contributing to your pelvic pain such as dysfunction in your hips, low back, neck, or possibly in the way that you walk, sit, or even breathe.

Because of the unique nature of CPP, it is important to consider the biopsychosocial elements surrounding the pain. The biological factors include things like genetics and the chemicals responsible for transmitting pain signals to our brains. The psychological factors include mood, behavior, and personality (i.e. depression, anxiety, and our ability to manage stress). The social factors include the relationships with those around us and how they can either help or hinder our ability to manage pain.

Exercise has been found to be a very effective treatment for chronic pain and can involve all three: biological, psychological, and social elements. Research has shown that exercise helps with releasing biochemicals to facilitate a natural healing response in the body.⁶ Our nervous system also responds positively to exercise.⁷ Additionally, exercise can help with improving mood and sleep. And if you exercise with a fun group of supportive people, then you have the social element covered too!

Dr. Alyssa George, PT, DPT, OCS

Alyssa wants to get you back to doing what you love, whether that be sports/recreational activities, your career, or caring for your family. Specializing in treating pelvic and orthopedic conditions, Alyssa develops individualized treatment plans because she understands that no two bodies are alike. She has been involved in research projects to help advance the field of physical therapy. Most recently she has written a case series detailing the benefits of dry needling for chronic pelvic pain and presented on the function of breathing muscles in pelvic pain at the American Physical Therapy Association’s Combined Sections Meeting. She has over nine years of experience as a physical therapist and has started and led pelvic health programs at clinics in Texas, Ohio, and now Minnesota, her home state.

Alyssa earned a Bachelor of Arts degree in biology from Gustavus Adolphus College, a Master of Physical Therapy degree from the University of Wisconsin-Madison, and continued her education at the University of Montana, earning her Doctorate in Physical Therapy. She is a board-certified clinical specialist in orthopedics and earned her certification in pelvic physical therapy from the American Physical Therapy Association Section on Women’s Health. She has been a lecturer and faculty mentor of both orthopedic residency and manual therapy fellowship programs at The Ohio State University and is a credentialed clinical instructor for physical therapy students. Alyssa has been certified in dry needling and utilizes other various manual therapy techniques in her management of abdominopelvic disorders (including incontinence, constipation, lumbopelvic pain, and pregnancy-related musculoskeletal disorders) and orthopedic conditions of the neck, back, shoulder, hip, knee, and foot/ankle.

Schedule an Appointment with Dr. Alyssa Today for a More In-Depth Assessment

References

1. Goueli, Ramy; Thomas, Dominique; Suresh, Aparna. Characterization of Bladder and Pelvic Floor Dysfunction in Women With Chronic Pelvic Pain. J of Women’s Health Phys Ther. 2017; 41(3):132-136.
2. Ahangari A. Prevalence of chronic pelvic pain among women: an updated review. Pain Physician. 2014 Mar-Apr;17(2):E141-7.
3. Mathias SD, Kuppermann M, Liberman RF, Lipschutz RC, Steege JF. Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet Gynecol. 1996;87(3):321–327.
4. Neville CE, Fitzgerald CM, Mallinson T, Badillo S, Hynes C, Tu F. A preliminary report of musculoskeletal dysfunction in female chronic pelvic pain: a blinded study of examination findings. J Bodyw Mov Ther. 2012;16(1):50–56.
5. Peters KM, Carrico DJ, Kalinowski SE, Ibrahim IA, Diokno AC. Prevalence of pelvic floor dysfunction in patients with interstitial cystitis. Urology. 2007;70(1):16–18
6. Alex Tardioli, Peter Malliaras, Nicola Maffulli; Immediate and short-term effects of exercise on tendon structure: biochemical, biomechanical and imaging responses, British Medical Bulletin, Volume 103, Issue 1, 1 September 2012, Pages 169–202
7. Dishman RK, Berthoud HR, Booth FW, Cotman CW, Edgerton VR, Fleshner MR, et al. Neurobiology of exercise. Obesity (Silver Spring) 2006;14(3):345–56. doi: 10.1038/oby.2006.46.