How pelvic floor exercise therapies and devices can assist in the treatment and management of chronic pelvic pain.
What is chronic pelvic pain?
Chronic pelvic pain is the term for any pain in the pelvic area that lasts for six months or longer. The term "pelvic pain" is used when the pain is generally covers the whole area of the lower abdomen, rather than just one specific place. Chronic pelvic pain can be a condition in its own right or can be a symptom of another disease.
Chronic pelvic pain can involve either steady or intermittent pain, dull aches or sharp cramps, or feelings of heaviness and pressure. It can occur at different times and when the sufferer is in different positions. It can vary from mild to severe and disabling.
A recent survey of Australian women has found that pelvic pain of different types is common. Over 71% of women reported that they experienced period pain, 14% pain associated with sex, and 21.5% reported other chronic pelvic pain. Only 23.3% of women reported no pelvic pain of any kind (Pitts & others).
In addition to generalised chronic pelvic pain, a number of specific pain conditions have been identified.
What causes chronic pelvic pain?
Common physical causes of pelvic pain include endometriosis, pelvic inflammatory disease, pelvic congestion, fibroids, ovarian cysts, irritable bowel syndrome, interstitial cystitis, and pelvic floor muscle tension. Psychological factors can also play a part and can set up a cycle of anxiety and pain. It can be very hard to work out what is causing chronic pelvic pain and many women who experience it never really know the cause. However, even if the cause isn't determined, it can be possible to manage the symptoms.
It's important to consult your doctor about your pelvic pain, in order to ensure that all possible causes are investigated and treated.
What are the treatments for pelvic pain?
Because the causes of chronic pelvic pain are diverse, your doctor may arrange for a variety of tests to determine which treatment is best.
Depending on the symptoms and the cause (if known), the doctor may prescribe drugs to kill pain, fight an infection, manage the menstrual cycle or help lift your mood. In some cases, surgery might be indicated, whilst in others, counselling may be helpful.
In some cases, different types of pelvic floor therapy may be prescribed. These are of two main types:
Pelvic floor muscle strengthening and relaxation exercises
Use of an electrical stimulation device (also known as TENS or transcutaneous electrical nerve stimulation device) to help manage the pain.
Can these pelvic floor therapies actually help me?
Because the causes of pelvic pain are so diverse, you should always consult your health practitioner before embarking on any form of self-help.
Depending on the underlying cause of your pelvic pain, and your symptoms, your doctor or physiotherapist may suggest one of these two pelvic floor therapies:
||Pelvic floor muscle strengthening and relaxation exercises:
Properly executed pelvic floor exercises will allow the muscles to relax fully before contracting again. However some women have pelvic floor muscles that do not fully relax, even when at rest, and even if they have not been exercising their muscles. A women's health physiotherapist will use specialist equipment to determine whether your pelvic floor muscles are overly tensed, and can assist you to learn to relax the muscles.
The Peritone EMG Biofeedback Unit can be used at home to give an absolute muscle activity reading for women who wish to track their own progress towards fully relaxing the pelvic floor muscles. It can be used with either the Periform or Veriprobe vaginal electrode. The vaginal electrode is connected to the Peritone EMG Biofeedback Unit and inserted into the vagina. Readings on the unit will indicate the level of muscle activity.
If your pelvic pain has been diagnosed as being caused by overly tense pelvic floor muscles, using the Peritone EMG Biofeedback Unit can help you to teach your muscles to relax, and therefore overcome the muscle tension that is causing your pelvic pain.
STOP PRESS MAY 2010: A recent research study found that 87% of women with Levator Ani Syndrome experienced relief from biofeedback such as the Peritone, four times as many as were helped by massage of the muscles (Chiarioni G & others)
||Transcutaneous electrical nerve stimulation (or TENS) to manage chronic pelvic pain:
TENS is a recognized pain management therapy which works via two methods. On the one hand, TENS delivers electrical impulses to block the pain signals in the body's nerve cnetres and thereby reducing the level of pain that is felt. At the same time, TENS stimulation generates a release of "feel good" endorphins from the brain. (Electrical stimulation is not appropriate for some women; read more).
The Pericalm Pelvic Floor Stimulation Unit is pre-set with a specific stimulation program for the treatment of pelvic pain, and is therefore the easiest way to harness the benefits of TENS for women with pelvic pain. It is intended for use with a vaginal electrode. You can choose between the Periform or Veriprobe. Using the Pericalm to manage your chonic pelvic pain is as easy as
Everything else, including frequency, rest and work intervals and program duration, are pre-set for you in the pelvic pain program.
- connecting the electrode
- switching on
- choosing the Pelvic Pain program
- inserting the electrode into the vagina and
- controlling the intensity of the stimulation to your own comfort level.
The Pericalm Pelvic Floor Stimulation Unit may be helpful in overcoming and managing the discomfort.
STOP PRESS: JAN 2010: A recent research study has found
that women treated with electrical stimulation show significantly a lower relaxation threshold of the pelvic muscles. This suggests that electrical stimulation could be a possible treatment for symptoms caused by overly tense pelvic floor muscles. ( Eyjólfsdóttir H & others)
Can I claim a Health Fund Rebate for the Peritone or the Pericalm?
Depending on the diagnosis of your particular pelvic pain, these devices may be appropriate for you. If your doctor is willing to write a supporting letter, you may be able to claim a rebate for all or part of the cost of either of these two devices from your private health fund. This will depend on your health fund's rules and on your specific cover.
What about vaginismus and vulvodynia?
Remember that you should always consult your health practitioner before embarking on a course of self-help, in order to ensure that the cause of your pain has been fully investigated and appropriately diagnosed.