by Ashley Newton, PT, DPT
Pelvic pain, a topic that when I started my career as a physical therapist was not well-talked about, is now enmeshed in conversations over platforms such as TikTok and Instagram. As someone who is passionate about health equity, literacy, and informed care, I am over the moon that more and more people are talking about this topic! But when we say pelvic pain, to what exactly are we referring?
The term pelvis technically refers to the basin-like area between the hip bones below the abdomen and contains the bladder, rectum, and reproductive organs. Thus, pelvic pain refers to the experience of pain in the lower abdomen and pelvis and is often intertwined with the urinary, digestive, and reproductive systems in addition to the muscles that ultimately support those systems. The experience of pelvic pain is not one that is limited to a specific character, meaning pain can be dull, sharp, aching, throbbing, chronic, acute, cyclical – the list goes on and on. Pelvic pain can also cause pain in other areas including the low back, buttocks, and inner thighs. Some people may notice their pain all the time, while others may only notice it during certain activities such as defecation, sexual activity, tampon use, sitting on a hard surface, etc. There is so much that is individual about the experience of pelvic pain, and it is often distressing for folks as it is not only uncomfortable to physically experience, but for many, uncomfortable to talk about. Hence, my elation for the exposure pelvic pain is getting on social media is unparalleled. People should be able to feel safe to talk about their health and ultimately get access to the help they need!
So, apart from the solutions to decrease pain, why is getting help for pelvic pain so important? When the body is in pain or anticipating pain, it guards in response to that stimulus. The pelvic floor musculature, the muscles that occupy the pelvis, are intimately connected with our nervous system. This makes sense – they have an important job of guarding and supporting our organs! When the nervous system enters fight or flight and we start to brace ourselves in response to pain, the pelvic floor contracts. However, the pelvic floor can get stuck in this contracted phase especially if we continue to brace/the stress that caused us to brace is not relieved. As a result, the pelvic floor has difficulty doing its jobs of supporting, stabilizing, facilitating blood and lymph flow, and relaxing/contracting for urination/defecation/sexual activity. It will become weak in this contracted position which will likely lead to other muscles trying very hard to stabilize to compensate for the pelvic floor. Truly, the list goes on and on when it comes to the effects of pelvic floor dysfunction on the rest of the body. It is the base of our core, and we know in life that a stable base or foundation is essential to just about everything.
Ultimately, pain and muscle dysfunction go hand in hand and I encourage anyone who experiences pelvic pain to start a conversation with a trusted healthcare professional regarding options for solutions. Maybe you have a ‘high pain tolerance’, but honestly a body in pain is one that isn’t working properly in some way, and it is always better to address things early so that maladaptive habits do not have the time to build and cement themselves in routine.
One thing that I think is especially important to note, however, is that people with pelvic pain can and should exercise. Now, it absolutely depends on the type of exercise (aka if it causes pain, don’t do it!), but motion is lotion! Movement helps facilitate blood flow while the cardiovascular component of exercise helps our body switch gears and go into the rest and relax phase of our nervous system. Don’t think that pelvic pain means that people can only do stretching exercises. Quite the contrary! Folks should be focusing on breathing mechanics, posture, and self mobilization of tissues as needed to help their core canister be more adaptive! In pelvic health physical therapy, my goal for clients is to be empowered to take charge of their health and feel like powerful, bada** as they move throughout their day. It’s all about getting the right tools so that the body has what it needs to succeed which truly looks different for every single person. If we meet the body where it is at and give it the love and respect it deserves, both the brain and physical body are able to heal in harmony. <3