Understanding and Treating Pelvic Pain in Women
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If you have pain in your pelvic area, you’re not alone. Up to 20 percent of women suffer from chronic pain in the pelvis, according to The Menopause Society (TMS). It may be sharp or dull, more pronounced during certain activities like sex or having to urinate, and it can range from mild to so severe it interferes with your daily life.
“Pelvic floor disorders are common in women for all age groups, but they increase in prevalence and severity as women age,” says Leslie Rickey, MD, MPH, an associate professor of urology and obstetrics-gynecology at the Yale School of Medicine in New Haven, Connecticut.
Regardless of the specifics of your pelvic pain, you shouldn’t suffer in silence. There are many possible causes of pelvic dysfunction, which can also result in leaking urine (urinary incontinence). Working with a healthcare practitioner can help you determine the cause and identify treatments that help. In some cases, this may simply involve a series of exercises to strengthen a range of muscles.
Midlife Women Are Especially Prone to Pelvic Dysfunction and Pain
One typical cause of pain is vaginal dryness and tightness in the pelvic floor, which become more common as women age, says Abigail Abbott, a physical therapist in private practice in San Miguel de Allende, Mexico.
Blame decreased estrogen levels that are a hallmark of menopause. “Estrogen keeps the muscles bulky and the blood flowing well. When you lose estrogen, connective tissues and muscles in the pelvis can be reduced as well,” Abbott says.
When that happens, pain in the pelvic floor or other areas may result. “The pelvic floor is like a trampoline at the bottom of the pelvis. It has to be strong, resilient, and flexible to help us move properly and support our organs and digestive system, and it also has to relax to allow for urination,” Abbott says. Nerves, veins, and arteries also flow through the area, so constriction in the pelvic floor can impinge these, too.
Keep a Pelvic Pain Journal
Other conditions beyond menopause can also cause pelvic pain, which is why it’s helpful to keep a pain journal to bring to your healthcare provider, advises the American College of Obstetrics and Gynecology.
Take note of the times of day the pain appears or worsens, whether it is steady or comes in waves, how intense it is, how long it lasts, whether it’s always in the same place or moves around, and more.
Documenting these issues can also help you see something is amiss. Many women incorrectly think bothersome symptoms are a natural part of aging, but this is not the case, Abbott notes.
“If you’re having pain with sex, that’s not normal. If you feel like you’re sitting on a ball or have to push your organs up with your fingers, that’s not normal,” she says. “It’s important to listen to what your body is telling you.”
The Many Causes of Pelvic Pain
Some common causes of pelvic pain, according to TMS, include:
If one or more of these conditions is found to be the cause following a pelvic exam, blood work, and possibly imaging, your doctor will recommend targeted treatments.
This may include medication, hormone therapy, or even surgery, depending on the specific problem and severity.
Consider Pelvic Organ Prolapse
Pain can also be caused by pelvic organ prolapse, a condition where the uterus, bladder, or other tissue descend and push towards — or even out of — the vagina due to weakened muscles in the area.
Treatment here typically involves a vaginal pessary, which is a removable silicone device that the person inserts into their vagina to hold everything in place, Dr. Rickey says.
Severe cases require surgery to reposition the top of the vagina, which can often be done with only small incisions, known as laparoscopically.
Weak Muscles Are Another, Common Reason for Pelvic Pain
If your doctor has determined you don’t have any of these conditions, your pain problem might stem from weak pelvic floor muscles. This is especially frequent when pain is accompanied by a leaky bladder, Rickey says.
Kegel exercises where you alternatively tighten and release the pelvic muscles, are one part of treating this.
But don’t stop there. “Many other muscles function because of the pelvic floor. When evaluating clients, I look at low back flexibility and the hips as well,” Abbott says. Then she provides a series of exercises for her clients to do during therapy and at home.
Exercises for Deep Abdominal, Back, and Hip Muscles
When starting an exercise routine for pelvic pain, it’s best to work with a pelvic floor physical therapist who can ensure you’re doing exercises correctly, Abbott recommends.
Contract your deep abdominal muscles. These deep core muscles attach to the pelvic floor via connective tissue, or fascia.
Lie on your back with knees up, feet on the floor. Place two fingers in line with your protruding hip bones but a few inches towards your pelvis in front. Breathe out forcefully as if fogging a window and feel the area tense under your fingers. Allow the inhalation to naturally return. Repeat several times. Then try to contract the base of your pelvis, like you do during a kegel exercise, while you exhale.
Work your hips. Sit up tall on a chair, feet hip width apart, hands placed on the outside of your knees. Push your knees into your hands while simultaneously resisting with your fingers. Hold in this state of resistance for five seconds, then relax. Repeat several times.
Strengthen your back. Begin on your hands and knees with hands under your shoulders and knees under your hips, spine in neutral position. Lift the right leg (don’t swing) while keeping the knee bent, until the sole of your foot is facing the ceiling. Don’t arch your back as you lift the leg. Return the knee to the ground. Repeat 10 times, then switch to the other leg.
Breathe to relax. “I probably spend the majority of my time with clients focusing on breathing,” Abbott says, since breathing both relaxes often-tense pelvic floor muscles and activates the diaphragm that connects to the pelvic floor.
Lie in a relaxed position, jaw relaxed, mouth open, hands on your rib cage. Inhale slowly through the nose and feel your ribs expand, which also lengthens the pelvic floor. Exhale slowly through the mouth and watch everything naturally contract. Practice 5 to 10 minutes daily.
Over time, you can progress to breathing this way while standing, sitting, walking up stairs, and rising out of a chair. “Controlling those muscles and breathing during movement is the ultimate goal,” Abbott says.
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