New Hope for Sufferers of Chronic Pelvic Pain
by Florene Carnicelli Johns, PT, MPC, SD
What is Chronic Pelvic Pain (CPP)?
Chronic pelvic pain (CPP) may affect as many as 25% of women between the ages of 18 and 50. Although this condition is more often reported by women, men also experience chronic pelvic pain. CPP is any pelvic pain that lasts for more than six months.
A precise definition of Chronic Pelvic Pain is not a simple one since the understanding of chronic pelvic pain is currently in transition. Those with CPP have found this frustrating and challenging often visiting several healthcare providers before being properly diagnosed and treated. In the past, the belief that this condition was “all in the head” prevailed among health care providers and patients but heightened awareness and understanding of the condition have changed this.
At present, CPP can best be explained by describing its symptoms, the impact of these symptoms on quality of life and describing treatments that have been effective.
Symptoms of chronic pelvic pain may or may not include sharp or severe pain but instead may present with some variation of discomfort, aching, burning, fullness, squeezing, tightness, sharp or dull sensation. These may appear in the genital, anal, bladder, tail bone, groin and low back as well as other areas. Reports of discomfort or relief when sitting and following bowel movements are common. Urinary symptoms include frequency, urgency, incontinence, hesitancy, burning and frequent night time urination. Sexual dysfunction may manifest as painful or impossible intercourse and absent or painful orgasm. Anxiety, depression and a feeling of helplessness prevail. Partner relational issues result from the condition and the condition magnifies existing issues.
Sources and Causes of CPP
Sources of pelvic pain include the organs that reside in the abdominal cavity as well as the bones and connective tissue on the front and back of the trunk, lower extremities and all areas in and around the pelvis. Instances of trauma to the pelvic floor resulting from childbirth, accident, sexual intercourse, sexual abuse, surgery, irradiation as well as acute disease can contribute to CPP.
The first step is a detailed medical screening and diagnosis often by a nurse practitioner or physician with a specialty in women’s health. Two major categories of pelvic pain exist: gynecological and non-gynecological. It is necessary to have a thorough examination in order to identity the problem and rule out infectious and neurological diseases. Screening for depression and anxiety disorders is also necessary.
Treatment of chronic pelvic pain must be multidisciplinary to be effective. A team approach is critical, whether the team is present in the same facility or exists as a referral network. It is important that the members of the team consult regularly. The team may include the physician, nurse practitioner, physician’s assistant, physical therapist, counselor and other providers involved in care.
Be patient with your treatment as it may take 3-6 months to resolve.
Medication including homeopathic preparations applied topically and by injection, bio-identical compounded hormones, sleep aides, antidepressants and others may be prescribed by the physician, nurse practitioner or physician’s assistant.
A physical therapist specially trained in pelvic floor dysfunction can provide a detailed evaluation necessary to identify the soft tissue structures that are responsible for the pain and dysfunction. Treatment may consist of myofascial release, electrical stimulation, biofeedback, and other procedures to release the shortened structures and strengthen the weakened ones. Postural correction and therapeutic exercises are also used.
Some patients find relief of pain with acupuncture and other alternative measures. Surgery should be a last resort since this may cause further restrictions of the connective tissue that may be contributing to the pain.
Counseling by a psychotherapist trained in couples’ work and sex therapy is very important. Depression and anxiety must be addressed. Eye Movement Desensitization and Reprocessing (EMDR) is an effective approach in treating distant past trauma or more recent distress actually resulting from the chronic pelvic pain. Here the condition has become the trauma. Mindfulness Based Cognitive Therapy (MBCT) is a valuable approach to assist the patient in dealing with chronic pain.
Understanding that the condition is not “all in the mind” puts patients at ease and facilitates the healing process. Since the mind is a tool of the brain and it functions to create thoughts and feelings, it is a misconception that the mind and body are separate. Since mental functions are dependent upon a physical organ, the brain, the mind and body are one. Chronic pelvic pain is in the mind and the body and both should be addressed along with the spiritual belief system of the patient.
If you are experiencing chronic pelvic pain, there is hope. Seek out a healthcare provider that has knowledge of CPP. Your gynecologist, urologist or urogynocologist may be good resources. Most large medical centers have a Women’s Health Center that may address CPP. More often there are nurse practitioners, physical therapists and counselors in your community that are specialized in diagnosing and treating CPP.
Florene Carnicelli Johns, PT, MPC, SD is a licensed physical therapist, pastoral counselor, sexuality counselor and spiritual director in private practice in Nashville, Tennessee with a specialty in counseling persons with chronic pelvic pain and relational issues resulting from the condition.
413 East Iris Drive,
Nashville, TN 37220
Phone: 615. 504. 3870