2. Interstitial Cystitis (IC)Unlike the kind of cystitis that can be treated with antibiotics, IC is a chronic inflammatory condition of the bladder wall. Some of the symptoms are an urge to urinate frequently, stinging the area surrounding the urethra, increased nighttime voiding (urinating), and a variety of pelvic and sexual pain symptoms. 3. Irritable Bowel (IBS)Constipation and/or diarrhea are symptoms of this syndrome. Some women find that IBS flare ups correlate to an increase in vaginal irritation. Therefore foods that aggravate the bowel may also cause vaginal symptoms. 4. Lichen SclerosisThis is an inflammatory chronic skin condition most common in the external genital area. Symptoms may range from none (for years) to mild or severe itching and irritation. Lichen Sclerosis does appear to be relatively prevalent in women with vulvodynia and sexual pain disorders. It can cause splitting and "paper cut" type tears in the region around the vaginal opening. 5. Myofascial Pain SyndromeMyofascia are the muscles and connective tissue in the body. When in spasm, knots and "trigger points" develop that need to be released to eliminate pain and restore function. These trigger points in the pelvic myofascia can cause sexual pain. 6. Pelvic EndometriosisEndometriosis occurs when endometrial cells, normally found only in the uterus, become imbedded in locations outside the uterus. These locations are usually within the pelvic cavity on reproductive organs, supportive ligaments, or structural systems like the bladder or bowel. This misplaced tissue forms growths that look like dark spots. These growths respond to the menstrual cycle and break down and bleed each month, the same way the lining of the uterus does. This causes cyclical pain and inflammation - called dysmenorrhea. Additionally, the body’s immune response to this internal bleeding and breakdown of blood and tissues begins to cause scar tissue and adhesions (affected pelvic organs or structures adhering to one another) which can also cause ongoing pain. Endometriosis affects millions of women but is often over diagnosed as the primary cause of pelvic and sexual pain. If the pain or deep sexual discomfort is intermittent and all month long, even though it may become worse leading up to the menstrual period, endometriosis may not be the primary reason for the pain. If you have been diagnosed and treated for endometriosis and you don't begin to get signifiant improvement either after medication or surgical treatment, insist on further evaluation for bladder, bowel, musculoskeletal, or nerve related causes of your pain. 7. Pelvic Floor DysfunctionThe pelvic floor encompasses all the muscles that surround and support the pelvic organs (uterus, bladder, and lower bowel). To function appropriately, these muscles must be toned. However, elevated tone in the pelvic floor muscles, making them too tight, tense, and "turned on" can result in painful sex and difficulty with bladder and bowel function. On the other hand, too little tone can lead to bladder and bowel incontinence (leakage) or prolapse (falling down, out of normal position). Pelvic floor dysfunction can refer to either too much or too little tone. 8. Previous life-long Pelvic TraumaEvents such as physical, emotional, and sexual abuse, surgeries, accidental injuries, and cumulative aggravating structural factors can play a role in sexual pain. Additional possibilities include years of various sports activities such as gymnastics, cheerleading, track & field, soccer, ballet dancing, horseback riding, skating, etc. More and more women have engaged heavily and competitively in these sports over the past few decades, making them extremely vulnerable to these types of bodily stresses. The nervous system bio-chemically "imprints" and "remembers" these accumulated traumas, and any or all of these may predispose a young woman to sexual and pelvic pain disorders even years later. 9. Generalized VulvodyniaGeneralized vulvodynia is a subset of vulvodynia, it is less common than vulvar vestibulodynia (see below) and often very difficult to successfully treat. It is a deeper, more generalized pain. Pain can occur spontaneously (unprovoked) or in response to touch or pressure (provoked, such as by intercourse). Pain emanating from the pudendal nerve and its distribution may be a significant contributor to this condition in some cases (pudendal neuralgia). 10. Vulvar Vestibulodynia (Vestibulitis)This condition causes pain and inflammation at the vaginal opening. Women describe the pain as burning, itching, raw, sandpaper, ground glass, and stinging. It is commonly mistaken for vaginal yeast infections and is often treated incorrectly. Vestibulitis is the most common reason for entrance pain (painful sex) in reproductive-aged women.
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EXERCISE ROUTINE TIPS FOR THOSE WITH PELVIC PAIN
"Toning up" may actually be a "sexual downer" on body parts that need to be the most relaxed and comfortable for those intimate moments. 2. Seats and ClothingFind the softest, most pliable seat possible and wear loose-fitting clothes when riding a bicycle, motorcycle, or scooter. Better yet, consider giving up these activities. The pressure against your already sensitive genital area can cause symptoms to flare up. 3. Give Up the Attitude of "Playing Through the Pain"While coaches often urge athletes young and old to "play through the pain", it's vital to abandon this attitude when it comes to enduring painful sex as an adult. Please don't believe that you must have sex to please your partner despite the pain and if you don't something is fundamentally wrong with you. Nothing could be further from the truth. A loving partner would never want to cause such suffering. 4. See a Pelvic Floor Physical TherapistMore and more physical therapists (PTs) are incorporating pelvic pain treatment into their practice as the urgency of effectively treating sexual pain increases. A growing number of doctors consider pelvic floor physical therapy a vital component of a complete treatment plan for sexual pain. Specialized pelvic floor PTs utilize various methods to release trigger points in the body. Trigger points develop through contraction or spasms in the muscle groups surrounding the vagina, bladder, and lower bowel. Using manual pressure, biofeedback, and other techniques these health care providers can often aid sufferers. Patients are eventually given techniques to maintain wellness at home.
 Vaginismus is a condition that affects the muscles of the pelvic floor and involves involuntary spasming or clenching of the pelvic musculature. Typically this reactive tightening of the muscles is in response to insertion or the attempt of insertion of an object into the vagina, making vaginal intercourse painful and sometimes impossible. Thankfully, this condition is becoming more and more recognized by the mainstream media. But coming along with it are some misconceptions about vaginismus that we'd like to clear up. Myth #1: Kegels Cure VaginismusKegels, done correctly, are a great strengthening technique for the muscles of the pelvic floor for many women and men. However, someone who is struggling with vaginismus is not a good candidate to begin practicing kegels. While kegels may be introduced later on to help the overall pelvic and core musculature function together during certain body movements, they should be avoided at first. The focus of treatment should instead be on the ability to consciously recognize and relax the pelvic floor muscles. It is best to receive this treatment under the direction of a specialized women's health physical therapist who can guide you through imagery and biofeedback techniques. Also, consider our physical therapy digital download chapter packages to assist you at home. Myth #2: Vaginal Dilators are Used to 'Stretch' the MusclesDilators are an incredibly helpful tool for those with vaginismus. Their function in the treatment process, however, isn't so much to "stretch" the tight muscles of the pelvic floor. The pelvic floor muscles are already quite capable of stretching far beyond what is needed for sexual intercourse (think, delivering a baby). The problem with vaginismus is that the central nervous system (the brain and all its related systems including the spinal cord and nerves) is sending signals to the pelvic musculature to brace itself for what it considers or 'remembers' to be painful: vaginal penetration. So dilators work by desensitizing the central nervous system (see Myth #3 for more on this) and by providing trigger point release (intentional pressure to points of muscular tension for the relief of pain, much like in your neck or shoulders). To learn more about the science of chronic pelvic pain and the use of dilators in the treatment of vaginismus, purchase the DVD Healing the Pain Down There: A Guide for Females with Persistent Genital & Sexual Pain. We recommend dilators from Syracuse Medical Devices as they are made of medical grade material and have a consistent length. It is important to have a long enough dilator to be able to reach the second layer of the pelvic floor musculature even with the smallest dilator in diameter. Myth #3: You Just Have to Try to Relax and Keep Practicing SexIf you continue doing as you have been doing - having sex that is painful, then setting yourself up in that same environment with your partner will actually perpetuate or re-enforce the pain - because your mind is already anticipating the pain - it is a known response and you cannot just "force" a relaxation response instead. But if we remove the “red flags” from the brain and place YOU IN CONTROL using the dilators, we can re-train the brain to realize that there doesn’t need to be a “fight or flight response”, we can begin to “unwind” the nervous system. When you start with an extra small dilator and can insert and move it and do self stretches with low to no pain - then the brain starts to realize that - OK - that wasn’t so bad and the secondary responses of muscular tensions ease also allowing for less pain and your overall confidence level with repeated successful sessions with the dilator allows you to become ready for return to intercourse with low to no pain. It is important that you abstain from intercourse (not intimacy) during dilator sessions until you can progress to the proper size. So essentially what happens is you change the perception in your brain about the health of your vagina, decreasing the sensitivity of your nervous system to keep the muscle tension in check to help achieve a good end result. Content Providers of this Article, paindownthere.com, and video guide series for Healing the Pain 'Down There':
Robert Echenberg, MD Karen Liberi, MS, MPT, WCS Alexandra Milspaw, PhD, LPC
"doing mode", you're operating almost exclusively in the sympathetic branch of your autonomic nervous system. This system is associated with the "fight or flight" response, shallow breathing patterns, muscle tension, and increased heart rate and blood pressure. These stress responses of the body not only negatively influence the pelvic floor muscles but also the overall pelvic region including bladder and bowel function, both common triggers of genital, sexual, and pelvic pain. 2. Pelvic Traumas, Injuries, or SurgeriesInjuries to the pelvic floor region caused by childbirth, previous pelvic surgeries, falls on the coccyx bone, and other accidental traumas to the region such as straddle injuries can all contribute to the development of chronic pain in the pelvis and genital area. Take for instance, the condition once known as "bikers syndrome" that affects long distance bike riders. Cumulative targeted pressure on the pudenal nerve overtime can cause damage to the nerve. This particular nerve branches out into the entire vulvar region and can therefore emit painful stimuli anywhere in the pelvic region, not just at the "sits bones". 3. Present or Past Physical, Emotional, or Sexual AbuseMemories from past (or current) abuses are stored in pathways along the central nervous system, and even in particular muscles, especially the psoas muscle. The psoas muscle has a direct and neurological connection to the pelvic floor muscles. These bad memories that are stored by the nervous system awaken when it is feeling threatened or when trying to protect itself. Even when attempting consented, pleasurable sex, the nervous system can interpret this environment as threatening. Protective measures include muscles tension and clenching (which leads to pain, which leads to the fear of pain, which leads to further clenching), and the over-sensitization of the pelvic nerves. 4. Participation in Competitive SportsMany popular sporting activities require tight, clenched body positions and breathing from the chest in order to perform. If we are taught by these sports (or cultural influences) to suck in our stomach and breathe from the chest and clench our buttocks at all times as a matter of "good posture" this can, over time, be detrimental to the health and function of the pelvic floor. In addition, young women who participate in sports are more likely to experience sports-related injuries such as injuries to knees, ankles, legs, and hips. If a knee, for instance, is favored for a long enough period of time the opposite pelvic area takes on more stress and can contribute to pain due to compensatory patterns. 5. Genetic, Hormonal, & Dietary InfluencesStructurally the body is not symmetrical and consequently curvatures of the spine, leg length difference, being left or right footed, all have a bearing on the long-term cumulative stress on one side of the pelvis or the other. Genetic and hormonal influences can also put us at risk for other triggers commonly associated with pelvic, genital, and sexual pain. For instance, endometriosis, irritable bowel syndrome, and interstitial cystitis (painful bladder syndrome or "IC"). The dietary decisions we make also influence how and when these triggers manifest in the body. Foods can promote the inflammatory responses contributing directly to pain, but also inhibit the immune system from functioning properly.
Understand Your Body, Elevate Your Health, and Reclaim Your Spark ~ Naturally |
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Take a look at the image in the blog post just below. This image of the female pelvis is incomplete because there is a great deal more to the anatomy of the female pelvis that is just not shown in this image. The pictures in this blog post show much more of the complete anatomy of the pelvic region.
The actual causes of chronic, persistent pain itself are in all of these neuro-myofascial components: Nerves, Muscles, and Ligaments. Bladder, bowel, and reproductive organs are commonly acting as "triggers" that set off painful, but protective responses in the region. Just as in any other area of the body, the muscles, nerves, and ligaments go into a protective bracing mode as a result of current tissue injury, protecting against further injury, and even when the system is reminded of past injury. These structures are trying to immobilize the region in order to control the pain.
Comprehensive assessment and treatment of chronic pelvic pain therefore will naturally include specialized pelvic floor physical therapy to rehab and release long term muscle spasming and trigger points, as well as a working knowledge of diagnosing and managing chronic nerve type pain in the pelvic and genital region.
The actual causes of chronic, persistent pain itself are in all of these neuro-myofascial components: Nerves, Muscles, and Ligaments. Bladder, bowel, and reproductive organs are commonly acting as "triggers" that set off painful, but protective responses in the region. Just as in any other area of the body, the muscles, nerves, and ligaments go into a protective bracing mode as a result of current tissue injury, protecting against further injury, and even when the system is reminded of past injury. These structures are trying to immobilize the region in order to control the pain.
Comprehensive assessment and treatment of chronic pelvic pain therefore will naturally include specialized pelvic floor physical therapy to rehab and release long term muscle spasming and trigger points, as well as a working knowledge of diagnosing and managing chronic nerve type pain in the pelvic and genital region.
Paindownthere.com and the educational/instructional videos Healing the Pain ‘Down There’ intend to explain, as best as possible, that there are many reasons in the pelvis for pelvic floor dysfunction and for genital and pelvic pain. One of these reasons may be hypertonicity (as posted about last time). Virtually everyone with pain, caused by all sorts of injuries to the body, has reactive hypertonicity in and around that injured area. The muscles around a knee injury or shoulder injury, for instance, always tighten to guard that area and stabilize or “splint” that area. Same in the pelvis. The way that pain is processed in the brain along with fear and anxiety factors can also continue to cause hypertonicity even after the initial injury has healed. Mind/body aspects of care become so important in this instance.
Other reasons or “triggers" in the pelvis for pelvic floor dysfunction and for genital and pelvic pain besides the implications of hypertonicity include:
Somatic reasons: Current or previous injuries or stress on all of the surrounding structural entities. These structural entities include bone, muscle, fascia (connective tissue), ligaments, and nerves.
Visceral reasons: Organ dysfunction like IC (Interstitial Cystitis or Painful Bladder Syndrome), IBS (Irritable Bowel Syndrome), Endometriosis, Prostatitis and others.
We want to help “connect these dots” for all the potential and interconnected sources or “triggers” of chronic pain in the pelvic and genital area.
Other reasons or “triggers" in the pelvis for pelvic floor dysfunction and for genital and pelvic pain besides the implications of hypertonicity include:
Somatic reasons: Current or previous injuries or stress on all of the surrounding structural entities. These structural entities include bone, muscle, fascia (connective tissue), ligaments, and nerves.
Visceral reasons: Organ dysfunction like IC (Interstitial Cystitis or Painful Bladder Syndrome), IBS (Irritable Bowel Syndrome), Endometriosis, Prostatitis and others.
We want to help “connect these dots” for all the potential and interconnected sources or “triggers” of chronic pain in the pelvic and genital area.
HYPERTONIC (TOO TENSE, TIGHT) PELVICFLOOR MUSCLES VS. HYPOTONIC (TOO LOOSE) PELVICFLOORMUSCLES.
10/9/2014
Hypertonic pelvic floor muscles (or hypertonicity) are too tight and tense which can lead to pain and can also create weakness which can actually lead to incontinence (loss of control) of the bladder. Hypotonic pelvic floor muscles (or hypotonicity) are too loose and can also lead to incontinence of both the bladder and the bowels. So both hypertonicity and hypotonicity can lead to loss of bladder control. However, loss of bowel control is more often associated with hypotonic related weakness. Pain would only be associated with hypertonicity. So to recap:
Hypertonic pelvic floor muscles (hypertonicity):
Hypotonic pelvic floor muscles (hypotonicity):
Hypertonic pelvic floor muscles (hypertonicity):
- Pelvic floor muscles are too tight and tense
- Sometimes associated with pain
- Tightness can lead to weakness
- Weakening of the muscles can cause loss of bladder control (urinary incontinence)
Hypotonic pelvic floor muscles (hypotonicity):
- Pelvic floor muscles are too loose
- Generally not associated with pain
- Associated with both loss of bladder control (urinary incontinence) and loss of bowel control (fecal incontinence) as well as prolapse or “dropping of the pelvic organs” - a topic for another time.
Author
Stephanie Yeager: Passionate about spreading the word of hope and healing for those like her, influencing a paradigm shift in the medical community toward greater understanding of chronic pelvic pain disorders, and prevention initiatives that may protect young women before onset can occur.
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