Pelvic pain is a symptomatology that involves a series of symptoms concentrated in the pelvic and perineal area and can have strong psychological and physical repercussions. It is defined as chronic when it lasts more than 3 consecutive months

Physiotherapy can play a very important role.

Chronic pelvic pain: What is it?

Chronic pelvic pain is localized pain in the pelvic or perineal area, which appears without any particular or manifest infection. 

It can appear through sudden spasms or sharp pain, but also continuously. Many patients refer to it as a ‘headache’ within the pelvis. 

Chronic pelvic pain: Causes

Chronic pelvic pain has been recently recognized as a proper disorder. In the past, it was often confused with other conditions such as urinary tract infection, prostatitis, and cystitis. 

Today, we are aware that chronic pelvic pain has heavier consequences in the gynecological, urinary (e.g., with difficulty urinating), and anorectal (difficulty defecating) areas and also affects the sexual sphere through decreased sex drive and erectile dysfunction.

Causes could be linked, at least in part, to bladder, urethral, prostatic, gynecological, anorectal, neurogenic, osteomuscular, and skin disorders.

Chronic pelvic pain: Symptoms

There are various symptoms of pelvic pain, and not all of them are well known, including:

  • Pain;
  • Discomfort;
  • Pain during sexual intercourse;
  • Feeling of abdominal or pelvic swelling;
  • Depression;
  • Bladder pain.

Chronic pelvic pain: Treatments

Therapy for chronic pelvic pain requires a multidisciplinary approach:

  • With physiotherapy, one can compensate for and resolve pain;
  • With psychology, cases of depression due to pain or difficulty in the sexual sphere can be treated;
  • With urology and andrology, in the case of male patients.

Remedies offered by physiotherapy include breathing and relaxation exercises for the pelvic floor muscles, which usually appear very contracted. 

In some cases, more rehabilitative techniques, such as electrostimulation or exercises guided by biofeedback, may be helpful. At the same time, local shock wave therapy may be used in more challenging situations. 

Some examples of physiotherapeutic exercises

Treating chronic pelvic pain efficiently requires a multidisciplinary approach. However, there are also some self-treatment exercises

In chronic pelvic pain, all the buttocks, lower abdomen, legs, and perineum muscles are extremely contracted and have a reduced ability to relax. Thus, they are sometimes unable to exert the necessary force, and it goes without saying that a stiff muscle is almost always weak. 

To relieve load-bearing tension, one should devote about 20 minutes a day, even separated into several sessions, to stretching the muscles of the abdomen, buttocks, and lower limbs. 

Each exercise should be performed for at least 20 seconds and should not be perceived as uncomfortable or painful:

  • To stretch the abdomen muscles, you should lie on your stomach and, pushing with your hands under your shoulders, try to lift your shoulders and chest off the floor without taking your pelvis off the mat.
  • To lengthen all the muscles of the spine and pelvis, you need to put yourself in a quadruped position and try, without moving your hands from the floor, to bring the buttocks toward the heels. 
  • To stretch the leg muscles directly connected to the pelvis (iliopsoas and adductors), you need to bring the feet close to the pelvis (starting from a seated position) and, again progressively, put the feet plant to plant and gradually push the knees apart by spreading them toward the floor.

A couple of warnings: Stretching exercises should not be too strong, so much so that all movements should be performed very calmly. Breathing also plays an important role, as it allows you to enter a state of extreme relaxation and autogenic training.