Pelvic Floor Physical Therapy Has Been Shown to Reduce Symptoms in up to 72% Of Patients, Even Among Those Without Improvement From Previous Treatment Modalities.1
Non-Surgical Treatments for Pelvic Pain
When pelvic pain is caused by pelvic floor dysfunction, the main non-surgical treatment for pelvic pain is physiotherapy. Pelvic pain caused by hypertonicity will often be just one symptom of the pelvic floor dysfunction. Other symptoms such as incontinence, pelvic organ prolapse, overactive bladder, sexual dysfunction (such as vaginismus or dyspareunia) and/or fecal incontnence can also be present. The treatments offered will depend on the severity of your specific symptoms.
Regardless of what treatment options are offered, PFMT is always required when the cause of your pain is pelvic floor dysfunction. Training your muscles will help to rebalance the pelvic floor to overcome hypertonicity bringing the pelvic floor back to a normal resting state.
Pelvic Floor Muscle Training (PFMT)
Your pelvic floor physiotherapist will make a complete assessment of your pelvic floor identifying the muscles that are hypertonic. Gentle to moderate pressure is applied to release the tension. Pelvic health physio’s are acutely aware of the pain and work with you on learning to relax while ensuring they stay within the boundaries of your pain tolerance. It is important to find a physio that you trust and relate to as this will make it easier for you to relax for the treatment. They will also give you pelvic floor relaxation exercises to do at home.
The exercises offered usually include reverse kegels, breathing exercises or yin yoga poses that help to bring relaxation into the pelvic floor. It can be helpful to practice relaxation exercises daily and to work to reduce stress as stress contributes to excess tension in the body. Learning to relax and let go of tension helps immensely when working to overcome pelvic pain. We have an extensive pelvic floor relaxation playlist on YouTube offering lots of different relaxation exercises.
You may also be taught to perform pelvic floor strength exercises (Kegels), although these are usually only offered as a method to tire out already contracted muscles in an effort to reduce hypertonicity.
Additional Conservative Treatments for Pelvic Pain
1. Exercise to Reduce Tension
Your pelvic floor muscles do not work in isolation and tension is often out of balance in other muscles groups. If you are suffering from constant pelvic pain, it is likely that you are also holding tension in hamstrings, glutes, low back and around your hips. Activities that help you to reduce tension through out the body, such as yin or restorative yoga, can be very beneficial when you suffer from pelvic pain. Active styles of yoga and walking in nature can also help to reduce stress while having a positive effect on your pain symtpoms.
2. Therapies to Improve Posture and Alignment
Your posture and alignment can impact the stability of your pelvic floor and should be assessed as part of your rehabilitation. Your fascia (connective tissue) holds your posture. A 2008 study into chronic pelvic pain found that women who suffered from chronic pelvic pain were more likely to have asymmetrical iliac crests (61%). They also found that 78% were unable to maintain a relaxed pelvic floor for more than 10 seconds.
Pain is not always related to your muscles. Your nerves and blood vessels which run thorough your network of connective tissue (fascia) can also play a role. 23% of those with chronic pelvic pain suffer from myofascial pain. Working with a specialist who focuses on myofascial release, structural integration or Rolfing can help to relieve myofascial tension while dramatically improving your posture and alignment. This, in turn, can have positive effects on the balance within your pelvis. You can find a local specialist in our specialist directory
3. Wand Therapy / Trigger Point Massage
As well as in-clinic treatments, your physiotherapist may suggest massage techniques to practice at home. A pelvic wand is often used for this treatment as it can be easier to reach and release tight spots with a wand than with your fingers. Regardless of whether you use a wand or fingers for trigger point massage, you should only apply a gentle pressure. This pressure is similar to the pressure used to check the ripeness of a piece of fruit.
4. TENS Transcutaneous Electrical Nerve Stimulation
TENS is a treatment that uses a gentle electrical current to interrupt nerve signals that trigger pain. This can help to reduce pain. This treatment is commonly used during labour to reduce pain from contractions. In the case of pelvic pain, the probes are often placed on the scrum or around the twelfth thoracic vertebrae. A 2017 study2 found a significant improvement in pain scores study participants who were treated with TENS, and two patients completely pain free following TENS therapy. You should never use any electrical stimulation devices without first consulting with your pelvic floor physical therapist. It is also important to follow the manufacturers instructions.
5. Pain Medication
Medication is often the first thing we reach for when in pain. Over the counter medications such as ibuprofen, Advil, Panadol, Tylenol and Aspirin are often used in the short term, however, long term use tends to not have any impact on chronic pelvic pain. It is important not to self-medicate. Speak to your doctor about your pelvic pain and they can help to decide if medication could the right for you. You may be prescribed stronger medications such as NSAIDS, anti-depressants or opioids. Topical medications in the form of vaginal suppositories or creams may also be given. In extreme cases, lidocaine can be administered by IV. This would involve a short stay as an outpatient in hospital.
Products for Management of Pelvic Pain
There are many products that can be used in the management and treatment of pelvic pain. We have include some of those products below. You should speak with your pelvic floor physiotherapist or doctor before using these products. Reviews of these products will be covered on our YouTube channel. If there is a specific product that you would like to see reviewed, just get in touch and we will review. Note that these products have affiliate links. Should you choose to purchase them, we will make a small commission.
Donut Cushion
Reheat-able Heat Pad
Trochanter Belt
Pelvic Wand
TENS Unit
Pelvic Clock
Invasive Treatment Options for Pelvic Pain
Having viewed the conservative treatments for pelvic pain, you may also be interested in the invasive (surgical) treatments, which you can get to from the button below. If you did not find what you were looking for, you can search this site using the search bar at the bottom of the page.
Explore the Pelvic Pain Page
You may be interested in finding out more about pelvic pain. You can do that from here:
References
- LShrikhande A, Ullger C, Seko K, Patil S, Natarajan J, Tailor Y, Thompson-Chudy C. A physiatrist’s understanding and application of the current literature on chronic pelvic pain: a narrative review. Pain Rep. 2021 Aug 30;6(3):e949. doi: 10.1097/PR9.0000000000000949. PMID: 34476302; PMCID: PMC8407606.
- Sharma N, Rekha K, Srinivasan JK. Efficacy of transcutaneous electrical nerve stimulation in the treatment of chronic pelvic pain. J Midlife Health. 2017 Jan-Mar;8(1):36-39. doi: 10.4103/jmh.JMH_60_16. PMID: 28458478; PMCID: PMC5367222.