Pelvic Pain and Role of Physiotherapy

The pelvis is the lowest part of your tummy (abdomen) and Pelvic pain is more common in women. Pelvic pain usually means pain that starts from one of these organs. In some cases the pain comes from pelvic bones that lie next to these organs, or from nearby muscles, nerves, blood vessels or joints. So, there are many causes of pelvic pain. There are many different causes of pain in pelvis and these can be identified basis the stage at which the pelvic pain symptoms start to appear like if these appear during pregnancy and if they are accompanied by other symptoms such as vaginal bleeding. The most common causes are mentioned below and most causes have treatments available.

Types of pelvic pain

Pelvic pain can be acute or chronic. Acute means that the patient is experiencing this type of pain for the first time. Chronic means that pain has been a problem for a long time – generally more than six months.

Causes of Pelvic Pain in Pregnancy:

Miscarriage:

Miscarriage is the loss of a pregnancy at any time up to the 24th week. 7 or 8 miscarriages out of 10 occur before 13 weeks of pregnancy. The usual symptoms of miscarriage are vaginal bleeding and lower tummy (abdominal) or pelvic cramps. The patient may then pass some tissue from the vagina, which often looks like a blood clot.

Ectopic pregnancy:

An ectopic pregnancy is a pregnancy that tries to develop outside the womb (uterus). It occurs in about 1 in 100 pregnancies. Usual symptoms include pain on one side of the lower abdomen or pelvis. It may develop sharply, or may slowly become worse over several days. It can become severe. Vaginal bleeding often occurs, but not always. It is often darker-colored than the bleeding of a period.

Rupture of corpus luteum cyst:

A corpus luteum makes hormones that help keep the patient pregnant, until other organs such as the placenta take over. It forms after the release of the egg at ovulation. They are often found, by chance, when the patient has an ultrasound scan for some reason. They often cause no problems at all and clear up without treatment. Sometimes it can become too swollen and may burst. This may cause sharp pain on one side of the pelvis. If the patient experiences pain in pelvis in the first 12 weeks of your pregnancy, then the patient must see the doctor.

Premature labour:

Normally labour starts after 37 completed weeks of pregnancy. Normal labour usually starts as tightening felt across the lower abdomen. These become stronger, more painful and closer together. The patient may also have a ‘show’ which is the mucous plug from the neck of the womb (cervix). If the patient experiences a gush of fluid from the vagina, the water bag may have broken. The patient should contact the respective healthcare provider immediately. If the patient has pelvic pains that come and go in a regular pattern, contact the respective healthcare provider immediately for advice.

Placental abruption:

In some rare cases (about 6 times in every 1,000 deliveries), the placenta detaches from the wall of the womb. Before 24 weeks of pregnancy this is a miscarriage; however, after 24 weeks it is called an abruption. When it happens it is an emergency. This is because the baby relies on the placenta for food and oxygen. Without a working placenta, the baby will die. The staff in the maternity department will quickly try to deliver the baby. This is usually by emergency caesarean section.

Physiotherapy Treatments for Pelvic Pains: Hands-On Therapy

The mainstay of physical therapy for pelvic pain is hands-on treatment which includes both external and internal techniques. Generally the therapists do not use the internal techniques until the patient is comfortable with them.

Various external techniques may include:

  • Skin rolling
  • Deep tissue massage, often called “Myofascial release”
  • Trigger-point therapy to release tight spots or “knots”
  • Nerve release
  • Joint mobilization

To treat the pelvic floor internally, the therapist may insert a finger or an appropriate instrument in the vagina or rectum to massage the muscles and connective tissue directly and to release trigger points. A common trigger point release technique is to put pressure on the spot until it relaxes. Sometimes anesthetics can be injected into these trigger points.Physiotherapists may do this in a few states, but in most states, a doctor or nurse must administer injections. Internal massage can also help to release nerves.

Other Treatments used in Physiotherapy:

Physiotherapists or a doctor can also advise the following techniques to treat the pelvic pain:

Biofeedback

It uses electrodes placed on the patient’s body (on the perineum and/or the area around the anus) or probes inserted in the vagina or rectum to sense how tense or relaxed the patient’s pelvic floor muscles are and display the results on a computer or other device. These cues can help the patient learn to relax those muscles.

Electrical Stimulation

This stimulates the patient’s pelvic floor muscles directly through a small probe inserted into the vagina or rectum. This may help desensitize nerves or even cause muscles to contract and relax. Stimulation through electrodes placed on the patient’s body may be used to calm pain and spasms. These units can be used at home.

Interferential Therapy

This is a kind of electrical stimulation delivered from electrodes placed on the skin. The impulses “interfere” with each other at the point of pain deep in tissues and can replace and relieve the sensations of spasm. These units can also be used at home.

Ultrasound

This technique uses high-frequency sound waves applied through a wand or probe on your skin to produce an internal image or to help treat pain. Real-time ultrasound can let the patient see his/her pelvic floor muscles functioning and learn to relax them. Therapeutic ultrasound uses sound waves to produce deep warmth that may help reduce spasm and increase blood flow or, on a non-thermal setting, may promote healing and reduce inflammation. Newer ultrasound devices administer low-frequency, low-intensity waves and can be used at home.

Cold laser

This treatment applies low-intensity laser light to the tissue and may help with pain, inflammation, and wound healing. These help in the temporary relief of minor muscle aches, joint pain and stiffness, and for relaxation of muscle spasm, and increased local blood flow where they are trapped or pinched by muscles.