How to Relieve Chronic Pelvic Pain with Physiotherapy

The muscular tension that I am referring to is the hypertonia of the pelvic floor, that is to say, the high tone that the muscles of this part of the body present without, in most cases, being aware of it.

And it is that some people can find it difficult to relax, in general, to reduce the tension in the muscles of their entire body and thus present an increase in tone in the muscles of their pelvic floor, as they can also have it in their trapezius (with the consequent neck pain…) or in their masseters.

But other times, that tension resides exclusively in the perineal musculature, and it is no longer just a matter of lack of awareness or difficulty relaxing, but may be due to triggering factors such as:

• Excessive training of the pelvic floor muscles (Kegel exercises) without enough rest to allow them to relax and recover.
• Frequent practice of impact sports (running, tennis, etc.) and/or hypertensive exercises (traditional sit-ups that overload your pelvic floor).
• Pelvic surgeries such as hysterectomy or surgical interventions to resolve a prolapse.
• Infections or inflammations in the pelvic area.
• Pelvic trauma (tears, episiotomies, etc., and their consequent scars).
• Recurrent cystitis.
• emotional factors.
• bad postures
• Wearing very tight clothing.

This tension of the pelvic floor muscles, in addition to manifesting itself through chronic pelvic pain, can show up in the form of dysfunctions such as dyspareunia (or pain during or after sexual intercourse), constipation, pain during defecation, low back pain and pain on urination or sensation of incomplete emptying of the bladder.

This can be detected through what is known as MRI for pelvis, a specialized study for the whole pelvis area which can reveal important details on possible problems in your pelvis.

Physiotherapy to relieve chronic pelvic pain

Physiotherapy tips to manage pelvic floor muscle tension and relieve chronic pelvic pain

If you are reading this article and you think you might have chronic pelvic pain (CPP), the first thing I recommend is to see your doctor get a proper diagnosis, ruling out other pathologies or possible pelvic floor dysfunctions.

If you have been diagnosed with CPD and its origin is hypertonus in your pelvic floor muscles, or this hypertonus is worsening the symptoms of your pain even if the origin of it was another, you can find relief by following these simple tips:

1. Global and specific relaxation techniques

Reaching an optimal state of relaxation, both physically and mentally, is a fundamental aspect when dealing with pain. If you get the muscles of your whole body to reduce their muscular tension and, specifically, manage to do it with your perineal muscles, you will be favoring the breaking of that tension-pain circle that feeds back and worsens your situation.

Reserve 20-30 minutes of your day to practice this simple relaxation, in which although I am going to focus on your perineal muscles, you should not forget the rest of the muscles of your body, from the feet to the neck, trying to do a global relaxation and specific:

• Lie on your back with a cushion under your knees to keep your pelvis neutral.
• Place a hot water bottle or a bag of seeds (hot pack) on your pelvis (between the navel and the pubis). Many patients report relief in their discomfort with the use of gentle heat for 15-20 minutes.
• Perform slow, deep, and relaxed diaphragmatic breathing, as we explain in this article.
• Become aware of your perineal muscles and visualize how each time you take a breath your perineum bulges slightly outwards (don’t force it, don’t push it, just imagine it and let it flow) and when you exhale your muscles return to the starting position.
• Check the state of the rest of the muscles during this time dedicated to relaxation. Sometimes, without realizing it, the fact of concentrating on a specific part makes us neglect the rest. Therefore, check if your neck is relaxed if your arms rest on the surface if your buttocks rest relaxed on both sides of the sacrum. If you notice tension in any of these areas, focus it, keep breathing through your diaphragm, and send all the tension out of your body with each exhalation.

2. Take care of your diet to promote intestinal transit and evacuation

Efforts to defecate every time we go to the toilet mean an increase in pressure on the pelvic floor muscles, which will increase their tension, worsening the pain picture.

For this reason, it is important to achieve a suitable consistency in the stools (if they are very hard, you will have to make more effort) and to learn and put into practice the correct posture and breathing when it comes to evacuating.

Hydrate yourself properly, perform physical activity regularly and eat a balanced diet.

3. Hand treatment

As pelvic floor physiotherapists, we can act manually, like any other muscle in the body, to relieve tension and improve the state of the perineal musculature.

Performing a massage in this area, eliminating painful points, balancing with the rest of the components of the lumbar-abdominal-pelvic compartment, myofascial techniques, and stretching… are some of the manual techniques that a specialized professional will make available to you.

In addition, Physiotherapy puts at your disposal instrumental techniques such as biofeedback, with which you can become aware of the state of contraction-relaxation of your muscles and learn to manage tension, or electrotherapy, with good results both in muscle relaxation of the pelvic floor as in the reduction of pain.

4. Use of vaginal dilators

As we have already told you on other occasions, the use of vaginal dilators is an effective tool for the treatment of pelvic floor hypertonia, in dysfunctions such as vaginismus, dyspareunia or chronic pelvic pain.

The vaginal dilators, which can be used both in the office and in the privacy of your own home, aim to progressively elasticize the tissues of your pelvic floor through the vaginal insertion of the different sizes included in the treatment kit, decreasing muscular tension and improving physical sensations upon penetration.

5. Be aware of your breathing

In recent weeks we have placed a lot of emphasis on the close relationship between breathing and the pelvic floor.

How many times do you breathe a day? How many breaths do you take throughout your life? Can you imagine if you weren’t breathing as well as you should?

It is quite likely that with each inhalation you are, in some way, harming your pelvic floor by not sending it all the oxygen its muscles need and by preventing it from dancing in rhythm with your diaphragm. This is how most adults, without being aware of it, breathe on a daily basis.

6. Take care of your intimate health

It is important to learn and put into practice some care guidelines for the genital area, as well as to know the basics about vaginal pH and its balance.

These tips on intimate health will help you protect yourself from irritations and infections, preventing your pelvic pain from worsening due to additional causes.

7. Modify your physical activity

Staying active is essential to achieve an optimal state of health and an adequate quality of life. However, not all physical activities are recommended for those who suffer from chronic pelvic pain.

An intense core exercise without sufficient relaxation of the abdominal and perineal muscles can worsen muscle tension in your pelvic floor and intensify the pain.

For this reason, and as long as your physiotherapist does not tell you otherwise:

• Avoid Kegel exercises
• Do not do traditional crunches
• Beware of certain Pilates exercises that also put hyper pressure on the perineum
• Avoid carrying weight repeatedly and, if you have to do it on time, learn to lift the weight without damaging your pelvic floor.
• Avoid penetration in your sexual relations, since it can increase hypertonia and vaginismus. Enjoying a full sexual life is one of the objectives that your physiotherapist, your psychologist and you will have set for yourself, but if you suffer from pain during penetration, it should be avoided until the treatment progresses with the practice of massage, the use of dilators, myofascial techniques, etc.
• Do not spend a lot of time sitting or standing, you will increase the tension on your pelvic floor.
• Replace impact sports with another physical activity that respects your perineal muscles.

8. Take care of your posture

We will not get tired of repeating the essential role that posture has in the health of the pelvic floor. You already know that this does not fulfill its functions independently, but needs the correct coordination with the rest of the teammates (abdomen, diaphragm, lower back) to carry them out properly.

One of the basic aspects of the treatment with your pelvic floor physiotherapist will be to provide you with tools so that you can maintain correct postural hygiene in your day-to-day: when you work, when you are sitting, when you make an effort and even when you rest.

Proper global postural re-education will help you relieve muscle tension not only in your pelvic area but throughout your body, balancing the pressures and releasing tension from the muscles of your perineum.