Pelvic Pain Conditions
Pudendal Nerve Irritation (Neuralgia or Entrapment)
The pudendal nerve is a nerve that runs from the sacral nerve roots in your spine, to your genital region on both the left and right side. It travels under the piriformis muscle in the buttocks and then past your pelvic ligaments into a small tunnel called Alcock’s canal. Alcock’s canal lies between the obturator internus muscle and the levator ani muscles in the pelvic floor (this space is just to the inside of your sit bones in your buttocks). The nerve then divides into 3 different branches. In women this includes the mons pubis (area over just below the pubic bone), clitoris, urethra, vaginal opening, labia, rectum and anus. In men the branches travel along the penis and extend as far back as the rectum and anus.
Symptoms are usually describes as a burning sensation, shooting or electrical pain, or sometimes an achy feeling wherever the nerve may travel. Some people feel hypersensitivity in this area, others describe a numbness. Occasionally people get the sensation of a full rectum or like they are sitting on a golf ball – but this feeling can be a sign of other conditions too. Other symptoms include pain with urinating, bowel movements, pain with intercourse (with arousal, orgasm or following intercourse).
Pain usually worsens with sitting and some degree of relief can often be achieved by standing. It seems that sitting in a straddling position might be slightly worse, as the rate of pudendal nerve irritation seems to be slightly higher in cyclists. Although sitting, heavy lifting, pelvic surgery, and pelvic injury are all potential causes.
Interstitial cystitis/Painful Bladder Syndrome
Patients with interstitial cystitis often describe bladder, pelvic or lower abdominal pain. This can be associated with urinary urgency (the feeling that you need to urinate) and increased urination (usually small volumes of urine). There are two recognized forms of IC. Non-ulcerative is the most common form (90%) where no substantial ulcers are present in the bladder. Roughly 5 – 10% of cases are ulcerative, where Hunner’s ulcers, or areas of bleeding and irritation are observed in the bladder wall (for resources see: https://www.ichelp.org/). Pelvic floor physiotherapy is often recommended to help treat secondary muscle issues – poor flexibility, over-active muscles, and poor coordination.
Coccydynia (Coccygodynia/Tailbone pain)
Coccydynia sometimes called Coccygodynia is pain experienced anywhere in the tailbone or immediately adjacent areas. Often the pain is worse right at the tip of the bone but it can also be felt in the ligaments on either side of the tailbone too. Sitting on firm surfaces, and directly on the tailbone worsens the pain, but some only experience the pain immediately after getting up from sitting. Using or squeezing the buttock muscles can exacerbate pain. Occasionally tailbone pain can be felt during bowel movements, or make bowel movements more difficult. There are many causes of coccydynia: falls upon the tailbone, childbirth, and sitting directly on the tailbone for too long are all common causes.
A condition where the tissue that normally lines the uterus (endometrium) is found in places outside of the uterus. This often leads to pain experienced in the low abdomen and pelvis. Endometriosis is typically treated with medication and/or surgery, but pelvic floor physiotherapy is also used to help cope with secondary muscle tension and include massage, stretching and relaxation techniques.
Male Genital Pain
Chronic Prostatitis/Non-bacterial Prostatitis/Testicular pain syndrome
This is not to be confused with bacterial prostatitis (prostate gland infection). This is pain that is often felt in one testicle, but can extend from the abdomen to the groin, and involve the penis itself or spread back towards the rectum. It can be constant but usually varies in pain, sometimes leaving altogether for short periods of time. Sometimes it switches sides. It’s usually achy and tender but can be sharp and shooting. Certain activities such as sitting for long periods, rigorous activity, heavy lifting, exercise (especially abdominal or inner thigh exercises), sexual activity, and straddling a bicycle or motorcycle can make it worse. Pain can also be increased by stress. The pain can interfere with sexual function leading to erectile dysfunction, pain with erection, or pain with ejaculation. It can also change urinary habits causing an increased urge to urinate, increased frequency of trips to the bathroom, difficulty initiating urine stream, or changes to your urine stream flow. Pelvic floor physiotherapy often plays a large role in the recovery process.
On rare occasions, scrotal pain can occur following a vasectomy procedure. Pain can begin immediately after the surgery or up to a year following the procedure. This mightbe attributed to scar tissue, but for others simply the chosen recovery position can be the exacerbating issue. Pelvic physiotherapy may be used in an effort to improve relaxation, contraction and coordination of the surrounding pelvic floor muscles.