Pelvic pain is a condition that affects 26% of the world’s female population, yet it remains cloaked in misunderstanding, often going misdiagnosed or untreated (Lamvu et al., 2021). While you may think this pain affects one exclusively in a physical sense, research long supports a strong relationship between pelvic pain and one’s psychological well-being. This relationship is complex, and one worth diving into to help explain not only how they are linked but what we can do to help decrease your pain and improve your quality of life.
Before we continue…
We want to acknowledge that pelvic pain affects people of all genders, even though this post focuses on female pelvic pain. Written from a physiotherapy perspective, this post aims to be valuable for both allied health professionals and individuals coping with persistent pelvic pain. Also note that while we use the term “chronic pelvic pain” during our discussion, we recognize that current literature supports the use of the term “persistent pelvic pain.”
Understanding Chronic Pelvic Pain
As Lamvu et al. (2021) explain, chronic pelvic pain (CPP) is a persistent pain in the lower abdomen or pelvis that lasts six months or longer, significantly impacting daily life and overall well-being. It can negatively impact your:
- Thoughts
- Behaviours
- Sex life
- Emotional/psychological state
You may also experience symptoms indicating issues with your urinary tract, bowel, muscles or gynecological health. Chronic pelvic pain can be non-cyclic, cyclic, or related to your menstrual cycle and intercourse (Lamvu et al., 2021). As this condition can stem from a variety of sources, diagnosis and treatment are complex. Oftentimes, multiple pelvic pain conditions coexist (Lamvu et al., 2021). Common pelvic pain conditions include:
- Endometriosis, where tissue similar to the lining of the uterus grows outside the uterus, causing severe menstrual cramps and pain during intercourse.
- Interstitial cystitis, a painful bladder syndrome, results in discomfort and pressure in the bladder and pelvis, often accompanied by frequent urination.
- Pelvic inflammatory disease (PID), an infection of the female reproductive organs, can cause chronic pain and is often associated with sexually transmitted infections.
- Irritable bowel syndrome (IBS) is another condition that can lead to pelvic pain, characterized by abdominal cramping, bloating, and changes in bowel habits.
- Musculoskeletal issues like pelvic floor dysfunction, where the muscles and connective tissues supporting the pelvic organs become tight or weak, can contribute to chronic pain.
The Physical and Psychological Intersection
The human body and mind are intricately linked, with each influencing the other in profound ways (Renoir & Gray, 2013). This is especially evident in chronic pain conditions, including pelvic pain. The central nervous system, which includes the brain and spinal cord, plays a crucial role in our perception of pain.
When someone experiences chronic pain, their brain’s pain processing centre can become hypersensitive, leading to an exaggerated pain response (Till et al., 2019). This phenomenon is known as central sensitization (Latremolier & Woolf, 2009). When someone is centrally sensitized, their nervous system goes on what could be called “high alert.” When on “high alert,” any stimulation might be perceived by the central nervous system as dangerous or painful. With repeated stimulation over time, the pain response continues to be amplified.
Beyond the physical symptoms, chronic pelvic pain can often lead to psychological distress. The persistent nature of the pain can contribute to anxiety, depression, and a reduced quality of life (Till et al., 2019). The psychological impact is not simply a derivative of living with chronic pain; the psychological impact can also exacerbate the pain itself (Till et al., 2019). Increased levels of stress and anxiety can trigger or worsen pain through the body’s stress response, which activates the sympathetic nervous system. This system releases stress hormones like cortisol, which can increase inflammation and sensitivity to pain (Till et al., 2019).
Individuals living with persistent pain can get trapped in a negative reinforcing feedback loop where their physical symptoms impact their mental and emotional well-being or vice versa, often amplifying their symptoms. Regardless of which one comes first, the impacts can be similar: increased pain, discomfort, and a decreased quality of life.
Breaking the Cycle: Integrated Treatment Approaches to Chronic Pelvic Pain
According to Till et al. (2019), a multidisciplinary approach to treating pelvic pain is often the most effective. This approach typically includes a combination of medical, psychological, and physical therapies aimed at addressing both the physical, emotional, and psychological aspects of pain (Lamvu et al., 2021).
Medical Interventions
Various medical interventions are often used in treating individuals living with persistent pain. These interventions can include medications to manage pain and inflammation, as well as treatments for underlying conditions such as endometriosis or interstitial cystitis (Lamvu et al., 2021). In some cases, nerve blocks or other interventions may be necessary to provide relief, however, the evidence supporting their use is limited when compared to other treatment modalities (Lamvu et al., 2021).
Psychological Therapies
Psychotherapies, including working with a registered clinical counsellor, can help individuals manage the psychological impact of chronic pain (Lamvu et al., 2021). These therapies can teach coping strategies, reduce stress, and address any underlying trauma or mental health issues.
As a team, we strongly believe in co-treating chronic pain and pelvic pain with the help of a mental health professional for the best results. You can read more about our resident Bump registered clinical counsellor here. Alternatively, you can find a list of additional resources at the bottom of this blog post.
Physiotherapy
Working with a registered physiotherapist who has taken additional training in the treatment of pelvic pain can be extremely beneficial for many individuals living with pelvic pain conditions. Physiotherapy techniques that can help reduce pain and improve overall function (Lamvu et al., 2021) include:
- Internal vaginal and rectal release work
- Myofascial release
- Soft tissue release
- Biofeedback
- Breathwork
- Body scans
- Yoga
- Generalized movement and gentle exercise
From a physiotherapy management lens, it’s important to find ways to downtrain or calm the nervous system to prevent the body from perceiving any kind of touch, stimulation, or movement as painful. It’s also important for physiotherapists and other medical providers to choose positive or neutral language when working with clients with chronic pain to avoid further catastrophizing and reinforcing a negative treatment outcome.
Lifestyle Modifications
Stress reduction techniques, such as mindfulness, meditation, yoga, and relaxation exercises, can also play a critical role in managing both chronic pain and mental health. Encouraging regular physical activity, a balanced diet, and adequate sleep are also essential components of a comprehensive treatment plan (Till et al., 2019).
The Value of a Holistic Approach
Understanding the connection between pelvic pain and mental well-being highlights the need for a holistic view of pain management. Those suffering from pelvic pain are encouraged to discuss their physical, emotional, and mental health openly with their healthcare providers and seek integrated treatment plans that address all of their needs. It’s important to know that each discipline and clinician might impart a different lens and treatment approach to your specific condition. Please know that what’s most valuable is that the treatment approach is best for you!
By acknowledging and addressing the psychological components of chronic pelvic pain, healthcare providers can offer more effective and compassionate care. This approach not only helps alleviate symptoms but also improves the overall well-being and quality of life for those living with pelvic pain (Till et al., 2019).
Final Thoughts
The relationship between pelvic pain and mental health is a testament to the complex, and wondrous, interplay between mind and body. Recognizing and addressing this connection is crucial for effective treatment and improved outcomes for those struggling with chronic pelvic pain.
If you are dealing with chronic pelvic pain, compassionate help is available. Please book online to seek advice/treatment from one of our experienced pelvic floor physiotherapists or to work with our registered clinical counsellor as we believe their interdisciplinary care goes hand in hand.
Bump Physio & Co is a community of health care providers dedicated to changing the way pelvic health and obstetrical services are delivered. Our two clinics locations are Port Moody and Langley BC, where we treat beyond the Bump and welcome clients from all stages and phases of life. Our team has advanced training in Pelvic Health, Orthopedics, Obstetrics, Clinical Pilates, and Active Rehabilitation.
Please follow us along on our socials @bumpphysio.co keep updated on all that is going on and for more information about how the Bump Community can help YOU!
Resources
International Pelvic Pain Society
Citations
Lamvu, G., Carrillo, J., Ouyang, C., Rapkin A. (2021). Chronic pelvic pain in women. Journal of the American Medical Association, 325(23),2381-2391.Retrieved from:
https://academy.flexwebdiensten.nl/wp-content/uploads/2023/09/Lamvu-2021.pdf
Latremoliere, A., & Woolf, C. J. (2009). Central sensitization: a generator of pain hypersensitivity by central neural plasticity. The journal of pain, 10(9), 895–926. https://doi.org/10.1016/j.jpain.2009.06.012
Retrieved from:
Central Sensitization: A Generator of Pain Hypersensitivity by Central Neural Plasticity – PMC
Renoir, T., Hasebe, K., & Gray, L. (2013). Mind and body: how the health of the body impacts on neuropsychiatry. Frontiers in pharmacology, 4, 158.
Retrieved from:
https://doi.org/10.3389/fphar.2013.00158
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3866391
Till, S. R., As-Sanie, S., & Schrepf, A. (2019). Psychology of Chronic Pelvic Pain: Prevalence, Neurobiological Vulnerabilities, and Treatment. Clinical obstetrics and gynecology, 62(1), 22–36. https://doi.org/10.1097/GRF.0000000000000412
Psychology of Chronic Pelvic Pain: Prevalence, Neurobiological Vulnerabilities, and Treatment – PMC