What are root causes of chronic pelvic pain and how do we heal and reconnect with our bodies?
Chronic pelvic pain affects many aspects of our lives, including daily functioning, work, exercise and sexuality. In the journey to healing chronic pelvic pain, it is helpful to identify some of the potential underlying causes and steps towards healing. Some of the root causes include excess tension in the pelvic floor, pelvic floor weakness or asymmetry, vulvodynia, poor posture and movement patterns and trauma.
Root causes of chronic pelvic pain
Excess tension or muscle imbalance in the pelvic floor can give rise to pelvic floor dysfunction and pelvic pain.
Pelvic floor dysfunction presents itself in a number of ways. Today we will address pelvic pain. However, pelvic floor dysfunction also surfaces as bladder incontinence, bowel incontinence, pelvic organ prolapse, pain with sitting and pain with sex or orgasm.
Most pelvic floor rehabilitation emphasizes the practice of Kegels. Kegels can be helpful, but not always. We must identify the root of pelvic pain before offering treatment. Many of us have a chronic pattern of holding tension in the pelvic bowl. This is often a response to stress, trauma or the fast stressful pace of our world. If we have a pattern of excess tension in the pelvic floor muscles, we must practice conscious relaxation of the pelvic floor muscles.
Pelvic floor weakness or asymmetry is frequently connected to pelvic pain or pelvic floor dysfunction.
The other side of excess tension in the pelvic bowl is pelvic weakness. Ironically, both tension and weakness in the pelvic bowl can exist at the same time. If we think of the pelvic floor as a bowl, we can then imagine that it has four quadrants. As a practitioner of Holistic Pelvic Care, when I assess the tone and balance of the pelvic floor, I notice a number of different patterns. For example, perhaps one quadrant has excellent muscle engagement, while another has no tone at all. Or perhaps all four quadrants have great muscle engagement but lack ability to relax.
Again, the standard medical recommendation is for the woman to practice Kegel exercises. If the tone in the muscles of the pelvic bowl is already imbalanced, practicing Kegels can accentuate that imbalance. If we repetitively contract and release the muscles, the stronger areas will get stronger, while the weaker areas remain unengaged, heightening the imbalance.
Vulvodynia is defined as pain in the vulva. Sometimes the pain is localized to one area. Other times it generalized throughout the vulva. Yet other times the location of the pain varies. It is often described as burning or stinging pain.
Our posture and movement patterns have a tremendous impact on how our bodies feel. These patterns are often deeply ingrained, so we need support and coaching to create new patterns of posture and movement that support alignment in our pelvic bowls that then extends out to our whole bodies.
My teacher Rosita Arvigo often says, “our issues are in our tissues”. I have worked with many women who have vulvodynia, Interstitial Cystitis, chronic pelvic pain and much more. Almost all of these women have experienced trauma. Trauma can come in so many forms, including childhood trauma from our parents, emotional abuse, neglect or sexual trauma. Though giving birth is a joyous occasion, the body can interpret the birthing process as trauma. Witnessing the #metoo movement, we have just begun to scratch the surface of how pervasive sexual trauma is in our culture.
How to heal chronic pelvic pain
In healing from pelvic pain, I recommend an approach that weaves together the suggestions below. It is best to take two or three microsteps at a time to make it easeful to integrate lifestyle changes. We do not want the healing path to add more overwhelm to the path of pain you have been living inside of, so be gentle with yourselves.
Holistic Pelvic Care™ or Women’s Health Physical Therapy
I trained in Holistic Pelvic Care™ with Tami Lynn Kent, who is a Women’s Health Physical Therapist. Our pelvic floor muscles work differently than many of the other muscles in our bodies. To strengthen our biceps we lift weights or do push ups. In our pelvic floor muscles, sometimes we need more strength, sometimes we need more balance and other times we need more relaxation. One pathway to creating the strength, balance or relaxation is to physically work on the muscles of the pelvic bowl through bodywork. Though our pelvic bowl muscles might work differently than other muscles, they are still muscles. Muscles often benefit from bodywork to relieve pain and discomfort.
Identify foods or body products that might be causing or exacerbating your pelvic pain
Food and body products are not necessarily the root cause of pelvic pain, but might irritate an already unhappy pelvis. Keep a food journal for a couple of weeks to see if you can notice patterns of increased pain with certain foods or drinks. Sometimes food allergy testing can be helpful, but keeping a food journal is more effective. I personally test negative for an allergy to gluten, but eating gluten irritates my digestion and my immunity.
Look at the ingredients of everything that goes on your body from toothpaste to laundry detergent. It is possible that chemicals from these products are irritating to you. For products you apply to your skin, choose options that have a minimal number of ingredients. Also, it is a bonus if you can eat your body products. I am not recommending that you eat your shampoo, but rather that you CAN eat your shampoo. I have a theory that we should not put anything on our bodies that we cannot put in our bodies. Our skin is our largest organ. Anything we apply to our skin penetrates into the rest of our bodies.
Create new movement and posture habits
Katie Bowman is an incredible resource for healthy movement and posture patterns. Also, if you sign up for my newsletter, you will receive a Posture Play practice video that will offer some useful tips and guidance to get you started. I also offer this support locally in my Northampton office and virtually through Skype. You can also find Women’s Health Physical Therapists all over the country who offer this support.
Gently unwind trauma
I could hardly do this topic justice in a short paragraph. Trauma is pervasive and affects so many aspects of our bodies and senses of self. Be gentle with yourself and seek out the pathways of support that feel aligned for you. EMDR, EFT, counseling, bodywork and movement are a few pathways that many find helpful. The Body Keeps Score is an excellent book that can help us to find context and understanding for how we experience ourselves, our bodies and relationships to others through the lens of the trauma we have experienced.
Please feel free to write with any questions you may have. In the relatively near future my intention is to expand this blog into an ebook to offer more support and resources around healing pelvic pain.