Many patients try to endure the pain in the pelvis (Pelvic Pain) because they think it is only ordinary lower abdominal pain, or think it is only menstrual pain that will go away by itself. But in fact the area of our pelvis is the meeting point of several systems in the body
Pain in the area of the pelvis (Pelvic Pain) means pain or soreness in the area of the lower abdomen below the navel, including the area of the pubis, around the hips, and the perineum. There are both the form of acute pain (Acute Pelvic Pain) and chronic pain (Chronic Pelvic Pain) lasting longer than 6 months, which greatly affects daily living
When a patient comes for examination, the doctor's main duty is "distinguishing which system the patient's pain really comes from" from taking the history and examining the body in detail, so that we can plan the treatment correctly, because the organs in the pelvis lie very close together, so that sometimes the pain can overlap. Mainly it is divided into 3 large systems, namely
1. The reproductive system (Gynecological Causes)
Menstrual pain (Dysmenorrhea), endometrium growing in the wrong place (Endometriosis), uterine fibroids (Uterine Fibroids), or a state of pelvic inflammation (Pelvic Inflammatory Disease - PID)
2. The muscular and skeletal system (Musculoskeletal Causes)
· A state of the muscles of the pelvic floor being in spasm (Pelvic Floor Dysfunction): the muscles that support the organs in the pelvis are too tight or are not coordinated
· The sacroiliac joint or the hip joint inflamed (Sacroiliac Joint Dysfunction): resulting in pain radiating to the pelvis and the lower back
· A state of inflamed muscles (Myofascial pain syndrome), such as having inflammation in the area of the group of muscles that squeeze the hips (Adductors), which causes pain in the area of the groin; or pain in the muscles of the abdomen, the back, and the buttocks themselves can also radiate to the area of the front of the groin in the same way
3. The digestive and urinary systems (Gastrointestinal & Urinary Causes)
· Irritable bowel syndrome (IBS): with symptoms of bloating, constipation, or diarrhoea, together with lower abdominal pain
· Chronic inflammation of the bladder (Interstitial Cystitis): with pelvic pain together with frequent or burning and difficult urination
The approach to treatment in physiotherapy (if it comes from the muscular system)
If on examination and assessment it is found that the patient's pain comes from the muscular and skeletal system, in rehabilitation medicine and physiotherapy there are a great many methods that can help treat it, divided into:
1. Training in exercise and adjusting behaviour by yourself
- Training correct breathing: because in fact breathing in the correct way has a direct effect on the muscles of the pelvic floor, helping reduce the pressure and relax those muscles very well
- Stretching and training the muscles at particular points: the emphasis is on stretching the parts of the muscle that are tight, particularly training the relaxation of the muscles of the pelvic floor (Pelvic Floor Relaxation) and building up the strength around the muscles of the hip and the central axis of the trunk, as well as training the squeezing of the genital area in order to increase strength (Pelvic Floor Muscle Strengthening) in the correct way
- Adjusting posture (Correct Posture): the sitting posture, the standing posture, and correct weight-bearing also have a part in helping reduce the impact and the held contraction of the muscles of the pelvic floor
· Soaking in warm water (Warm Bath): sitting and soaking in warm water (Sit bath) often has a great part in helping reduce the tightness, helping relax the held contraction of the muscles of the pelvic floor, and increasing the circulation of blood in the area of the lower abdomen
2. Other physiotherapy by a physiotherapist
· Treatment with Manual Therapy: the use of techniques of massaging, moving, and stretching by an expert, in order to help stretch and relax the connective tissue as well as the muscles of the pelvic floor that are tight and pulling, in order to reduce the pain and adjust the movement of the joints all around so that they come back into balance
That said, we can use physiotherapy instruments as well, such as:
- Using the PMS machine (Peripheral Magnetic Stimulation): using electromagnetic waves to stimulate the peripheral nerves and the muscles, which helps relieve deep pain well
- ESWT (Extracorporeal Shock Wave Therapy): a treatment that releases high-energy shock waves through the skin, in order to release the tight points of muscle that are the cause of the pain, as well as increasing the circulation of blood to the organs around the pelvis
3. Treatment at particular points
- Needling to treat particular points (Dry Needling): if a tender point or an embedded point in the muscle (Trigger Point) is found that is the agent sending radiating pain to the groin from other parts, that particular point can be treated for the patient with Western needling (Western dry needling), in order to release that point
Therefore, the advice is that if pain or soreness begins, it is best to come and see a doctor in order to check and distinguish the disease clearly. There is no need to worry or feel shy. The patient telling us their symptoms in detail will help us plan treatment that is on target and as effective as possible.