Chronic Pelvic Pain

There is, or was an injury (pathology) at the place (site of origin) where the pain first started. This injury might be endometriosis, ovarian cysts, pain from the bowel, bladder infection, or adhesions (scar tissue from surgery). The pathology may also be an injury to a nerve in the abdominal wall, pelvis or pelvic floor, or genital area.

What about Male Pelvic Pain?

Guys suffer similar pain issues but have the pains in different anatomy. The male does not worry about endometriosis and/or female organ issues. However, his pain can be extremely severe. Pain in the perineum (between the anus and scro­tal sac) is often confused with a prostate infection. Pain in the urethra or bladder may be erroneously treated as a bladder infection or sexually transmitted disease. Testicular pain may be treated as epididymitis. Some men have had varicose vein surgeries or even removal of the testicle without pain relief. Often these men are found to have abnormalities of the pelvic nerves, called the pudendal nerves. This type of nerve pain can affect women as well. Typically those with pudendal neu­ropathy were active in high school sports and later were very active exercisers. At sometime, a fall onto the tailbone/buttocks caused their pains. Another “at risk” group are accountants, computer programmers, etc., who sit at their jobs for years. For women, pregnancy and childbirth or pelvic surgeries can be the cause.

Your brain influences your emotions and behavior. It also interacts with your spinal cord and affects how you perceive the visceral and referred pain. For instance, if you are depressed, your brain will allow more pain signals to cross the gates of the spinal cord to the brain. Certain regions of the brain are also “off-line” when you have chronic pain and may not be functioning effec­tively to inhibit pain signals. Sometimes the nervous system is overwhelmed by pain signals and there may be excessive sweating, nausea or loss of appetite, fatigue, and other problems.

It is important to remember that all of these levels of pain must be treated togeth­er (“multidisciplinary therapy”) for CPP therapy to be successful. Treatment of CPP can include psychological counseling, physical therapy, medications, nerve blocks, and surgery.

Several peripheral nerves surround the abdomen and the pelvis. These can be irritatedor compressed individually in any one person, or there can be combina­tions of painful nerves that confuse both the patient and his/her doctors. The most commonly affected are the abdominal cutaneous nerves and the pudendal nerve although other nerves can be affected as well.

Abdominal cutaneous neuropathy is usually due to nerve injury. Ilioinguinal and iliohypogastric nerves can be injured during abdominal surgery or with exercise, heavy lifting, or an accident.

Pudendal Neuropathy:

There is a pudendal nerve on each side of the pelvis. It travels a twisting pathway after it forms from nerve fiber from sacral cord lev­els. Pressure may occur between two ligaments that French physi­cians’ call the clamp or lobster claw.

Pressure can be caused by coverings over the obturator internus muscle. The muscle is important in all hip rotations such as jogging, skating, yoga, etc. Only after a fall is the pain’s onset immediate. Usually, the onset is slow and not recognized early (often referred to as repetitive microtrauma). Because the nerve can affect blad­der, bowel, and/or sexual function it is called the “social nerve.” Bladder irritation and vulvar pain are common. Painful intercourse/orgasm/ejacu­lation can occur in many bizarre combinations. This is why patient and doctor may be confused in the diagnosis.

Your body has two types of nerves: (1.) Visceral nerves carry impulses from the organs and structures within your abdomen and chest (stomach, intestines, lungs, heart, etc.); and (2.) Somatic nerves bring messages from the skin and muscles.

Myofascial pain can be the primary source of pain, unrelated to organ pathology or a secondary source of pain due to a re­flex response (visceral-muscular reflex). Often trigger points develop in the affected muscles. Trigger points are specific areas of tenderness occurring in the muscle wall of the ab­domen. Trigger points may start out as just one symptom of your pelvic pain or they may be the major source of pain for you. For this reason, treating the trigger points may signifi­cantly reduce the pain. For others, the original source of injury as well as the trigger points must be treated. Nerves in the pelvis, such as the pudendal nerves, can also stimulate the pelvic muscles and cause myofascial pain.