One reason that patients with CPP continue to experience pain is that CPP can be caused by more than just the internal organs in the pelvis. Oftentimes, the source of CPP could be due (at least in part) to musculoskeletal problems involving the muscles, joints, nerves and/or connective tissues that may have occurred in combination with internal organ issues.

The comprehensive physiotherapy approach utilised by the physiotherapists here at Anandi’s Physiotherapy is to identify the musculoskeletal causes of chronic pelvic pain (CPP), and then treat the CP using physiotherapy intervention to help improve muscle function, joint mobility, and movement patterns.

The purpose of this blog will be to explain what CPP is, why it occurs, and how physiotherapy can help manage the musculoskeletal components of CPP.

What is Chronic Pelvic Pain?

Chronic pelvic pain (CPP) is generally considered to be any type of pain that is present in the lower abdominal/pelvic region that has lasted for greater than three to six months.

 The pain may be constant or intermittent, but it is often severe enough to interfere with daily activities, work, or overall well-being.

People experiencing chronic pelvic pain may describe symptoms such as:

• A deep aching sensation in the pelvis.
• Sharp or burning pain in the lower abdomen.
• Discomfort when sitting for long periods.
• Pain during or after intercourse.
• Tailbone pain.
• Groin or inner thigh discomfort.
• Unexplained bladder or bowel discomfort.

In many cases, medical imaging such as ultrasound, CT scans, or MRI may not reveal a clear cause. This can leave patients feeling confused or discouraged, even though the pain is very real.

The Musculoskeletal Connection

A lot of different parts come together to create the pelvic area, such as musculoskeletal structures, which include bones, muscles, ligaments, tendons, and nerves. The muscles of the pelvic area work together with the other structures in the pelvic area to aid in the functioning of organs and are crucial to an individual’s ability to move freely.

When these musculoskeletal structures become dysfunctional, they may cause pain that feels like a problem with one’s internal organs. This is one reason why chronic pelvic pain may continue even when a physician examines and rules out any abnormalities by way of medical testing.

Many different musculoskeletal factors may cause pelvic pain. Here are three very common ones that are associated with chronic pelvic pain.

Pelvic Floor Muscle Dysfunction.

The pelvic floor muscles lie at the base of the pelvis and serve three primary functions. First, they provide support for the bladder and bowel. Secondly, they provide support to the sexual and reproductive organs. Finally, the pelvic floor muscles assist in maintaining good posture and facilitate movement.

• Pelvic floor muscles may become dysfunctional due to one or more of the following reasons.
• Pelvic floor muscles may be overactive or excessively tight.
• Pelvic floor muscles may be weak or uncoordinated.
• Pelvic floor muscles may develop painful trigger points.

If the pelvic floor muscles continue to be tight and/or unable to relax, this may result in the presence of several symptoms. For example, an individual with pelvic floor muscle dysfunction may experience pain while sitting, during sexual intimacy, with urinary urgency, or a sensation of pressure or heaviness in the pelvic area.

Therefore, effective management of chronic pelvic pain would include addressing pelvic floor muscle dysfunction through appropriate treatment.

Sacroiliac Joint Dysfunction

The sacroiliac (SI) joints are where your spine connects to your hips and are designed to appropriately transfer your weight from your upper body to your legs while still allowing for stable motion. Just a small change in how the SI joint moves or sits can cause pain that may radiate outwards to other nearby joint areas, such as:

• The lower abdominal region.
• The groin.
• The buttocks.
• The hip region.
• The pelvic region.

This pain can often feel very deep in your pelvis and may lead to confusion about whether it originates from a gynaecological or urological issue.

Myofascial Trigger Points

The muscles around your pelvis can develop trigger points or “tight spots” within the muscle’s tissue. Trigger points can refer pain to distant sites on the body.

The muscles most commonly involved with developing trigger points are:

• Obturator internus.
• Iliopsoas.
• Piriformis.
• Adductor muscles.
• Lower abdominal muscles.

In addition, trigger points that develop within these muscles can create pain that radiates into the pelvis, bladder area, and/or perineum, producing feelings of deep internal discomfort.

Nerve Sensitization

Chronic pain can affect the nerves of your pelvis as well. Over time, nerve tissue in the pelvis may experience greater sensitivity than normal. Specific nerves involved with this process may include:

Pudendal nerve.

Ilioinguinal nerve.

Genitofemoral nerve.

When these nerves become irritated or sensitised, people may experience symptoms such as burning, stabbing, or electric-like pain sensations.

Why Tests and Medications May Not Solve the Problem?

Many patients with Chronic Pelvic Pain undergo various medical tests. These tests are important for ruling out serious medical conditions. However, they mainly focus on organs and structural abnormalities.

Muscle tension, movement dysfunction, and fascial tightness may not appear on imaging tests. As a result, patients may be told that everything appears normal, even though they continue to experience discomfort.

Medications may help reduce pain temporarily, but they often do not address the underlying musculoskeletal causes of the problem.

This is where physiotherapy can play an important role.

How Physiotherapy Helps Treat Chronic Pelvic Pain?

At Anandi’s Physiotherapy, treatment focuses on identifying the physical factors contributing to Chronic Pelvic Pain and addressing them through targeted rehabilitation.

Detailed Musculoskeletal Assessment

The first step is a comprehensive assessment. This may include evaluating:

• Pelvic alignment.
• Hip and lower back mobility.
• Muscle strength and flexibility.
• Trigger points in the surrounding muscles.
• Movement patterns and posture.

This helps determine whether the pain is related to musculoskeletal dysfunction.

Pelvic Floor Physiotherapy

When appropriate, physiotherapy may include techniques aimed at improving pelvic floor function.

Treatment may involve:

• Relaxation techniques for tight muscles.
• Breathing exercises to improve coordination.
• Exercises that help restore proper muscle control.

These approaches are helpful when pelvic floor tension contributes to pain.

Manual Therapy and Myofascial Release

Hands-on techniques can help release tight muscles and improve tissue mobility. These treatments may:

• Reduce muscle tension.
• Improve circulation.
• Decrease trigger point sensitivity.
• Improve movement of the pelvis and hips.

Manual therapy is often combined with exercises for long-term improvement.

Core and Pelvic Stability Training

The muscles in the stomach and hips provide a layer of support, but when they are not strong enough or do not work well together, this can increase pressure put on the organs located within your pelvis.

Your physiotherapy treatment session will often include exercises designed to improve strength within all of the deep abdominal and hip muscles. This will create better stability, therefore relieving some of the pressure placed on the pelvic region.

Sensitivity of the nervous system

When an individual experiences persistent or chronic pain, the nervous system often becomes very sensitive to stimuli. The aims of physiotherapy include retraining the nervous system by gradually moving in specific patterns of movement, educating the patient, and teaching pacing strategies.

Using these techniques, an individual will begin to develop confidence in their movement and experience decreased sensitivity to painful stimuli within their pelvis.

Individuals who are suffering from chronic pelvic pain may benefit from physiotherapy, particularly if they:

– Have experienced ongoing pelvic pain and had normal medical tests performed.

– Have pain when sitting in their pelvic area.

– Have experienced pain in the tailbone, hips, or groin area.

– Have experienced discomfort in the bladder or bowel with no apparent cause.

– Have pain in their pelvis after having a baby or undergoing an abdominal surgical procedure.

An appropriate assessment performed by a qualified physiotherapist will reveal any musculoskeletal problems that you may have that could contribute to your pain.

Conclusion

Chronic Pelvic Pain can be complex and challenging, but it is not always caused by internal organ problems alone. In many cases, dysfunction in muscles, joints, and nerves within the pelvic region contributes to ongoing pain.

By addressing these musculoskeletal factors, physiotherapy offers an effective and evidence-based approach to managing chronic pelvic pain.

At Anandi’s Physiotherapy, the focus is on understanding each patient’s condition through detailed assessment and providing targeted treatment to improve movement, reduce pain, and enhance quality of life.

With the right guidance and rehabilitation plan, many individuals experiencing chronic pelvic pain can regain comfort, mobility, and confidence in their daily activities.