Pelvic pain encompasses several conditions that cause pain throughout the pelvis and can also cause difficulty with bladder frequency and urgency, bowel (constipation) and sexual function.

Pain, pressure or ache can be felt in the tailbone, rectum, or pelvic (testicular and penal pain). The symptoms may be intensified by prolonged sitting, sexual activity, defecation and constipation. The pain can refer or travel to the legs, tailbone or buttocks. Severe sharp burning or aching during urination may also occur. This can be caused by unusual tension in the levator ani or pelvic floor muscles.

Pain can be arising from the prostate gland (chronic prostatitis/chronic pelvic pain CP/CPP).

Many studies have shown that men with chronic pelvic pain have very little inflammation (as measured by white blood cells, or pus cells, in their prostatic fluid).

It is estimated that pelvic floor muscle spasm may be the main cause of symptoms in the majority of chronic pelvis pain/chronic prostatitis patients. It is recommended that everyone with CP/CPP should have a pelvic floor examination, as part of a complete urological work-up by physiotherapist specialist in trigger point/myofascial evaluation.

Physiotherapy treatment is focused on the pelvic floor muscles, teaching you to be able to identify them, how to tighten them and, therefore, how to relax them and reduce the tension in them. It is the ability to relax the pelvic floor muscles that provides the key to breaking the pain → muscle spasm → pain cycle.

This muscle spasm is similar to spasm and tension people often get in the neck and shoulder muscles, but in that case, you are often aware of the tension, you can feel your muscles tightening and see the effect as your shoulders rise up towards your ears. You can then use techniques to reduce the tension, such as massage, exercises, relaxation techniques, or just remind yourself to let go of the muscles. However with the pelvic floor muscles, we are often unaware that they exist, let alone aware that they might be in spasm or particularly tight. If we are unaware of the muscles, then we are unlikely to be able to relax them or reduce the tension in them.

Computerized biofeedback is a very useful tool in teaching pelvic floor awareness and relaxation. Through the use of carefully placed electrodes or internal electrodes, you are able to see on the computer screen the activity of your pelvic floor muscles. Being able to see when the muscles are contracting and when they are relaxed, teaches you how to control muscles that you have previously been unaware of.

Muscles that have been in spasm for a long period of time will often become shortened and tight (hypertonicity). Manual therapy or ‘ hands-on’ techniques including internal and external triggerpoint therapy (releasing muscle knots) can be used to treat the painful muscles and gradually stretch the muscles and tissues to improve their flexibility. Work might then be done to strengthen them. This might involve the muscles of the pelvic floor, hips, buttocks, back or abdominals.

If an internal examination is too painful, the connective tissue of your abdomen, thighs, groins and lower back are often very tight. The connective tissue forms the container of the muscles and this tissue often needs to be relaxed before any internal work can be done.

Throughout treatment you are given support and encouragement, as self-care is an important part of the treatment. Avoid straining and pushing during toilet visits, you begin a home exercise program with breathing exercises, and learn techniques to take control of your symptoms.

Persistent pain education is an important part of treating pelvic floor dysfunction since the pelvic area is an area that we often hold our stress. Psychosocial factors such as anxiety, stress and our thoughts, attitudes and beliefs can perpetuate the pain in our pelvis, understanding how our pain works has shown to be an effective way of reducing the threat of ongoing pelvic pain.

Chronic constipation is frequently a cause of damage to the pelvic floor muscles and fascial support (ligaments).  Chronic constipation can cause stretching of the pudendal nerve due to prolonged and repetitive straining (leading to pelvic floor weakness secondary to nerve damage).

Constipation also creates more pressure on the bladder and urethra, which may cause increased urinary frequency or retention.

When you are constipated, general recommendations on diet (fluid and fibre intake), toilet habits and positions, breathing/pelvic floor relaxation exercises and bowel mobility exercises such as the abdominal massage, all need to be considered.

Your ability to consciously relax your pelvic floor muscles is a critical part of your recovery program.  You must learn to relax these muscles before they can become functional again.  The feeling of dropping your pelvic floor is similar to the moment of relief when you have reached the bathroom. When you urinate or have a bowel movement, you first drop your pelvic floor and let the pelvic floor muscles (PFM) go.  Pay attention to this and see if you can feel that happening. The key to dropping your pelvic floor is visualization and deep breathing.  The best way to consciously release tension from the PFM’s is to try to release the muscles while you inhale.

When you relax your pelvic floor muscles, it should also feel like you are creating more space between the pubic bone and tailbone.  Don’t make it happen, visualize and let it happen!

Eventually, once we have taught you ’the art ‘of relaxing your pelvic floor muscles, you will need to check in with your pelvic floor throughout the day, and let go of any tension that you discover. Together with correct defecation posture and techniques we will work up to an easier bowel emptying, without straining.

When you are constipated, general recommendations , diet (fluid and fibre intake), toilet habits and positions, and breathing /pelvic floor relaxation exercises and bowel mobility exercises such as the abdominal massage all need to be considered.

Your ability to consciously relax your pelvic floor muscles is a critical part of your recovery program.  You must learn to relax these muscles before they can become functional again.   The feeling of dropping your pelvic floor is similar to the moment of relief when you have reached the bathroom; when you urinate or have a bowel movement, you first drop your pelvic floor, and let the pelvic floor muscles (PFM) go.  Pay attention to this, and see if you can feel that happening. The key to dropping your pelvic floor is visulasation, and deep breathing.  The best way to consciously release tension from the PFM’s is to try to release the muscles while you inhale.

When you relax your pelvic floor muscles,  it should also feel like you are creating more space between the pubic bone and tailbone.  Don’t make it happen, visualize and let it happen!

Eventually, once we have taught you ’the art ‘of relaxing your pelvic floor muscles, you will need to check in with your pelvic floor throughout the day, and let go of any tension that you discover. Together with correct defecation posture and techniques we will work up to a easier bowel emptying with no straining.