Welcome back! In part 1 of this blog we discussed how pelvic pain can affect anyone, regardless of their age or gender. We also discussed that pelvic pain can feel many different ways and may occur in different body locations and be triggered by different activities. Now that we have the basics under our belt, we can march forward and start to explore different ways to manage and treat pelvic pain. First steps Now that you have a name for what you are experiencing, it is important to get a handle on the various characteristics of the pain you are experiencing. This information will provide valuable insights to the clinicians who are treating you. Some questions to think about include:

• How long has this pain been going on?
  • Chronic pelvic pain is classified as pain that has gone on for 3 or more months, this type of pain likely has musculoskeletal involvement and will likely require the help of a pelvic floor physical therapist in addition to medical intervention
  • Also try and think if there were any significant events around the time of your symptoms onset; these events may be physical like spraining an ankle or emotional, like moving or starting a new job
• What makes it worse and what makes it better?
  • Sometimes you won’t know and that's ok too.
• Where is the pain?
• What does the pain feel like?
  • Describing the character of pain can be really tricky. Here are some words we hear a lot
    • Burning
    • Itching
    • Stabbing
    • Buzzingwork
    • Aching
    • Gnawing
    • Sharp, Shooting
    • Dull
    • Tingling/numbness

Now that you have this information, it’s time to make an appointment with a doctor, who ideally has experience in treating pelvic pain. Your doctor will work to determine if there are any immediate medical concerns that require treatment. It is important to be patient when starting this step. Usually it is not immediately clear on exactly what is causing your pain, especially if it has been going on for some time. Usually chronic pelvic pain is caused by more than one system (i.e it could be a bit digestive and also a bit musculoskeletal). That is why your first visit with a clinician is typically just a jumping off point. Next Steps After your initial appointment you may have a referral in hand to see a specialist. Specialities that treat pelvic pain include:

• Colorectal
• Gastroenterology
• Gynecology
• Physical therapy
• Physiatry
• Psychiatry
• Psychology
• Neurology
• Urology
• Urogynecology

It is important to visit a clinician who specializes in pelvic pain, considering it is a very specialized topic, and unless a clinician has an interest in it, their exposure to pelvic pain may be limited. The next two pieces of advice I am about to give may seem mutually exclusive, but hear me out. Trust your gut, but also be patient with the process. For chronic pelvic pain, it takes some time to see improvement. Think about it, you’ve had this pain for a very long time, it will take a while to improve. In physical therapy, we expect our patients to see some improvement in 4-6 weeks, and similar timeframes can be expected for other types of interventions. That said, if you feel like the clinician you are seeing is dismissing you or not taking your complaints seriously, that is important. A colleague of mine, who I adore, tells her patients “who knows your body better than you?”. The answer is no one. If you think something is wrong, it is your right to be taken seriously. First Steps in Treatment There are steps you can take to start addressing your pain almost immediately. I discuss some of them in this blog. Getting a handle on your stress is really important when dealing with chronic pelvic pain ( I am currently writing this during a global pandemic, so I do recognize this is much easier said than done). This is important because chronic stress can cause the pelvic floor to tighten which can exacerbate pain issues. It is important also to recognize that despite anxiety and stress being strong contributors, pelvic pain is not in your head and your symptoms are real. It also may be worth your while to experiment with gentle heat or cold. A warm bath or hot pack or cold pack can be helpful. Just make sure to put plenty of layers between you and the cold/ hot pack. Professional Interventions Address your muscles. Yes, we are a PT clinic and we will always say muscles are important, but the truth is, with chronic pelvic pain, muscles spasm/tightness is involved in most cases of pain. For those of us on lockdown, physical therapy is still accessible and considered essential. Beyond Basics offers both in person and telehealth appointments to guide you on your way. A trained pelvic floor physical therapist can help to teach you exercises to do on your own to manage pain, release muscle tightness, and correct poor postures and overuse patterns that may have contributed to your pain in the first place. Depending on your diagnosis you may see other medical specialities who will prescribe medicine, injections, or surgery in some cases, like endometriosis. You may also be referred to a nutritionist, acupuncturist, or mental health therapist as well. Like I mentioned earlier, typically pelvic pain can have many different contributing factors so it is really important to have a team and to make sure your team is communicating well together. Although pelvic pain can be massively disruptive and upsetting, that fact is people can get better. Have hope, trust your gut, and reach out if you need us. Beyond Basics Physical Therapy 212-354-2622 How to find a physician familiar with pelvic pain: International Pelvic Pain Society, Interstitial Cystitis Association Bonder J, Chi M, Rispoli L. Myofascial pelvic pain disorders. Phys Med Rehabil Clin N Am . 2017 28(3), 501-15 Speer L, Mushkbar S, Erbele T. Chronic pain in women. Am Fam Physician. 2016 1;93(5):380-7 Van der Velde J, Laan E, Everaerd W. Vaginismus, a component of a general defensive reaction. An investigation of pelvic floor muscle activity during exposure to emotion- inducing film excerpts in women with and without vaginismus. Int Urogynecol J Pelvic Floor Dysfunct. 2001; 12 (5) 328-31