Pelvic Health Support

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Pelvic Pain

Pelvic Pain

Coccydynia (Tailbone Pain)
    • Pain in/around the area of the coccyx, also called the tailbone
Potential Causes
    • Childbirth
    • Repetitive Strain Injury (RSI)
    • Poor posture
    • Ageing
    • Being overweight/underweight
    • Infection/cancer (Both very rare)
    • Pain when pressure is applied to the tailbone
    • Immediate and severe pain when moving from sitting to standing position
    • Pain during bowel movements
    • Pain during sex
    • Deep ache in the region of the tailbone

Medical history

    • To find out if you’ve had any particular past/recent injury, prolonged labor or an injury while giving birth


Physical exam

    • To check for obvious fracture, deformity, mass or an abscess (infection)


Lateral X-ray/CT scan

    • To check for fracture


MRI/Bone scan

    • If deemed necessary to check for inflammation/spine tumour

Non-steroidal anti-inflammatory drugs (NSAIDs)

    • Ibuprofen/Naproxen


Therapeutic sitting cushion

    • To take the pressure off the tailbone when sitting


Pelvic physiotherapy

    • To include exercise to stretch the ligaments and strengthen the supporting muscles


Coccygeal manipulation

    • To move the coccyx back into its proper position and relieve pain


Multidisciplinary chronic pain rehabilitation program


Heat application


Massage therapy



    • Surgery to remove the coccyx
    • In severe cases only
    • Chronic condition associated with painful varicose veins in the abdomen, thighs, buttock region or genital area
    • Also known as Pelvic Venous Insufficiency (PVI)
    • Can be the source of pain in up to 30% of women who have chronic pelvic pain 
Potential Causes
    • Multiple pregnancies increase the chance as a result of pelvic structural and hormonal changes
      • Rise in estrogen levels during pregnancy can weaken the blood vessel walls 
    • Dull pain and ache that can increase:
      • When standing for a period of time
      • During/after sexual intercourse
      • In the evenings
      • Days prior to menstruation
      • In the late stages of pregnancy
    • Painful menstruation (dysmenorrhea)
    • Abnormal bleeding during menstruation
    • Backache
    • Depression
    • Fatigue
    • Varicose veins around the vulva, buttocks and legs
    • Abnormal vaginal discharge
    • Swelling of the vulva/vagina
    • Abdominal tenderness
    • Increased urination
    • Irritable bowel symptoms

Abdominal/Pelvic Ultrasound

    • Can help eliminate other common causes of chronic pelvic pain


CT/MRI scan

    • To visualize any abnormal veins within the pelvis



    • Can identify the abnormal varicose veins and the reversal of blood flow within the affected veins

Oral Medications

      • Non-steroidal anti-inflammatory drugs (NSAIDs)
      • Chronic pain medications (gabapentin, amitriptyline)


Pelvic Vein Embolization (PVE)

    • Minimally invasive surgical procedure that blocks off certain varicose veins that are believed to be the source of pain
      • Small coils/plugs are placed to block blood flow into the ovarian vein, which reduces the pressure within the enlarged pelvic veins



Pelvic Floor

    • A group of muscles in the pelvic region, supporting the organs in the pelvis
    • 1 in 3 Canadian women are affected by a condition associated with PFD


2 Types

1. Hypotonic PFD

    • Pelvic floor muscles that are too weak and do not provide enough support for the bowels, bladder and/or uterus
    • Associated Conditions: Incontinence, Pelvic Organ Prolapse


2. Hypertonic PFD:

    • Pelvic floor muscles that are too tense and unable to relax
    • Associated Conditions: Dyspareunia (painful sex), Vulvodynia, Pudendal Neuralgia, Chronic Prostatitis/CPPS
Potential Causes

Pelvic floor muscles are either too weak (hypotonic) or too tight (hypertonic) as a result of

    • Childbirth
    • Old age
    • Obesity
    • Straining
    • Traumatic injury to the pelvic region and/or tailbone
    • Nerve damage
    • Pelvic surgery

Hypotonic PFD

    • Urinary Incontinence
    • Pelvic Organ Prolapse


Hypertonic PFD

    • Constipation/straining pain with bowel movements
    • Painful sex (also known as dyspareunia)
    • Urgency/painful urination
    • Urinary frequency
    • Slow flow of urine
    • Pain/pressure in the pelvic region, genitals or rectum
    • Pelvic muscle spasms
    • Unexplained lower back pain

Medical history

    • To address past and current health issues


Physical exam

    • Pelvic muscle floor control is checked for weakness, spasms or knots


Pelvic Muscle Control Test

    • Surface electrodes (self-adhesive pads) are placed on the perineum (the area between the vagina and rectum in women and between the testicles and rectum in men) or sacrum (the triangular bone at the base of your spine)


Uroflow Test

    • To determine if the flow of urine is weak


Anorectal Manometry

    • Measures how well the rectum and anal sphincter are working by testing the pressures, muscle strength and coordination


Defecating Proctogram

    • Special video x-ray to record muscle movement as you attempt to push the thick liquid you’re given through an enema out of the rectum

Pelvic Physiotherapy

    • Internal and external assessment treated with exercise and programs that help manage pain and discomfort in the pelvic region



    • With the help of a pelvic physiotherapist, you learn how to relax/contract your pelvic muscles through video and special sensors
    • Muscle activity is observed and feedback is provided to help improve your coordination
    • Provides improvement for more than 75% of those with PFD


Relaxation Techniques

    • Yoga
    • Meditation
    • Warm baths


Oral Medication

    • Muscle relaxants to prevent your muscles from contracting


Botox Injections

    • To relax the pelvic floor muscles



    • If your PFD is the result of a rectal prolapse/rectocele
Pelvic Girdle pain (PGP)
    • Pelvic pain in pregnancy
    • Stiffness of your pelvic joints/joints moving unevenly at either the front/back of your pelvis
    • Affects up to 1 in 5 women
    • Also referred to as Symphysis Pubis Dysfunction (SPD)
    • Uneven pelvic joints can lead to the pelvic girdle becoming less stable and therefore painful
    • The extra weight and the change in the way you sit/stand puts additional strain on the pelvis


Women who are more inclined to get PGP:

    • History of lower back/pelvic girdle pain
    • Previous injury to the pelvis
    • PGP in a previous pregnancy
    • Physically demanding job
    • Overweight
    • Multiple birth pregnancy
    • Pain over the pubic bone 
    • Lower back pain
    • Pain in the area between your vagina and anus (perineum)
    • Pain spreading to your thighs
    • A clicking/grinding in the pelvic area
    • Worsened pain from movement
    • Assessment of your posture, back and hip movements by a pelvic physiotherapist to rule out other causes and determine if you have PGP

Pelvic Physiotherapy

    • To relieve/ease pain, improve muscle function and improve your pelvic joint position and stability

TENs machine

    • Delivers small electrical impulses through electrodes that have adhesive pads to attach them to the skin

Pelvic support belt

    • Can alleviate pressure by supporting the abdominal and lower back area



Exercise to strengthen your pelvic floor, stomach, back and hip muscles 

Warm baths

Ice/heat application

Deep tissue massage

    • Men and women with this condition become sexually aroused without any sexual activity/stimulation
    • Can last for hours, days or weeks at a time
    • Also called PSAS (Persistent Sexual Arousal Syndrome)
Potential Causes
    • Unknown
    • Some researchers believe it may be related to restless leg syndrome as a similar type of disorder (and should be called Restless Genital Syndrome)
    • Pinching/compressing the pudendal nerve, which helps you feel sensations around your genitals, is thought to cause PGAD
    • Anxiety, depression, bipolar 1 disorder, OCD and other similar conditions are common to exist alongside PGAD
      • It’s unclear if these conditions cause PGAD, or are caused by PGAD
    • Spontaneous and intense physiological sexual arousal
    • Genital fullness/swelling and sensitivity that can persist for hours/days
    • Symptoms do not decrease with orgasm and might require multiple orgasms over hours/days to resolve
    • The persistent genital arousal can also be triggered by a non-sexual stimuli/no apparent stimulus at all
    • Increased anxiety and distress

Medical history and medication record


Physical exam

    • Of the genital area


Testing to measure blood flow to your genitals before, during and after sexual arousal


Neurological testing

    • To determine if nerve damage may be causing the condition


Psychological assessment and testing


Pelvic physiotherapy

    • With biofeedback and combined with Mindfulness-Based Cognitive Therapy (MBCT)


Transcutaneous Electrical Nerve Stimulation (TENS)

    • Uses electrical currents to help relieve nerve pain


Oral Medications

    • Tricyclic antidepressants and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)


Botulinum toxin injections


    • Long-term pelvic pain that originates from damage/irritation of the pudendal nerve – a main nerve in the pelvis
    • Supplies areas including the:
      • Lower buttocks
      • Area between the buttocks and genitals (perineum)
      • Area around the anus and rectum
      • Vulva, labia and clitoris in women
      • Scrotum and penis in men
Potential Causes
    • Compression of the pudendal nerve by nearby muscles/tissue – sometimes called pudendal nerve entrapment or Alcock canal syndrome
    • Prolonged sitting, cycling, horseback riding or constipation (usually for months or years) – can cause repeated minor damage to the pelvic area
    • Pelvic surgery
    • Broken pelvis
    • Damage to the pudendal nerve during childbirth
    • A growth pressing on the pudendal nerve
    • Pelvic pain (any of the areas supplied by the pudendal nerve can be affected), which can feel like a burning, crushing, shooting or prickling sensation
      • Can develop gradually, suddenly or be constant
    • Numbness and pins and needles in the pelvic area
    • Increased sensitivity to pain
    • Feeling as though there’s swelling or an object in your perineum
    • Needing to go the toilet frequently or suddenly
    • Pain during sex
    • Difficulty reaching orgasm
    • Erectile dysfunction in men

Vaginal/Rectal exam

    • To see if the pain occurs when pressure is applied to the pudendal nerve


MRI scan

    • To check for problems such as a trapped pudendal nerve and to rule out other possible causes


Nerve studies

    • A small device inserted into the rectum is used to stimulate nearby nerves with mild electrical impulses to check how well the nerves are working


Nerve block injections

    • Painkilling medication is injected around the pudendal nerve to lessen/eradicate pain

Nerve pain medication

Pelvic physiotherapy

    • Learn exercises to relax your pelvic floor muscles and other muscles that can irritate the pudendal nerve


Painkilling injections

    • Local anaesthetic and steroid medication for temporary relief


Decompression surgery

    • Tissue removal (if there is any) to keep it from pressing on the pudendal nerve


Nerve stimulation

    • A small device is surgically implanted under the skin to deliver mild electrical impulses to the nerve and interrupt pain signals sent to the brain


Avoid things that make the pain worse ie: cycling, prolonged sitting

Stay regular