This
is Part 2 in a three part series on finding relief from pelvic pain through
physical therapy, yoga, and other complementary therapies. Click here to read Part 1, which covers how to recognize pelvic pain. Click here to read Part 3, which details yoga poses that can can offer relief.
Question from Kate, a mother of two boys, ages 5 and 7:
“I
have pelvic pain due to a non-relaxing pelvic floor. I cannot even sit
down without pain. I am already doing pelvic physical therapy and have had
multiple therapies (see below). What can yoga do to help me find relief?”
What can you do to find relief from pelvic pain?
Start by talking with your health care team. This could an ob/gyn, midwife, or nurse practitioner, women’s
health physical therapist, behavioral psychologist, naturopath, rheumatologist,
or internist.
First: Ask your team
member(s) for a referral to a women’s health PT. In all states, you have direct
access to a PT as a specialist, but your insurance company may limit your
benefits and require a referral, even though it is not legally necessary.
Second: Consider the
benefits of combining the best of conventional and integrative medicine. Yoga
prescribed by a health care provider (medical therapeutic yoga) includes
breathing, relaxation, meditation, and mindful movement that work to relax the
pelvic floor and retrain muscle groups in the pelvic area to improve neural
patterning, motor control, and psychoemotional well-being.
Here are some questions to ask your health care provider, as well as considerations to help you manage your pelvic pain:
1. Ask about the potential benefits of prolotherapy for facilitating joint
stability and reducing pain.
2. Ask your therapist
about therapy for the obturator internus, often implicated in pelvic pain.
3. Ask about neuromuscular
re-education for the hip rotators and pelvic floor.
4. Ask about the benefits
of getting a CRP (C-Reactive Protein) test, which identifies systemic
inflammation, a possible contributor to chronic pelvic pain.
5. Ask for a salivary
diurnal cortisol test, which can identify presence of HPA Axis Dysregulation, a
very important consideration when treating pelvic pain and women’s health in
general. Dysregulation is directly related to pain, fatigue, and other chronic
disease processes.
6. Begin a mediation
practice. Meditation is well-supported in the literature to regulate the HPA
Axis and improve neuroendocrine function.
7. Learn about your pelvic
floor. A PT can teach you how to identify weaknesses or hyperactivity in
different areas of the pelvic floor, and also teach you how to address the
problem(s).
8. Don’t overexercise.
Pelvic pain has many causes, but in women who seem relatively “fit,” sometimes
the cause of pain can be traced back to overtraining or training the wrong
muscle groups. A PT can help design an exercise program that fits your needs as
a woman.
9. Consider that loss of
range of motion or mobility in a seemingly unrelated joint, such as the spine
or knee or hip, could actually be contributing to pelvic pain. A PT can
evaluate this possibility and determine whether or not another joint is
contributing to, or is being affected by, your pelvic pain.
10. Evaluate your lifestyle
and personality. Are you a “go-getter” or have a “type A” personality? Are you
a mom who works, cares for children, and otherwise tries to do everything just
right? Are your rigid in your scheduling, exercise regimen, or on the other
hand, are you a mom that never received postpartum physical therapy? If so,
these are all reasons that could contribute to pelvic pain.
11. Consider Ayurvedic
medicine. Ayurvedic medicine can be another viable option for treatment, but
only in conjunction with your current therapies; and with discussion and
approval of your physical therapist or physician.
Finally,
learn why all new mothers should be receiving pelvic floor physical
therapy after childbirth. Postpartum PT is the norm after childbirth in Europe, but in
the US no mother receives routine PT after giving birth. This is why, even 20
years after giving birth, a mother can still be considered “postpartum” if the
problems she is having are pregnancy and birth related.
In Part 3, we will discuss different yoga techniques and poses that can offer relief from pelvic pain.
