It's not in your head . . .

Pelvic pain is a syndrome that encompasses many points on a continuum. Each person who experiences it comes from a slightly different background of experiences and perspectives, and may have various components of the disorder.

For some, it begins suddenly, and may feel like a bladder infection that just won’t go away. For others, it begins slowly and continues to build layer by layer. First, there is some low back discomfort, then some groin pulling, then an ache that will not go away. It may feel like a burning, stabbing, or throbbing pain anywhere in the lower abdomen, perineum (where you sit), penis, testicles, vagina, bladder, rectum, or thighs. The discomfort may feel like rubbing sandpaper on raw skin, or like part of one’s body is on fire. This tends to be something one is reluctant to discuss with even the closest of companions. Symptoms tend to worsen under stressful circumstances, after sexual activity, with changes in the menstrual cycle for women, or sometimes with exercise or strenuous work. It is not unusual for standard medical testing to turn up "negative" results, so people may be left with the feeling that the discomfort is "all in their head".

Some of the medical conditions that are a part of this disorder include interstitial cystitis, endometriosis, irritable bowel syndrome, pudendal neuralgia, pelvic floor muscle spasm, back pain, sacroiliitis, and others. Many sufferers have underlying scoliosis or other abnormalities of low back and pelvic alignment, or have had remote lower extremity injuries or leg length discrepancies. Others have had multiple pelvic surgeries, radiation, or cancer treatments.

If any of these scenarios describe you, you are not alone, and help is available. You may need evaluation and treatment by more than one doctor and/or physical therapist. The problems are often multifactorial and require a combination of treatment modalities. Be your own advocate and ask for help!

Nel E. Gerig, MD