How painful is too painful when it comes to pelvic pain?
During menstruation, low to moderate pelvic pain is common. However, when it becomes severe over time, your Aunt Flow turns into a chronic medical problem. And, while it sometimes feels more comforting to dig your head in the sand and write off pain as a normal symptom, there are certain red flags you should look out for.
For instance, there are more serious conditions that involve severe pelvic pain, like endometriosis, adenomyosis, interstitial cystitis, recurring urinary tract infections, pelvic inflammatory disease and irritable bowel syndrome, among others, according to WedMD.
While treatments for pelvic pain can often involve prescription medication, hormonal treatments, antibiotics, and antidepressants, for some patients physical therapy is the answer.
“Unfortunately, what motivates women to seek physical therapy for pelvic pain is ongoing pain that nobody is listening to,” explains licensed physical therapist and pelvic pain expert Dr. Sallie Sarrel. “If a doctor says go home and do a kegel, all you’re doing is strengthening a muscle spasm and just causing more pain. I do internal physical therapy both to strengthen and lengthen the muscles inside of a woman.”
Her job often acts like a gatekeeper, helping patients access treatments and validating their ignored pain. Sarrel works to minimize the root pain as well as the side effects that can come with it, like painful sex, bowel dysfunction, urinary pain and back pain. She considers her care to be multidisciplinary that “isn’t just about diet or just about surgery.”
According to the Atlantic, women’s pain is often invalidated and dismissed by doctors and other healthcare professionals. For instance, a University of Oxford study reports a significant delay in endometriosis diagonsis (of up to a 12 years), which could speak to the gender-based discrimination female patients face when pursuing healthcare.
“Pain that persists longer than six weeks can be a signal something is wrong,” she explains. “Six months of pelvic pain is too long to wait because, by then, there is already cortical changes in the cortical sections of the brain.”
Some common red flags include pain during sexual intercourse and menstrual cramping that is so painful that interferes with everyday life.
“A physical therapist will work on you one-on-one for an hour, who will primarily listen to you,” she elaborates. “As physicians, we are committed to treating and healing patients.”
Additionally, patients are also motivated to seek physical therapy if they are either preparing or recovering from a pelvic surgery, like the removal of their uterus.
“If you’ve had extensive surgery, this particular technique helps the body re-sense how the organs should work versus being in pain all the time,” she adds.
According to the American Physical Therapists Association, any patient in the United States, regardless of state, can see a physical therapist without a referral from a primary care provider. However, restrictions on how physical therapists can pursue treatment plans for their patients varies from state to state. For instance, in Dr. Sarrel’s practices in New York and New Jersey, patients can visit a physical therapy without a referral from a primary care provider up to a certain amount of visits.
If physical therapy doesn’t help, there’s also laparoscopic surgery and hysterectomy as well as structured pain rehabilitation programs. Otherwise, not many other options are available, unfortunately.
Oftentimes, patients wait too long to pursue physical therapy to treat their severe pelvic pain. But it’s not always these patients’ fault. As Dr. Sarrel emphasized, many doctors dismiss and invalidate female pain, which leads to misdiagnosis and serious conditions left untreated.
“No woman or girl should miss out on schooling, career, social engagements or motherhood because of pelvic pain and painful periods,” Sarrel adds.