Pelvic Pain Treatments

The treatment of pelvic pain depends on what is causing it, the intensity of the pain, and how often it occurs.

How is Pelvic Pain Treated?

Some cases of pelvic pain, including pain caused by endometriosis, male chronic pelvic pain, and interstitial cystitis/painful bladder syndrome, can be treated with pelvic floor physical therapy. This treatment is conducted by physical therapists (PT) who are trained to treat the pelvic muscles. They use a technique called myofascial release to stretch out the muscles. A person lies flat as the physical therapist works on the body to manually release the tightness and restricted movement of the connective tissue and muscles of the vagina or rectum, abdomen, hips, thighs, and lower back.

Pelvic floor physical therapy is generally performed an hour a week for at least 12 weeks. Patients are also given stretching exercises to do at home. The American Physical Therapy Association’s Section on Women’s Health has a physical therapy locator on its website where you can look up PTs who specialize in pelvic pain.

Medications may be used for pelvic pain including gabapentin (Neurontin, Gralise); pregabalin (Lyrica); amitriptyline, nortriptyline (Pamelor); muscle relaxants; two classes of antidepressant drugs: selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs); topical medications including estrogen, testostoerone, baclofen and gabapentin; duloxetine (Cymbalta); and rectal/vaginal valium suppositories.

For endometriosis pain, the first-line therapy is nonsteroidal anti-inflammatory drugs (NSAIDs). These medications work best when used one to two days before the beginning of a woman’s  period.

Other treatment options include hormonal therapies, such as combined hormonal contraceptives that contain both estrogen and progesterone (available in pill, patch, and vaginal ring form); progestin medications (available as a pill, injection, or intrauterine device (IUD); or gonadotropin-releasing hormone agonists (GnRH agonists), which can be taken in a nasal spray or as an intramuscular injection.

Some women with severe endometriosis and/or infertility caused by the disease may need surgery to remove the uterus and ovaries (hysterectomy). In many cases, endometriosis surgery can be performed with a minimally invasive surgical approach using laparoscopic incisions. Surgery also may be used to treat uterine fibroids and adhesions.

Treatment for vulvodynia includes topical medications such as lidocaine ointment or hormonal creams; medications such as pain relievers, antidepressants, or anticonvulsants; biofeedback to help decrease pain sensation; physical therapy to relax pelvic floor muscles; injections of steroids or anesthetics for pelvic floor muscles; and surgery to remove the affected skin and tissue in localized vulvodynia. (Visit the National Vulvodynia Assocation for more information, resources and patient stories.)

There are many treatments for interstitial cystitis. These include stretching the bladder to capacity by filling it with liquid or gas (called bladder distention), and placing medications directly into the bladder. Oral drugs include pentosanpolysulfate sodium (Elmiron); as well as pain-relieving drugs such as aspirin and ibuprofen. Some people are helped by taking tricyclic antidepressants such as amitriptyline (Elavil) or antihistamines.

Another treatment for interstitial cystitis is electrical nerve stimulation, in which mild electrical impulses are used to stimulate the nerves to the bladder, either through the skin or with an implanted device.

Treatment for pudenal neuralgia may include:

  • Pelvic floor physical therapy that includes myofascial release, which focuses on releasing muscular shortness and tightness.
  • Injection of a steroid and an anesthetic agent to reduce pain in the pudendal nerve, similar to the diagnostic nerve block.
  • Lifestyle changes, such as avoiding sitting, bending and bicycling.
  • Medication with drugs that treat nerve pain; muscle relaxants and antidepressants, as well as topical medications.

In addition to medical treatments for pelvic pain-related conditions, patients can be helped with counseling to help them cope with the pain. Patients also may benefit from acupuncture, meditation, relaxation training, or biofeedback if their intimate relationships have been affected by pelvic pain.

Updated on: 07/17/17
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