Did you know that May is Pelvic Pain Awareness Month? As someone who has suffered from pelvic pain in the past, I am very passionate about raising awareness about this often debilitating condition that many women and men experience, but are hesitant to discuss. Pelvic pain can have significant consequences on an individual’s physical, mental and social well-being and I am honoured to work as a pelvic health physiotherapist to help people learn about the causes of their pelvic pain and work with them to improve their overall health.

So, you might be wondering “what exactly is pelvic pain and what causes it”? Pelvic pain can be caused by several different systems in the body but there are seven main categories: gynaecological, gastroenterological, musculoskeletal, urological, neurological, vascular and psychological and to make things more complicated, there is often overlap. The pelvic pain experience varies for each individual patient, however, the following are some common symptoms:

1. Pain that is located in the lower abdomen, pelvis, lower back, buttocks and/or genitals
2. Pain that is described as sharp, dull, shooting or widespread
3. Pain that occurs cyclically, during urination and/or defecation, with vaginal/rectal penetration and during/post exercise.

Each individual’s journey to overcome pelvic pain will look different depending on the nature of their condition and their goals for treatment but the following tips can be helpful for anyone suffering from pelvic pain.

Tip 1: Breathe with your Diaphragm!

Diaphragmatic breathing is a form of deep breathing in which the diaphragm contracts on inhalation and relaxes on exhalation. This type of breathing stimulates the vagus nerve which activates the relaxation response of the parasympathetic (our rest and digest) nervous system. Performing this technique for 5 minutes, 1-2 times a day can help your abdominal and pelvic muscles relax and help to decrease overall tension, stress and anxiety in your body.

Instructions:

1. Imagine a tube passing from your mouth or nose, through your chest and ending in a balloon that sits above your belly button.

2. When you inhale, the air passes through the tube, and fills the balloon, causing your abdomen and the side walls of your chest to press out. Your neck and shoulders should not move.
3. When you exhale, the air leaves the balloon, and your abdomen and the side walls of your

chest retract.

Tip 2: Perform Stretches To Loosen And Relax The Muscles Around And Inside The Pelvis

Did you know that when you experience pain in your body, your muscles can tighten as a protective response? Although this response is trying to help you, it can further increase your pain. The following stretching exercises help to reduce tension and pain in the pelvis. With all of these stretches, you want to take the movement to the point of tension, but not pain. Try to hold each stretch for 30-60 seconds, up to 3 times each, 1-2x/day.

1. Child’s pose: start on your hands and knees. Relax your buttocks towards your heels trying to keep you knees apart. Relax your head into the floor.
2. Happy baby: start by lying flat on your back. Hold the inside of each foot with your arms inside of your knees. Allow your knees to open to the side.
3. Relaxed frog: start by squatting toward the floor supporting your weight with your hands and feet. Slowly relax your bottom down between your heels.
4. Butterfly: start by lying flat on your back. Bring the soles of your feet together allowing your knees to fall apart. You can use pillows or yoga blocks to support the weight of your legs if needed for comfort.

Tip 3: Focus On Good Bowel Habits

Constipation is both a common cause and consequence of pelvic pain. You should not experience any pain when emptying your bowel and your stool should be easy to pass. I encourage you to google “Bristol Stool Chart” to determine your stool quality. If you are Type 1 or 2, you are constipated. The following tips can help to improve your bowel movements.

1. Ensure adequate water intake. Your non-caffeinated and non-alcoholic fluid intake should be approximately 0.5 oz/lb of body weight.
2. Ensure adequate fibre intake. Your daily fibre intake should be approximately 25-35 grams.
3. Add physical activity. Your intestines have a natural motion to move stool forward. Physical activity such as walking can promote motion that helps you poop. Try to walk daily for 30 min.
4. Improve your bathroom posture. Resting your feet on a small footstool where your knees are above the level of your hips will improve the angle of your colon to help with the passage of stool.

Tip 4: Try To Engage In Stress-Relieving Activities

Pelvic pain can often be associated with anxiety, depression, stress or past trauma. Deep breathing, practicing mindfulness and listening to calm music can all be helpful. If you are struggling to manage this on your own, it can be helpful to seek support from a professional such as a counsellor or psychologist to develop strategies to cope with your pain.

Living with pelvic pain can feel very lonely but know that you are not alone and that there is help. The best plan of action you can take is to discuss it with your healthcare provider or reach out to one of our clinics to book an appointment with a pelvic health physiotherapist.

- Renae Hunter

Renae Hunter, Pelvic Health PhysiotherapistPT, BSc (KIN), MPT, Certified Postnatal Fitness Specialist

Renae graduated from the University of Calgary with a Bachelor of Science in Kinesiology in 2007 followed by a Masters in Physical Therapy from the University of Western Ontario in 2009. Renae is a certified Pelvic Floor Physiotherapist treating a variety of pelvic health disorders including prolapse, dyspareunia, urinary and fecal incontinence and pelvic pain. She is also certified in ROST Therapy for the treatment of pregnancy-related pelvic girdle pain. In addition, she has completed training in acupuncture through the Acupuncture Foundation of Canada Institute and has completed her Level 2 certification in Manual Therapy through the Canadian Physiotherapy Association Orthopaedic Division. She has a passion for patient-centred care and works hard to help patients achieve their maximum potential and overall well-being. Renae grew up as a competitive soccer player competing as a Dino for the University of Calgary for 4 years and continues to enjoy living an active lifestyle. Outside of the clinic, Renae is a busy mom of 3 and enjoys spending time with her family and exploring the outdoors.

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