Chronic Pelvic Pain: What Is It & How Can Your Chiropractor Help?

Part of being a woman involves dealing with discomfort in the pelvic region at some point.

This can be menstrual pains that are tolerable and brief or those that are persistent and severe, which could be an indication of chronic pelvic pain. For some, sharp and stabbing pain comes and goes. For others, it’s steady and dull, like a mild stomach ache.

So what's the deal with chronic pelvic pain?

First I want to hit you guys with some pretty concerning stats. When I first read these statistics from a lecture I was taking I was looking at a study from 2015 and thought; “Well that has to have improved over almost a decade.” Unfortunately, it hasn’t. The most recent review is from April 2023 and the statistics have only gotten worse...

• Chronic pelvic pain is diagnosed after 3-6 months of pain

• One in seven women in the United States is affected

• The prevalence is similar to migraine headaches, asthma, and low back pain

• An estimated 50% of cases remain undiagnosed

• Many women wait 2 years before seeking help

• Chronic pain has a strong association with previous physical or emotional trauma

Chronic pelvic pain can be associated with a multitude of other comorbidities such as irritable bowel syndrome, endometriosis, interstitial cystitis, post-traumatic stress disorder, and depression. However, due to this, musculoskeletal pain is sometimes overlooked and the focus is on the “diagnosed” condition. That being said; it can be difficult for providers to diagnose certain conditions due to the large amount of structures that are in and around the pelvis.

The table below just touches the surface of a variety of different conditions.

Musculoskeletal	Gyno/GI/Urological	Neurological
​Myofascial Pain	Endometriosis	Pudendal Neuralgia
Chronic Widespread Pain	Adenomyosis	Visceral Hyperalgesia
Pelvic Floor Dysfunction	Secondary Dysmenorrhea
Sacroiliac Joint Dysfunction	Pelvic Congestion
Pubic Bone Dysfunction	IBS
Hip Flexor Hypertonicity	Constipation
Piriformis Syndrome	Interstitial Cystitis
Sciatica	Adhesions
	Fibroids/Leiomyoma

The following pictures are to show you how many important structures connect to the pelvis:

I will spare you the tedious anatomy lesson and instead concentrate on a few key elements that will assist in emphasizing the value of consulting a chiropractor for issues that don't seem to be related.

Before starting treatment, I like to show my patients what I mean by pulling out a spine and explaining each structure I'll be working with. I like to concentrate on all of the structures that are in contact with the Webster approach when treating pelvic pain. These comprise the round ligaments, piriformis muscle, psoas muscle, sacrum, pubic bone, and sacroiliac (SI) joints.

The two bony landmarks directly behind your lower back are the SI joints. Using a drop table to apply motion to these joints can aid with pain management and dysfunction improvement. It's crucial to remember that your sacrum is the extension of your spine; numerous nerve innervations are located there, and it is directly attached to the lowest lumbar vertebrae.

Uterosacral Ligaments: Your sacrum and uterus are joined by this ligament, which is visible in the picture below. It gives your uterus solidity and support. It's a five-inch-long ligament that is fairly substantial. Your anus passes through the two of them, one on each side. Vaginal prolapse and endometriosis can both be caused by problems with its function. "Deep infiltrating endometriosis most frequently occurs in the uterosacral ligament." However, due of the numerous nerve systems that run along this area, sacrum adjustments made by a chiropractor can aid in pain alleviation and the reduction of inflammation. Although there is no guarantee that endometriosis will be cured, the input to the neurological system may aid with pain management.

Chiropractic treatment can be an effective treatment for painful periods. One study found that lumbosacral adjustments reduced cramping and discomfort associated with primary dysmenorrhea. Primary dysmenorrhea is cramping that occurs before or during your menstrual cycle and is described by 1 out of every 4 women.

Round Ligaments: These structures are well known to pregnant patients, however, they can cause pain for women throughout their menstrual cycle. Tension and discomfort during a woman's menstrual cycle can be reduced by giving the ligaments themselves a little massage.

Sacrotuberous Ligaments: These ligaments connect your sacrum on both sides to your ischial tuberosity, or sit bones. This ligament frequently becomes tense during pregnancy, but it can also become strained at any point throughout your menstrual cycle (because of trace levels of relaxin), which can be bothersome. Tension and discomfort can be released with gentle touches along this ligament.

Last, but not least, a quick moment for relaxin: because relaxin is produced during pregnancy, there is a considerable change in pelvic biomechanics. It is intended to facilitate childbirth by reducing pelvic rigidity, promoting range of motion, and raising pelvic measures. Pregnancy and childbirth require this adjustment, but it can also cause low back and hip pain, pelvic discomfort, and sensations of instability. Throughout their whole pregnancy and after giving birth, patients can benefit from chiropractic care.

Are there ways to prevent pelvic pain?

• It is not always possible to avoid pelvic pain. However, you can lower your risk by following these suggestions in your day-to-day activities:

• Limit activities that require you to stand or walk for long periods of time

• Eating more fiber can help especially with diverticulitis

• Exercise regularly to help keep your joints and muscles in good condition

• Stretch your body to reduce the risk of pain or torn ligaments

• Visit your chiropractor or doctor regularly to help detect issues earlier

In Summary

Ultimately, the purpose of this post is to emphasize that most women experience painful periods or pelvic pain, which can be misdiagnosed or left untreated for years. In our office, we take the time to evaluate the symptoms of each patient and obtain a complete picture of their condition. Because the problems are outside of our area of expertise, if they continue receiving care and don't notice any changes, we have the means to refer them to an expert and will fight for their rights to care all the way through.

By: Dr. Abby Kellogg

Chiropractor at ANH Wellness

Disclaimer: "The information including but not limited to text, graphics, images, and other material contained on this website is for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis, or treatment."

Sources: https://www.ncbi.nlm.nih.gov/books/NBK554585/#:~:text=pelvic%20inflammatory%20syndrome.-,One%20in%20seven%20women%20in%20the%20United%20States%20is%20affected,of%20chronic%20regional%20pain%20syndrome. 23261-uterosacral-ligament https://pubmed.ncbi.nlm.nih.gov/18394502/ https://www.ncbi.nlm.nih.gov/books/NBK482258/