Treatment of pelvic floor pain
Pelvic floor pain and dysfunction
Pelvic floor pain can come in a variety of forms, from burning and itching to a constant dull ache.
Frequently patients will describe an uncomfortable feeling, which they associate with passing urine or
a bowel motion. The pain can also be accompanied by episodes of minor incontinence
Most pelvic floor pain is generated through the pudendal nerve. This nerve is formed by 3 sacral nerve
roots and then enters the pelvis before travelling through a tunnel before it splits into 3 branches.
These 3 braches supply pain and sensation, as well as the sphincter muscles essential for urination and
defecation
The nerve can be injured anywhere along its course. Local back or pelvic trauma can damage the
nerve. Up to 30% of all women can experience some transitory symptoms following vaginal birth. Of
these women a further 1/3 can develop chronic problems.
Pelvic floor pain can be treated in a number of ways
1. Oral Medication
2. Neuromodulation
3. Injection therapy.
Oral Medication
The oral medication used to treat pelvic floor pain are similar to those used to treat “neuropathic pain
syndrome”, and include, Simple analgesics, non-steroidal anti-inflammatory, Pregablin and sildenafil
like medication.
The first 2 options work by interrupting the inflammatory cascade that is associated with injury and
pain
The pregablin medication alters the nerves response to the painful stimuli, by blocking the calcium
channels on the nerves, thus altering the nerves response, and reducing the symptoms of pain.
The 4th oral option is medication which selectively increases the pelvic blood flow to the injured nerve
All oral medication have side effects, these will by described by your medical practitioner.
Neuromodulation
Electrical stimulation to reduce pain has been used for over 60 years.
Neuromodulation has been recently shown to reduce the symptoms of pelvic floor pain.
The treatment involves a nerve in your foot [ the posterior tibial nerve] being stimulated by an
electrical impulse. This sends a message up the nerve to the spine where the message “bounces off”
the spinal cord and is sent down the affected nerve. In this case the pudendal nerve. The treatment
involves 12 sessions lasting 10-15 minutes. This treatment has proven to be successful in over 70% of
cases of pelvic floor pain and dysfunction involving the urinary system
Injection therapy
In cases of severe pain the pudendal nerve can be injected in an effort to block the pain emanating
from the injured nerve.
In these cases the nerve is identified by ultrasound and the doctor injects a solution containing local
anesthetic and a steroid around the nerve, and by blocking the nerve in this way reduces the pelvic
floor pain
Recently PRP [Platelet Enriched Plasma] has also been used with good effect in these cases blood is
drawn from the patient, and the platelets are concentrated by spinning them in a centrifuge, before
they are injected back into the patient around the affected nerve.
There is also research ongoing using a similar system to inject stem cells from bone marrow and
adipose tissue ,in an effort to promote healing in the injured nerve