Chronic pelvic Pain

Question 1

What are Pre-existing risk factors for CPP?

Answer 1

 SIJ pain
 Pubic bone pain
 Inner thigh pain
 Bladder pain ( lower abdominal)
 Rectal pain
 Dysuria ( CPP vs UTI)
 Chronic constipation
 Hx sexual abuse / depression / anxiety
 Painful intercourse / VE’s – dyspareunia
 Post childbirth ( SVD/ perineal trauma)
 Pain on sitting
 Coccyx pain
 Pain with a PFM contraction

Question 2

Treatment for Bladder and Bowel function?

Answer 2

 Address constipation ( structure vs stool form)
 Address post void residuals ( > 30 mls)
 Poor bladder habits ( positioning, straining)
 Poor bowel habits ( positioning)
 Diet (low fibre)
 Fluid intake ( over or under hydrated)
 Treat any UTI’s ( MSU / Ab’s)

Question 3

Treatment of CPP

Answer 3

 Breathing awareness / pelvic floor down training
 Abdominal wall relaxations
 Relaxation!
 Medication / surgery
 Neural stretches
 Trigger point therapy ( VE, PR, and superficial)
 TENS ( perineal / vaginal)
 Bladder and bowel function
 De‐sensitising techniques ( self trigger point / dilators)
 Chronic pain management

Question 4

What is the role of diaphragmatic breathing in labour? Outline the instructions

Answer 4

• Deep breathing can cause relaxation and breaks the panic cycle where people tend to hold their breath during the first stage of labour, it is useful to practice in advance
• Diaphragmatic breathing can help supply more oxygen to your baby, and may even decrease the intensity of contractions you may experience during labour
• Breath in deeply from your lower stomach, imagine it filling up like a balloon and expanding outwards, then hold it for a couple of seconds before releasing and slowly letting all of the air out

Question 5

Causes of dyspareunia and why causes are contributing to Pain:

Answer 5

• Episiotomy scar tenderness: incorrect healing can cause sensitivity and pain on scars, which in turn cause dyspareunia.
• Poor repair following perineal trauma causing scar tissue formation
• Dyspanueria is most commonly caused by pelvic floor muscle pain i.e. pelvic floor myalgia
• Pelvic floor muscle pain involves pain in the muscles of the pelvic floor, perineal or levator ani, commonly due to overactive pelvic floor, causing vagina-related pain
• Typically involves overactivity and/or pain of pubococcygeus, iliococcygeus and puborectalis which are all in close proximity to the vagina