Pelvic Pain That No One Can Explain - Episode 42
This episode of the Marrón Pelvic Health Podcast, hosted by Dr. Kari Roberts, focuses on unexplained pelvic pain— a persistent and often frustrating condition that can occur without a clear diagnosis. While many expect pain to have an obvious cause, pelvic pain can affect individuals of all ages and may be linked to factors like muscle tension, nerve sensitivity, stress, or past injuries. The podcast emphasizes the importance of understanding pelvic pain and its underlying contributors. Dr. Roberts suggests that pelvic physical therapy can help by providing personalized assessments and exercises to reduce pain and improve muscle coordination. Awareness and proper care are essential for managing unexplained pelvic pain effectively.
Book a call with Dr. Kari Roberts today.
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Dr. Kari: Have you ever gone to the doctor and been told everything's normal or they can't figure out your pelvic pain?
Well, if you or someone you know has, then stay tuned because I'm going to chat about that today.
Dr. Kari: Welcome to the Marone Pelvic Health Podcast. Hi, I'm your host, Dr. Carrie Roberts. On this show, we will be discussing a variety of things regarding your pelvic health. These conversations will be a mix of education,
personal experiences, and a blend of tips you can apply to have a healthier pelvis. The goal of this show is to normalize conversations around pelvic health and help women stop suffering in silence.
Dr. Kari: Today we're going to get all into pelvic pain and why you sometimes get the answer.
There's no explanation or we don't know why.
Why sometimes people can't explain your pelvic pain. And when I say pelvic pain. I'm sorry,
when I say people, I'm speaking about our general practitioners that we might go to as our first line of defense. Our gynecologists, our primary care providers, our internal medicine providers,
and family physicians. Sometimes you just are. You get missed, and people want to know why. So if you have any questions or comments about what I'm talking about,
if you want more detail or if you less detail,
please give me any feedback, and I will gladly take that into consideration.
Okay.
What are the reasons why you can have this pelvic pain? What are the drivers behind this elusive pelvic pain that may not be able to be explained?
Well, one of the drivers is the pelvic floor muscles. Yes, of course I'm gonna talk about pelvic floor muscles as a pelvic floor physical therapist. Those muscles, just like any other muscles in our body, they can get out of whack.
They can be too tight, they can be too lo.
They can be not coordinated, meaning they don't turn on and off when they're supposed to, or they may not coordinate with their partners. Well, and all of that stuff can lead to pelvic pain.
Another thing is our nervous system. A lot of times when you think of your nervous system,
sometimes you think about your stress and anxiety.
That's kind of what I'm talking about. That parasympathetic nervous system that controls rest and relaxation as well as fight, flight, slight freeze. That whole system is designed to protect us.
And sometimes people's protective system can be an overdrive. And so when your neurological system gets trapped in that protection mode and it's an overdrive, you can have chronic pain. As a result,
those tissues might become more sensitive than what we would like. And that increased sensitivity can present as pain.
Stress, anxiety,
former trauma, chronic pain conditions. All of those things can contribute to a really sensitive nervous system. And a really sensitive nervous system can present in different ways. And one of the ways could be pelvic floor pain or pelvic pain.
Something else that can drive this is when you have multiple conditions or different conditions have overlapping symptoms, like bladder pain syndrome, also known as interstitial cystitis.
Those symptoms are very similar to people that have PMDD or people that have. Which PMDD is kind of like an extreme PMS condition.
Also, people can have heavy menstrual cycles and heavy cramping and bleeding with their menstrual cycles.
Also, if you have ibs,
IBS with constipation, IBS with diarrhea, IBS with a combination endometriosis,
all of those symptoms have multiple. All of those conditions have multiple symptoms that overlap. And if you have.
That can be hard to treat. And if you have more than one, that can also pose a challenge. Also, other things can happen structurally inside of those pelvic organs. Like I did mention endometriosis, adenomyces,
endometriosis,
and fibroids. All of those things are structurally involved with the pelvic organs that also can be a driver for that pelvic pain. And then if you've got scar tissue, some people have scar tissue from an episiotomy or tearing during labor of birth.
Or you can have scar tissue in your abdominal area from abdominal surgeries, or you can have a C section scar. Also, if you have laparoscopic surgery for endometriosis or laparoscopic surgery for a total or partial hysterectomy, if you've had your ovaries removed, all of those surgical procedures can result in scars.
And scars in your abdomen or in your pelvic area can present as pelvic pain, because the scars can change the tension of that soft tissue, and it can sometimes cause adhesions.
Where the soft tissue is not as.
As mobile as we would like it to be. It can impact your overall movement.
The nerves that go in those areas can also be affected by the pain or by the scar tissue. So all of that, you can see how we're getting, like, a layering effect, right?
And how one thing could affect, like one thing, like a surgery can affect tissue in an area.
Excuse me, from a surgery or tissue in the area from a scar.
And the scar can impact the mobility.
And that mobility can impact the nervous system and that nervous system can present in pain. So that's how things can kind of cascade, but also how things can be related and they could be missed.
So that's just something I wanted to walk through. And then of course, we can't forget about our dear friends, the hormones, because hormones, especially in women's bodies, and have all kinds of impact with bone health and muscles and of course those pelvic floor organs and, and the way that they function.
And when you're thinking about some hormonal periods of a woman's life, perimenopause, there's a huge hormonal shift. Postpartum, there's a huge emotion hormonal shift. And menopausal, there's a huge hormonal shift.
So why do patients get dismissed? Why? If these are all the things that can be the drivers,
then why can they still be missed? Well, in traditional medicine it can be more focused on structure and the function of a particular organ or a body part, as opposed to that body part working with other organs.
So there's a lot of emphasis on images,
there's a lot of emphasis on blood work,
on labs. And if all of those come back within normal limits, then it's kind of like, eh, we don't really know why that happens.
But pain is multifactorial, as you could just see with the last example. And pain can be very complex.
And to really get to the root of what's going on with someone who's dealing with pain, especially pelvic pain, you really need the time and the space to the space so that the patient can feel comfortable to share his or her story and then the time for that patient to share his or her story.
And so you need both of those together. If that, you might have all the time in the world. But if you're not creating a safe environment where the patient feels comfortable opening up, then you might be missing some key pieces.
And as a patient,
I encourage you to find providers that have the time to really sit down and listen, because you might take five minutes. Why are you dealing with this pelvic pain? When did it start?
Well,
I had a little blip when I started my period in middle school. And then when I became sexually active, I noticed this. And then when I had a baby, I noticed this.
So it may not be something straightforward like I fell off a horse. And ever since then I had my pain. Sometimes it takes a while and sometimes you have to verbally process through that so that your provider can get to the root of the problem.
And if you only have a couple of minutes, or if they seem dismissive, or if they're busy doing multiple things with multiple people, you may not feel comfortable sharing that, or it may not feel like it's important.
So the practitioner really needs to be able to create the time and the space so that they can really listen undividedly and listen to what's going on. And a lot of times in our traditional healthcare system,
at least in this country,
the time is just not available. So that's a huge barrier.
Something else is we all have our biases. Providers have biases. Everybody's human. We might have a bias. Oh,
I've seen this a hundred times. It's probably this.
Our patients might have biases where they think that something might be really important that ends up not being important,
or you might think that something's not important, it might be really important.
And then you might look at your provider and judge them and think, oh, it doesn't seem like they're interested.
Or you might look at your provider and have a really good bias. Either way, we all have biases. We all make micro judgments, whether we want to or not. But we just have to kind of understand that those are happening and that those biases can have an impact on what we share,
what we decide to listen to,
and that can impact our care.
And then also in the women's health or in the pelvic floor setting. Pelvic floor is kind of unofficially women's health.
And so you might deal with practitioners that are very biased towards women,
and you might be married to someone or have a partner or a family member that's male that is dealing with some of these similar issues,
and it may not feel like a safe space for him. So all of those biases can impact how these very common drivers can get overlooked.
I did want to go back, because I don't remember if I said it or not when I was talking about the nervous system, how trauma can really impact the body.
So you can have physical trauma, you can have emotional trauma, mental trauma. All of those traumas can impact that cascade of events that I talked about earlier.
So what's the best approach to make sure that we can get to the root cause of what's going on with this pelvic pain that seems like no one else can explain?
We need to, as a community,
as a profession, as providers, as patients,
we need to hold each other to a standard where we are looking at the whole body.
You are not a pelvis that is in pain. You Are a person that's dealing with pelvic pain, you, you might be trying to conceive a baby, you might be trying to buy a house, you might have just lost a loved one, you might have pain with intimacy,
you might have some family dynamics that are stressful, you might have moved to a new place, your dog might be sick. All of these things can be impacting your life.
And sometimes multiple things are happening at one time. And so yes, when you walk in and say,
my pelvis hurts when I have intercourse, we still as providers need to be aware of if your dog is dying and if,
if the this and the in the in the that, because all of that can impact it.
We want to make sure, as providers, as patients, that we are making sure that those, all of those symptoms systems are being checked. So yes, we want to make sure those organs are functioning well.
We want those labs to be good, we want those images to be good. But it doesn't stop there. We want to remember there is something called central sensitization,
which is when that nervous system gets caught or gets stuck in that protective role. And we want to make sure we are addressing that nervous system so that it knows to not be in protection mode all of the time,
so that it can start to dial back a little bit. And as it dials back a little bit, the pain can also dial back. And we wanna look at your lifestyle and we wanna also look at your emotions.
And the way that we do that as physical therapists, we do not have all of the tools, all of those tools that I just mentioned, that's not all within our scope of practice, but there are other providers that are.
You might have a functional medicine professional or.
What I've experienced personally is an ob. GYN may not necessarily be what you need for your women's health. You might really need to switch to adjusted gyn. Someone that's not dealing with the delivery of babies, someone that's working with more the 30 and 40 and 50 year old population and dealing with more of those common things away from labor and delivery.
You might need to look at a holistic practitioner, maybe an acupuncturist. We also want to make sure your diet, your nutrition is dialed in.
And do you need a talk therapy or a mental health therapist,
do you need a psychologist? All of those things can be so beneficial.
I think about one of my patients, I won't give too much detail, but one of my patients, she was in her mid-20s and she had a sexual experience that left her with some vaginal scarring and physically she was doing well.
She came in, her muscles were a little out of whack, worked with her for several months,
everything was going well. But what happened here in the clinic was not translating to when she wasn't in the clinic. So as we start digging deeper, I realized she had a history of some mental health issues that had been dealt pretty well with non medical approaches.
But I said, I think you might need to speak to someone about this. Make sure that your mental health is dialed in, make sure your nervous system is taken care of.
And sure enough, when she started going to therapy, when she started seeing her psychologist, psychiatrist rather,
in addition to what she was doing with me, in addition to what she was getting at her gynecologist, we were able to get that last little bit of progress and she was able to really get to a place where she was pain free and she could manage stuff on her own.
So that's just a small example of why we don't usually get chronic pain dialed in by itself.
Sometimes we need to pull in other practitioners, physical therapy,
mental health therapy, nutritionists, all these different practitioners, to really give you the care that you need to treat that whole person.
So as a patient, if you're listening, what can you do?
The more information you have, the better.
So track, track as much as you can. Track your stress, track what you're eating, track your sleep, track your exercise, track cycle. You might pick up some patterns just from tracking those things.
And that information that you track might help lead you in the right direction. Is it time to see a gynecologist? Is it time to see someone for talk therapy? Is it time to see a pelvic physical therapist?
Then after you've checked some of that information on your own for at least 90 days, because 90 days gives us a well rounded view of what's going on with your body,
then that's when you want to make sure you're seeking your pelvic health professionals. Of course I'm biased,
so I definitely recommend looking into pelvic physical therapy. If you're having this pelvic pain that no one seems to be able to give the answer to.
And wherever you go,
whichever practitioner you see, whether you love them or it might take a little while, or I should say, regardless if you love them,
make sure you're digging deeper,
make sure you're getting to the root cause, make sure you're getting answers to questions until you are satisfied and you understand what's going on, because then you and your practitioner can partner together to help you overcome this pain that you're dealing with as a review.
There are common drivers that can impact the pelvic pain, your pelvic floor muscle activity,
having overlapping medical conditions,
scar tissue or previous surgeries, and hormonal changes.
There are several reasons why patients get dismissed. We could be seeing a practitioner that's really focused on organ function.
Our healthcare system really focuses on images and labs.
And we might be overlooking the multifactorial approach that comes with pain.
And we might be overlooking the fact that everybody has their own bias.
What's a better approach is finding practitioners that look at the whole body.
And even better is having a multidisciplinary team so that your whole body can be properly treated.
And you want to make sure that you're getting good information before you seek out these professionals. After you track this information,
go ahead and call a pelvic health physical therapist or another provider that can help you. And then don't be afraid to keep the bar high and keep your practitioners held to the same standard so that you can get the answers to those deeper questions and get to the root cause of your issues.
Your pain is real. Even though it might be not able to be explained.
It is real and there is a reason. And there is a team out there that is willing to do the work to help you get out of pain. So that's my message for today.
I will be back next week with another episode.
Thank you for listening to this episode
Dr. Kari: of the Marone Pelvic Health Podcast.
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This episode of the Marrón Pelvic Health Podcast, hosted by Dr. Kari Roberts, focuses on unexplained pelvic pain— a persistent and often frustrating condition that can occur without a clear diagnosis. While many expect pain to have an obvious cause, pelvic pain can affect individuals of all ages and may be linked to factors like muscle tension, nerve sensitivity, stress, or past injuries. The podcast emphasizes the importance of understanding pelvic pain and its underlying contributors. Dr. Roberts suggests that pelvic physical therapy can help by providing personalized assessments and exercises to reduce pain and improve muscle coordination. Awareness and proper care are essential for managing unexplained pelvic pain effectively.
Check out Ep. 41 - Pelvic Floor Health for Men: What Your Doctor Might Miss
Book a call with Dr. Kari Roberts today.
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