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Physical Therapy for Chronic Pelvic Pain

Many women suffer in silence or are afraid or embarrassed to talk about such a personal issue – chronic pelvic pain, including painful intercourse and interstitial cystitis. Other women visit many healthcare providers seeking answers about the source of their pain, and an estimated 15 percent of women aged 18-50 experience chronic pelvic pain, which can vary in intensity and increase in severity during menstruation. It can also affect a woman’s ability to work and perform activities of daily living, including walking, sitting, bowel movements, sexual intercourse and the use of tampons as well as impact her relationships with her spouse or significant other as many women avoid sexual intercourse because of the pain. Chronic pelvic pain is common, and it can be treated effectively with physical therapy.


Chronic pelvic pain can present itself in numerous ways:

  • Lower abdominal pain
  • Painful intercourse (dyspareunia)
  • Itching or burning around the vagina or pelvic floor (may have diagnoses of frequent yeast infections)
  • Pain in the bladder or rectal areas (may have diagnosis of interstitial cystitis)
  • Painful clitoral area and/or inability to achieve orgasm
  • Low back pain


Other names and related diagnoses can include:

  • Dyspareunia
  • Vaginismus
  • Vulvodynia
  • Vulvar Vestibulitis
  • Interstitial Cystitis
  • Pudendal Neuralgia
  • Pelvic Inflammatory Disease
  • Coccydynia
  • Perineal pain


Sometimes, these symptoms can be related to endometriosis, ovarian cysts, yeast infections or other medical problems, but in some instances, the woman has undergone numerous diagnostic procedures including laparoscopy, and the source of the pain remains unknown. This is where a relatively new specialty within physical therapy can help with pain relief and return a woman to a more normal level of functioning, whether that’s normal bowel and bladder function or pain-free sexual intercourse.


Pam Palmer, physical therapist and founder of Palmer Physical Therapy for Women, has seen women who frequently complain of painful intercourse, which can be devastating to a relationship. The woman might feel that it’s her fault she experiences pain with sex. Her partner might not understand the problem. This frustration can lead to diminished sexual interest and avoidance. Pam has also seen many women suffering from interstitial cystitis (IC), which includes a variety of symptoms with an unknown cause. Women with this diagnosis suffer from inflamed bladder walls, intense bladder or chronic pelvic pain and pressure and the need to urinate frequently with urgency, and most complain of painful intercourse. Symptoms worsen during menstruation, and medications are not effective at controlling the pain.


To treat chronic pelvic pain with physical therapy, a physical therapist trained in women’s health will evaluate the pelvic area from a muscular, skeletal and nerve standpoint and may find that muscles are in spasm, the spine or pelvis may be misaligned and nerves may be irritated or not functioning properly – all of which can result in pain and dysfunction. She will then calm irritated nerves and stretch muscles gently back to normal lengths using individualized physical therapy techniques, such as bladder and pelvic floor muscle re-training. Recent studies show that a manual physical therapist specializing in pelvic floor dysfunction can relieve discomfort and improve muscle, bowel and bladder function.


The following are examples of actual cases treated with physical therapy for chronic pelvic pain:

Names have been changed to protect patient privacy.


Sara suffered from chronic pelvic pain for years. She had pain with pelvic exams, sexual intercourse and rectal pain following bowel movements. Because a gynecological cause was suspected as the source of her pain, she underwent a hysterectomy. She continued to suffer following this surgery for another two years. She admits thinking her doctor was crazy for suggesting she see a physical therapist. She could not imagine what type of physical therapy could be done for her chronic pelvic pain. Reluctant, but desperate for a solution, she went to physical therapy. Within a few weeks, she had a decrease in her symptoms by 80 percent.


Bev experienced low back pain and pain in her lower abdomen and groin for more than two years. Like Sara’s story, a gynecological cause was believed to be the source of her pain, and she underwent a hysterectomy. In addition to her other symptoms, she began to experience vaginal pain following the procedure. She didn’t understand how physical therapy could help, but thought she should explore every possible option. Her symptoms were related to nerve irritation in the spine, and she did very well with physical therapy.


Jill remembers pain with any attempt to use a tampon from the time she was 15 years old. She recalls pain with pelvic exams, and, on occasion, not being able to tolerate the exam due to pain and muscle spasm. She had saved herself for marriage, was newly married and experienced painful intercourse. This took a toll on her physically and emotionally. Following evaluation and treatment with a women’s health female physical therapist at Palmer Physical Therapy for Women, she found decreased pain with intercourse, decreased cramps with menstruation, decreased constipation and improved bowel function.


Kari lived with chronic pelvic pain and complained of burning and itching in the vaginal area for more than three years. Her symptoms were worse with sitting, walking and during menstruation. She saw numerous specialists and was treated for various diagnoses including vulvar vestibulitis and contact dermatitis without relief. A physical therapy evaluation revealed her symptoms to be related to her spine and nerve irritation. She was 75 percent better and managing her symptoms independently within just one month.


Chronic pelvic pain can be treated effectively with physical therapy. It is not “all in your head,” and it is not an inevitable part of menstruation. Women do not have to live with chronic pelvic pain, painful intercourse or pain from interstitial cystitis. If you are experiencing symptoms of pelvic pain, consult a women’s health physical therapist at Palmer Physical Therapy for Women to evaluate your needs and move toward recovery.


Pam Palmer, PT

Physical Therapy for Exercise and Eating Disorders

12 February 2024
Are you or someone you know an “exercise junkie?” Do you worry about your weight, restrict your food and fluid intake, diet constantly or exercise excessively to avoid gaining weight? Has your menstrual cycle been disrupted, is it erratic or has it stopped altogether? Do you feel stressed or depressed? Have you resorted to taking diet pills and laxatives? Do you ever force yourself to vomit after eating? These are a few of the questions health professionals may ask if they suspect someone may be a victim of the female athlete triad, which includes disordered eating, amenorrhea and osteoporosis. Women and girls with this condition exhibit signs of pathogenic weight control and are at high risk for many medical problems. Eating Disorders Eating disorders span the spectrum from restrictive eating or avoiding certain foods to anorexia or bulimia. Disordered eating results in a negative energy balance, where more calories are being used than consumed. An electrolyte imbalance can occur, which can lead to dehydration, decreased thermal regulation, cardiovascular problems, poor healing and even sudden death. Most people have heard of anorexia nervosa, which is an eating disorder characterized by an intense fear of fatness, an abnormal body image, absent or disrupted periods and weight loss to less than 85 percent of normal. There may also be associated signs like low blood pressure, slow heart rate, dry skin and nails, hair loss or thinning and excessive fine hair on the sides of the face and arms. Bulimia nervosa is a related eating disorder characterized by recurrent bingeing and purging, two times a week or more. Associated signs may include enlarged salivary glands, periodontal disease, conjunctival bleeding and scars on the back of the hand from repetitive, forced vomiting. Statistics show that about one in every 100 women binges and purges to lose weight. Amenorrhea Menstrual dysfunction occurs in women and girls with disordered eating. Primary amenorrhea is a condition in which girls do not start their periods by age 16 when the usual sex characteristics are present or by age 14, if no other sex characteristics are present. Secondary amenorrhea is a condition in which the period is absent or irregular and is diagnosed in previously menstruating women when there is an absence of three consecutive periods, or less than two cycles per year. Athletic amenorrhea is a condition that falls under this secondary category and occurs when there is a combination of caloric restriction, excessive exercise, emotional stress and low body fat. Health Consequences Health consequences that may result from eating disorders and amenorrhea include osteoporosis, stress fractures, scoliosis, infertility and cardiovascular disease. Osteoporosis, in this instance, is a premature loss of bone in premenopausal women, an inadequate formation of bone or a combination of both. People at high risk of osteoporosis are likely to include women of slender build, those with low calcium intake, those with a family history and those of caucasian and Asian heritage. Female Athlete Triad When the eating disorders, amenorrhea and osteoporosis exist together, it may be diagnosed as the female athlete triad, which occurs most frequently in athletic women but can also affect non-athletic women and girls. The true prevalence is not known because it is often unreported or underdiagnosed. Prevention and treatment should include a multidisciplinary approach by physicians, dietitians, psychologists, physical therapists, nurses, coaches, athletic trainers, dentists and family. Appropriate history and education are the keys to recognition of the problem and prevention. Counseling and family support may help in determining the underlying cause, promoting a healthy body image, promoting healthy eating habits and addressing issues, such as stress, anxiety and depression. Proper exercise should be in an appropriate balance with the fuel consumed to achieve and maintain a healthy body and lifestyle. For more information regarding diet, nutrition, and exercise, please consult your physician, a nutritionist and a women’s health physical therapist. Ann Sundgren, PT Palmer Physical Therapy for Women

"Let's Get Physical" to address side effects of cancer treatment

12 February 2024
"After cancer diagnosis, many patients anticipate a treatment regimen that might include surgery, chemotherapy, targeted therapy, immunotherapy or radiation. But there's another type of treatment that can benefit people with cancer, and it's one that they don't always get - physical therapy. Physical therapy can help address side effects of cancer or its treatments, including pain, weakness, body changes and fatigue." "Many people being treated for cancer experience severe fatigue, which often tops lists of common side effects of both chemotherapy and radiation. Although it might seem counterintuitive, physical therapy can play a vital role in fighting fatigue." "You don't have to rehabilitate what you don't lose. Waiting for patients to lose function, and then give it back to them is not best practice. Our job is to keep you happy, healthy, and moving." "Patients often worry that they are not well enough for physical therapy, but people who try physical therapy don't get as sick, don't have as much pain, and tolerate chemotherapy and radiation better." From the winter 2018 edition of Cure magazine. Please follow the link for more information about the benefits of physical therapy during cancer treatment. https://www.curetoday.com/publications/cure/2018/winter-2018/lets-get-physical Research shows that physical activity during and/or after cancer treatment can help you minimize and overcome the effects of cancer treatment. At Palmer Physical Therapy for Women, our therapists are trained in oncology rehabilitation and will evaluate your pain, neuropathy, range of motion, tissue restriction, strength, endurance and balance. An individualized plan of care and exercise program will help you address any deficits and achieve your specific needs and goals. We are ready to help you get your quality of life back! Susan Palmer, PT

Nordic Walking

12 February 2024
Nordic Walking—What Is This New Craze? Popular in Europe for many years, Nordic Walking, also known as Urban Poling, is recently becoming an exciting exercise option here in the United States. To understand Nordic Walking better, envision cross-country skiing without the skis. There are many great benefits from Nordic Walking. Namely, there is 80% more muscle activation than traditional walking, with up to a 40% increase in calorie burning. Nordic Walking improves posture, gait pattern, and balance, while increasing core and upper body strength. Using the poles with walking significantly decreases stress on the back, hips, knees, ankles and feet, enabling those with painful or chronic conditions to tolerate and enjoy more physical activity. Working out with the Nordic poles helps to increase overall strength and endurance, which can carry over to other daily activities and enhance the quality of life. Weightbearing and resistance activity with the upper body helps prevent bone loss due to osteopenia or osteoporosis as well. At Palmer Physical Therapy for Women, we are utilizing the poles as part of our individualized rehab programs for those with balance or falling issues, for those with spine or lower extremity pain or dysfunction, or for those with postural problems. There are many great exercises that utilize the poles to assist with stretching, strengthening or balance. We have also been promoting Nordic Walking to our clients and to other community groups as a new, unique form of fitness activity. Especially during the recent COVID-19 pandemic, Nordic Walking can easily be done outdoors for social distancing, nearly anytime, anywhere. It requires little equipment, with minimal expense. Once the proper gait pattern is achieved on level surfaces, Nordic Walkers can challenge themselves on uneven ground, hills, or inclines. Palmer Physical Therapy for Women is now offering classes for an introduction to Nordic Walking. Participants learn a comprehensive home exercise program using the poles to help with stretching, strengthening and balance. Physical therapists adjust and fit the poles properly to the individual, and educate them about proper gait pattern, posture correction and control. Some of the comments from our recent classes: “I started walking with Nordic poles July 18, so have been walking with them for a month. Previously, my walking was a chore and just something I felt I had to do for health reasons, not so much because I enjoyed it. Now, every morning, I am eager to exercise with the poles. I also started doing the recommended stretches, balance and strengthening exercises using the poles. I feel like I have settled into an exercise program that I totally enjoy! Even after only one month, I sense that I am more aware of having correct posture. I can tell from my Apple Watch app that I am burning more calories with the poles. I initially thought I would be embarrassed walking in my neighborhood, but I mostly get smiles, thumbs up, and inquiries about this form of exercise. Now I like being the unique exerciser! I would highly recommend walking with Nordic poles!” Jan Dav is Future ongoing fitness classes will be offered for those interested in advancing with more comprehensive exercise and conditioning. For further information about class times, please call Palmer Physical Therapy for Women, 316-630-9944. Our office is located at 10333 E 21 st ST N. #406, Wichita, KS 67206. We look forward to working with you!
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