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Pelvic Pain

Dr. Tayyab Ahmad is a Doctor of Physical Medicine and Rehabilitation who was born and raised in New York. She is Board Certified in Physical Medicine and Rehabilitation from the New York College of Osteopathic Medicine and is also a fellow of the Academy of Physical Medicine and Rehabilitation and a member of the International Pelvic Pain Society. Dr. Ahmed is a contributing author to a textbook that is considered a staple during every physiotherapist training.

Pelvic pain is classically defined as pain anywhere between the belly buttons and the knee because there are a lot of joints in between those two areas. We’re seeing men and women classically. We thought pelvic pain was mostly a female dysfunction – however, everyone has a pelvic floor and it does not discriminate. So we see both people from all genders inclusive of pelvic.

With men, it’s a lot of penile pain and testicular pain, and pain with sitting. This region does not discriminate. Both men and women can experience pelvic pain. But, the causes of pelvic pain depend on the situation for men. A lot of the common causes or diagnosis is that people will have bacterial prostatitis, prostatitis, they might have true infections. There are also patients who don’t have true infections but have an inflammation of their prostate. There’s a handful that has chronic constipation, whether it’s related to IBS, or inflammatory bowel disease.

If a patient has anything going on with their GI tract, they can have pelvic floor dysfunction, thus causing pelvic pain. Women, it’s different. There’s a lot of endometriosis. One of the biggest causes of pelvic pain is not just a gynecologic condition, but a total body inflammatory disease that affects multi-system. 

We do see some people postpartum or during their pregnancy who have pain during the pregnancy and then resulting pain that happens after the pregnancy. We cannot exclude mental health like anxiety and depression and see that pelvic floor dysfunction is in the setting of mental health dysfunction. When we get to the actual assessment of the pelvic floor, many times what we’re seeing is hypotonia sitting on the pelvic floor. For patients who we think of as having a hypertonic pelvic floor, we’ll order an MRI pelvis, and try to see if I’m looking about a hernia or sports hernia.

Vaginismus, are involuntary contractions of the muscles due to anything entering the vagina. The muscles tighten in a response to trauma as a protective mechanism, even if there’s not necessarily tissue damage, but because of the emotional component of it. 

A lot of the different causes and getting to the bottom of what the causes are is really what helps figure out how to treat it. Getting to the root cause so that patients may stop experiencing symptoms is crucial. It’s so important that if you may even think something is wrong or have gone through many appointments, don’t give up. The fact that you’re investing time means that there are people just like you looking for answers and they’re out there.

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