Pelvic pain in IBD: An overlooked complication

By Tina Aswani Omprakash, Guest Contributor

A complication of inflammatory bowel disease (IBD) that often goes unaddressed and misdiagnosed is chronic pelvic pain (CPP).

CPP is often defined as pain in the pelvic area that isn’t cyclic and isn’t related to pregnancy and that lasts for three to six months. It may affect from about 6% to 26% of women,¹ depending on how it’s defined. The condition can arise from a variety of causes.

How I’ve experienced pelvic pain

So how does CPP apply to us as IBD patients? In my case, as someone living with Crohn’s, after many colorectal surgeries and given my perianal disease, I’ve developed CPP that requires constant management.

Several problems are contributing to my pain, which includes rectal, vaginal, perineal, and lower back pain. For instance, I have had peritoneal inclusion cysts, which are a result of fluid build-up in the pelvis due to adhesions. My cysts impinged on my bladder, resulting in urinary urgency and incontinence. More recently, I’ve been facing potential diagnoses of endometriosis and an inguinal hernia.

A few ways to treat pelvic pain

Some cases of CPP arise from problems with the muscles that line the floor of the pelvis, a condition called pelvic-floor dysfunction. Pelvic-floor physical therapy and home exercises are sometimes used to treat CPP.

“Pelvic-floor muscles tend to tighten in patients with IBD,” says physical therapist Dr. Kara Mortifoglio of Solstice Physiotherapy in New York City.

By practicing some internal rectal or vaginal manual therapies, a person can increase blood flow to the pelvic floor, thus improving muscle movement and blood supply to nerves, according to Dr. Mortifoglio. This may help with overall movement and pain relief.

It’s important for patients to coordinate with their colorectal surgeon to decide at which point after surgery it may be worth starting pelvic-floor physical therapy, and how quickly to progress with manual therapy and home exercises, says Dr. Mortifoglio.

What should a patient do if physical therapy isn’t delivering the desired results?

If after 4 to 6 pelvic- floor physical therapy visits, a patient doesn’t show significant improvement or hits a plateau in treatment, then it might be time to administer an injection to either block a nerve or to target one set of muscles in the pelvic floor, according to Tayyaba Ahmed, DO, a pelvic pain physiatrist (a doctor of physical medicine and rehabilitation) at Pelvic Rehabilitation Medicine in New York City.

For some people, nerve blocks and trigger-point injections are used as a supplement to physical therapy. They may reduce nerve pain and muscle tension.

Dr. Ahmed also prescribes rectal and vaginal suppositories of diazepam to ease pelvic spasms. If necessary, she uses a variety of oral neuropathic medications instead of opioids to manage CPP.

Along with traditional medicine, Dr. Ahmed says it may be helpful to also use holistic therapies to ease symptoms, like:

• Acupuncture
• Gentle yoga exercises
• Meditation

Dr. Ahmed says these modalities help to focus the mind on relaxation and work to retrain the brain.

How I manage my chronic pelvic pain

In addition to regular physical therapy visits and following my home exercise program, I try to alternate between sitting, standing, and walking as much as possible. For me, sitting for long periods of time, especially in cars and planes, results in significant pelvic pain.

I also find that sitting on a cushion prevents intense pain or spasms and at other times, use a TENS, or transcutaneous electrical nerve stimulation, unit machine calms the nerves.

More recently, I’ve started suppositories and oral medications alongside weekly nerve blocks and trigger-point injections, which have significantly reduced the pain and soreness at the pelvic floor site. After 4 to 6 weeks of weekly nerve blocks, Dr. Ahmed encourages patients to follow up with her quarterly to decide whether maintenance injections are needed to prevent CPP flare-ups.

If you’re experiencing pelvic pain, check in with your care provider to develop a comprehensive approach, personalized for your needs.

Medically reviewed by Jenny Blair, MD