Hip, Lower Back Pain and Pelvic Floor Dysfunction

Back Pain, Hip Pain, and Pelvic Floor Disorders

The pelvic floor is a system of muscles that help support the pelvic organs. It’s commonly known that pelvic floor problems can cause incontinence and sexual dysfunction (Jundt, Peschers, & Kentenich, 2015). But did you know your pelvic floor health is also correlated to pain in your hips and lower back?

Women have a higher prevalence of lower back pain than men do (Schneider, Randoll, & Buchner, 2006), and while this relationship is not well-understood, emerging research is starting to establish a link between pelvic pain and the pelvic floor (Dufour et al, 2018).

Let’s talk about some of these side effects of pelvic floor dysfunction--and what you can do about them.

Pelvic Pain and Incontinence

Urinary incontinence is one of the strongest predictors of pelvic floor dysfunction--and it often coincides with pelvic pain. One survey of 200 women with lower back pain found a 78% prevalence rate of urinary incontinence--a significant difference when compared to the control group of women with neck pain (Eliasson et al, 2008).

Another study surveyed patients with hip osteoarthritis before and after a total hip arthroplasty (hip replacement). Before surgery, 43% of the patients reported urinary incontinence; after surgery, 64% of those patients had seen improvements in their incontinence (Tamaki et al, 2014).

Pelvic Pain and Sexual Dysfunction

Because the pelvic floor involves the vaginal muscles that control sexual arousal, satisfaction, and orgasm, pelvic floor dysfunctions can also cause sexual dysfunction. We can also see a relationship between pelvic pain and sexual dysfunction.

One study found that back pain in women caused more sexual dysfunction (less frequent sex and more discomfort during sex) when compared with neck pain (Maigne & Chatellier, 2001).

In addition, a qualitative study published earlier this year showed that patients with osteoporosis--a leading cause of hip pain--found that sex was often more painful, and fear of that pain led to a decrease in their sexual frequency. Several respondents reported that they were able to communicate with their partner in order to make adjustments to their sex life that limited pain, such as using different sexual positions (Strid & Ekelius-Hamping, 2020).

Solutions

If you’re having symptoms like incontinence, sexual dysfunction, and pelvic pain, and think this might be tied to your pelvic floor, what can you do about it?

See a Pelvic Physical Therapist

A physical therapist specializing in pelvic floor dysfunction is instrumental in addressing hip, back, and pelvic issues and pain. They posses the skills to evaluate and address these issues to help patients reach their goals.

Kegels

Like every other muscle in your body, the pelvic floor muscles can benefit from regular exercise. One of the most commonly recommended exercises to improve pelvic floor functioning is the Kegel exercise (Stothers & Macnab, 2010), performed by tightening the muscles as though you’re trying to shut off the flow of urine.

Though further research is needed, a 2013 study of adults with chronic low back pain found “significant benefits” for patients that combined pelvic floor exercises with treatment for their back pain (Bi et al). If you already have an exercise routine that you follow, consider incorporating pelvic floor muscle training into that routine.

Reverse Kegels

Some people have a condition called overactive pelvic floor muscle dysfunction. In this population, the pelvic floor muscles are too tight. The tight muscles can develop tender points or trigger points, which can be a driver of pain. For these people, a pelvic floor drop exercise is appropriate, also called a reverse Kegel. Instead of contracting and lifting the muscles, the muscles are purposefully relaxed and slightly dropped, or bulged downward to elongate and stretch the muscles.

Lifestyle Changes

There is a strong relationship between excess weight (particularly obesity) and urinary incontinence associated with pelvic floor dysfunction (Fornell, Wingren, & KjØlhede, 2004). In addition, a review of 65 studies on the relationship between lower back pain and body weight indicated a weak relationship between the two--though more research is needed to determine whether body weight causes pelvic pain (Leboeuf-Yde, 2000).

In addition, while heavy physical exercise (such as that in female athletes) is associated with an increased risk of urinary incontinence, one study found that a mild to moderate amount of physical activity every week can decrease the risk of incontinence--in part because of the role of exercise in maintaining a healthy weight (Townsend et al, 2008).

Because of this relationship, lifestyle changes such as exercise and weight management may help improve pelvic floor health.

Therapy

Pelvic pain can sometimes be disabling, and this can have a negative effect on your mental health. Incontinence and changes to your sexual functioning can also impact your mental health. Plus, there is a strong relationship between mental health and chronic pain; your mental health can worsen as your pain does, and vice versa (Gatchel, 2004).

Because of this relationship, many doctors will recommend personal therapy--such as pain-focused cognitive behavioral therapy--to help lessen the intensity of your pelvic pain and deal with the challenges it brings to your life. Sex therapy can also help you connect with your partner and find intimate solutions that work for both of you.

Conclusion

Pelvic floor exercises can help improve continence and sexual function--and when combined with exercises, it can also help improve pain in your hips or lower back. However, because research on the relationship between pelvic pain and the pelvic floor is still ongoing, your doctor may not mention pelvic floor exercises to help with your pelvic pain unless you ask.; Seeing a pelvic physical therapist will help move towards improvements to drastically improve your quality of life.

Amanda Thumbnail

By Dr. Amanda Olson, DPT, PRPC

 

References

  1. Jundt, K., Peschers, U., & Kentenich, H. (2015). The investigation and treatment of female pelvic floor dysfunction. Deutsches Arzteblatt international, 112(33-34), 564–574. https://doi.org/10.3238/arztebl.2015.0564
  2. Schneider, S., Randoll, D., & Buchner, M. (2006). Why do women have back pain more than men? A representative prevalence study in the federal republic of Germany. The Clinical journal of pain, 22(8), 738–747. https://doi.org/10.1097/01.ajp.0000210920.03289.93
  3. Dufour, S., Vandyken, B., Forget, M. J., & Vandyken, C. (2018). Association between lumbopelvic pain and pelvic floor dysfunction in women: A cross sectional study. Musculoskeletal Science and Practice, 34, 47-53. https://doi.org/10.1016/j.msksp.2017.12.001
  4. Eliasson, K., Elfving, B., Nordgren, B., & Mattsson, E. (2008). Urinary incontinence in women with low back pain. Manual therapy, 13(3), 206-212. https://doi.org/10.1016/j.math.2006.12.006
  5. Tamaki, T., Oinuma, K., Shiratsuchi, H., Akita, K., & Iida, S. (2014). Hip dysfunction‐related urinary incontinence: A prospective analysis of 189 female patients undergoing total hip arthroplasty. International Journal of Urology, 21(7), 729-731. https://doi.org/10.1111/iju.12404
  6. Maigne, J. Y., & Chatellier, G. (2001). Assessment of sexual activity in patients with back pain compared with patients with neck pain. Clinical Orthopaedics and Related Research (1976-2007), 385, 82-87. https://doi.org/10.1097/00003086-200104000-00014
  7. Strid, E. N., & Ekelius-Hamping, M. (2020). Experiences of sexual health in persons with hip and knee osteoarthritis: a qualitative study. BMC musculoskeletal disorders, 21(1), 1-9. https://doi.org/10.1186/s12891-020-03596-5
  8. Marques, A., Stothers, L., & Macnab, A. (2010). The status of pelvic floor muscle training for women. Canadian Urological Association journal = Journal de l'Association des urologues du Canada, 4(6), 419–424. https://doi.org/10.5489/cuaj.10026
  9. Bi, X., Zhao, J., Zhao, L., Liu, Z., Zhang, J., Sun, D., Song, L., & Xia, Y. (2013). Pelvic floor muscle exercise for chronic low back pain. Journal of International Medical Research, 146–152. https://doi.org/10.1177/0300060513475383
  10. Fornell, E. U., Wingren, G., & KjØlhede, P. (2004). Factors associated with pelvic floor dysfunction with emphasis on urinary and fecal incontinence and genital prolapse: an epidemiological study. Acta obstetricia et gynecologica Scandinavica, 83(4), 383-389. https://doi.org/10.1111/j.0001-6349.2004.00367.x
  11. Leboeuf-Yde, C. (2000). Body weight and low back pain: a systematic literature review of 56 journal articles reporting on 65 epidemiologic studies. Spine, 25(2), 226. https://doi.org/10.1097/00007632-200001150-00015
  12. Townsend, M. K., Danforth, K. N., Rosner, B., Curhan, G. C., Resnick, N. M., & Grodstein, F. (2008). Physical activity and incident urinary incontinence in middle-aged women. The Journal of urology, 179(3), 1012–1017. https://doi.org/10.1016/j.juro.2007.10.058
  13. Gatchel, R. J. (2004). Comorbidity of chronic pain and mental health disorders: the biopsychosocial perspective. American Psychologist, 59(8), 795. https://doi.org/10.1037/0003-066X.59.8.795