Everyone knows that muscle cramp is painful, but imagine how a muscle cramp on the inside of your hip bones might feel.
Many people with pelvic pain describe a sudden pain that can come on at any time, sometimes wakes them at night, makes them want to curl up in a ball, may go down into the legs and isn’t helped much by normal pain medications. They may have trouble walking when they have pain, and core-strength exercise often worsens it. Other people describe a sudden stabbing pain up the vagina or bowel or into the back.
While many girls, women and men have daily pelvic pain – it is when these muscles cramp that pain becomes much more severe, and they may attend the emergency department of a hospital, anxious that this pain must be a danger to their health.
People with this type of pain often find getting the help they need very frustrating. Nothing shows at laparoscopy or on an ultrasound scan, and often no diagnosis is made when they present for help, but they are exactly right; it’s a bad pain.
So why isn’t pelvic muscle spasm diagnosed easily?
Muscle spasm is well recognised in other pain conditions such as back pain or neck/shoulder pain. In these situations, the muscles affected are outside the body. They can easily be seen and examined.
The muscles involved in pelvic pain are inside the pelvis. They can’t be seen and are more complex to examine. A gentle examination with one finger in the vagina (or anus for men) to check the pelvic floor muscles and a muscle called the Obturator Internus that lies on the inside of the hip bones can find the painful muscle. There may also be tenderness of the lower back or tenderness across the back of the hips over a muscle called Gluteus Medius, but this is less common.
Short term strategies
There are short-term treatments that you can use when the pain is severe – but as soon as possible, you should work on longer-term strategies to help the muscles work normally again and avoid these severe attacks of pain.
When the pain is especially severe, useful treatments include:
- a hot bath to relax the muscles – or a hot pack if this is unavailable
- stretching using the pelvic muscle stretches for women or men you will find on this site
- keeping moving, even if just for short walks – this helps the muscles move normally rather than cramp
- an anti-inflammatory medication – as a suppository (in the bowel) if you have this available to you
- consider what may have caused the pain to be particularly bad at this time. This may include a recent increase in core-strength exercise, a urine infection or flare of painful bladder syndrome (see the information sheet on bladder pain), constipation, a painful period, and prolonged sitting or standing.
- a diazepam (valium) suppository inserted in the vagina or rectum. These suppositories should only be used occasionally, (maybe once or twice a month) as they will lose effectiveness if taken regularly.
Please do not drive or use machinery for 12 hours after using the suppository. Your doctor can prescribe these suppositories (5mg diazepam in a fatty base) for you, but they will need to be made up by a compounding pharmacist. Your doctor will know of suitable pharmacies in your area. This type of treatment should always be used under the supervision of your doctor.
Remember to always see your doctor if you could be pregnant, have a fever, or are generally unwell.
Are there treatments I should particularly avoid?
Yes. While an occasional strong painkiller from the opioid (narcotic) group can be used, these medications actually make chronic pain worse when used regularly.
Opioid medications include codeine, oxycodone, fentanyl, morphine, pethidine, hydrocodone and other related drugs.
What else could cause sudden pain on one side?
Other common causes of pain on one side include:
- Appendicitis (right side. Not usually a long-term pain)
- Ovulation pain (2 weeks before a period starts when not on the pill, and only once each month)
- A ruptured ovarian cyst (less common if you are on the oral contraceptive pill)
- An ectopic pregnancy (a pregnancy test will be positive)
- Bowel pain
- A kidney stone (there will be blood in your urine. Not usually a long-term pain)
Longer term strategies
- managing the other pelvic pain issues you have – such as painful periods or an overactive bladder
- pelvic physiotherapy to ‘down-train’ the pelvic muscles and reduce cramps.
An mp3 audio file teaching this pelvic floor relaxation technique – ‘Pelvic Muscle Relaxation Audio’ can be purchased for download from our online shop. There are separate downloads available for men and women.
The audio file features Dr Patricia Neumann, specialist pelvic physiotherapist, describing the technique of pelvic muscle relaxation. There is a 30-minute version for use when learning the techniques and for regular practice, and a 10-minute version to make daily practice possible when time is short.
For personalised care, a physiotherapist with training in pelvic floor physiotherapy will be most useful to you.
Other useful tips:
- Keep active with exercise ‘away from the core’, such as walking. This means exercise with lots of different movements. You will find suggestions for exercise on this website. Core-strength’ exercise should be avoided until you have further advice from a physiotherapist who understands this area.
- An injection of Botox or Dysport in the pelvic muscles often relieves severe pelvic muscle pain for 4-6 months if available to you. It is not a cure, but allows you time to look at other factors in your life that can be improved over this time.
