Pelvic and Coccyx Pain
Sayer Clinics pelvic pain clinics in London are the world's leading Coccyx pain, Pelvic Floor Pain, Vulvodynia, Vulvar vestibulitis and Pudendal Nerve pain specialist musculoskeletal treatment Clinics.
Michael Durtnall, the neuromusculoskeletal coccyx and pelvic pain specialist has successfully treated over 5,000 patients suffering coccyx dysfunction, pudendal neuralgia and pelvic pain over 40 years. He is uniquely experienced in successfully treating neuromusculoskeletal pelvic pain. He is expert in spinal manipulation, in spinal, sacroiliac and sacro-coccygeal digital radiological (x-ray) and pelvic ultrasound diagnosis. He treats pelvic joints, muscles, ligaments, fascia and nerve pathways using manipulation and medical acupuncture and works closely with his specialist pelvic physical therapy team
We specialise in the diagnosis and treatment of Coccyx pain, Pelvic Girdle Pain (PGP), Pelvic Floor Pain and dysfunction, Pudendal Neuralgia (PN) and Pudendal Nerve Entrapment (PNE) as well as vulvodynia, vulvar vestibulitis and unexplained neuromusculoskeletal pelvic pain in our three specialist pelvic pain clinics located in West London: Kensington W8, in Central London W1 off Wigmore Street West End and in East London at Moorgate in the City of London EC2.
Michael leads, practises and liaises closely with his exceptionally skilled Pelvic Pain Physiotherapy Team of Sofia Ornellas Pinto, Marta Dias De Oliveira, Karolina Krzaczek and Katy Goncalves who are not only excellent pelvic therapy specialist physical therapists but also the most caring, experienced and highly recommended for effective treatment of pelvic pain, vulvar vestibulitis and Pudendal neuralgia. Sayer Clinics are the leading coccyx-tailbone pain, pelvic pain and sacroiliac pain manual Physical Therapy specialists in London, UK.
Michael received unique training direct from the USA gurus of pelvic pain Dr Rhonda Kotarinos and Dr Amy Stein and shares his expertise with his Sayer Clinics Pelvic Therapy team making us the world leading non-surgical treatment clinics, painlessly resolving miserable, chronic and acute musculoskeletal coccyx and pelvic pain.
Read the 150 coccyx testimonials for Michael and his team at http://www.coccyx.org/treatmen/docsuk.htm and www.coccyx.org as well as 30 pelvic-pain patient reviews for Michael Durtnall and his team on the UK and Ireland forum of www.Pudendalhope.info.
Michael and his team are the foremost coccyx and pelvic pain diagnostic and manual treatment hands-on specialists registered with www.pelvicpain.org, www.coccyx.org, www.pudendalhope.info and listed for their specialist diagnostic and manual treatment of musculoskeletal tailbone-coccyx dislocation and dysfunction, pudendal neuralgia, pudendal nerve compression and entrapment, pubic symphysis, pelvic girdle pain and associated or referred groin, hip and pelvic floor pain.
Read here 10 years of Michael's research on coccyx.org at 'Chiropractic and Acupuncture works for acute & chronic Coccyx pain/dislocation and read his 2012 statistics on 87 consecutive coccyx and pelvic pain patients and http://www.coccyx.org/medabs/durtnall.pdf on http://www.coccyx.org/medabs/durtnall.htm
Michael has conducted extensive research into effective pelvic pain manual treatment as well as quantitative and qualitative analysis of post-partum coccyx pain (coccyx pain after childbirth). He has successfully treated multiple cases of coccyx dislocation and reset sacral fractures following ventouse and forceps deliveries in London hospitals.
Michael Durtnall's pelvic pain knowledge progressed further when he studied with New Yorker Dr Amy Stein DPT (author of 'Heal Pelvic Pain') at her workshop at the World Congress of Lower Back and Pelvic Pain in Barcelona in 2007. Dr Stein was adamant that all pelvic pain patients must first have their pelvic joints examined and, if necessary, manipulated by a specialist chiropractor. Dr Stein had herself learned from the leading pioneers of the profession as a physical therapy graduate, studying with Holly Herman who with Kathe Wallace had founded the Herman & Wallace Pelvic Rehabilitation Institute in Seattle, USA.
Michael next decided to study 'hands-on' with American pelvic pain guru Dr Rhonda kotarinos and was instrumental in inviting her to London to lecture at an intensive specialist workshop at St George's Hospital in London and afterwards they went on to treat their mutual pelvic pain patients together at Sayer Clinic: Kensington.
We are pleased to report that over the last 10 years countless patients with severe, acute and chronic musculoskeletal pelvic pain are deeply grateful for the dramatic and sustained improvement in their pelvic function along with the ability to live a normal pain-free life following a course of manipulation and physical therapy with Michael, Sofia, Marta, Karolina and Katy at Sayer Clinics.
Many GPS and doctors have not heard of pelvic-floor physical therapy. Pudendal neuralgia, coccydynia and vulvodynia can be excruciatingly painful and chronic, yet surprisingly the majority of people who suffer neuro-musculoskeletal referred pelvic pain are still treated with surgery, nerve cauterisation, cortisone injections, painkillers, anti-epileptic and antidepressant drugs which fail to resolve pelvic dysfunction but cover-up symptoms which perpetuates their misery.
GP's best help these patients by referring them first to Dr Michael Durtnall at Sayer Clinics' and his experienced pelvic-floor manual physiotherapy team for a thorough examination and clear diagnosis with pelvic rehabilitation therapy instead of surgery or 'cover-up the pain' drug treatment.
Healthy connective tissues cushion and protect blood vessels and pelvic nerves from compression.
Our manual therapy works on connective tissue restrictions caused by dysfunction or injury in muscles, pelvic nerves and joints or which develop as a reflex from malfunctioning abdominal and pelvic organs. Connective tissue which has thickened over time, reduces local blood flow and entraps or sensitises nerve endings, causing pain. When we manually release connective tissue restrictions we relieve trigger point activity and pain referred from bladder, uterus, prostate and other tissues and organs. We manually perform the pinch-roll test of the pelvis, abdomen, buttocks and thighs to finely assesses for painful tissue thickening or panniculosis and our pelvic physiotherapists use skilled connective tissue manipulation to mobilise, improve circulation, desensitise and remove negative reflex effects on muscles, nerves, organs which are ubiquitous in pelvic and coccyx syndromes in women and men.
Men and women who suffer chronic pelvic floor pain with sitting typically have widespread connective tissue thickening of their pelvic floor tissues, pubis, perineum, the inner part of the sitting bones (ischial tuberosities) buttocks, groins and inner and rear-thighs. We also examine for tissue restrictions and postural contractions of the chest, pectorals, intercostals, upper abdominal muscles and diaphragm.
Our latest 2017 super-low-dose, extreme high-definition standing digital x-rays detect and accurately measure significant leg-length difference and compensatory scoliosis with pelvic asymmetry and sacroiliac joint torsion which can often often be seen in patients suffering pubic symphysis dysfunction and coccyx and pelvic neuralgia pain. Tissue manipulation normally causes slight pain and soreness for several days after treatment, but after a few treatment sessions, the connective tissue manipulation pain diminishes and finally disappears both during and following treatment.
Sayer Pelvic Physiotherapy Team
Sayer Clinics' specialist pelvic physiotherapists, Sofia Ornellas Pinto, Marta Dias De Oliveira, Karolina Krzaczek and Katy Goncalves, are rare hands-on experts. Most NHS and private physiotherapists have not been taught these manual techniques even at post-graduate level. Successful treatment depends on very experienced therapists with expert connective tissue evaluation and individualised treatment ability.
Michael Durtnall presented the world-first workshop lecturing on Coccyx and Pelvic pain at the 8th World Congress of Low Back and Pelvic Pain in Dubai in 2013 and at the first Coccyx Symposium in Paris in July 2016 as the world expert in coccyx manipulation and rehabilitation to international medical audiences of doctors, therapists, specialists and professors to begin the process of educating the medical profession how to properly diagnose and effectively treat musculoskeletal coccyx and pelvic pain without mind-altering drugs, steroid injections or invasive surgery.
Michael Durtnall and Sayer Clinic chiropractors and physiotherapists are highly experienced in working with pregnant women. We understand the demands placed on the body during the different phases of pregnancy with many pregnant women experiencing neck pain, headaches, low back pain and leg pain. We clearly understand and expertly treat postural changes, sacroiliac, SPD or PSD pubic symphysis joint dysfunction and PPGP pregnancy-related pelvic girdle pain.
Dr Allison Hyman at our Welbeck Street, London W1 clinic is expert in Webster technique to help realign breach babies and optimise the health of the mother before birth.
Causes of chronic & acute pelvic pain and coccyx pain - coccydynia - tailbone pain:
Abdominal muscle pain (trigger points)
Nerve entrapment in Caesarian (c-section) or episiotomy scar tissue.
Spondylolisthesis - forward slippage of one lumbar vertebra on another – treated by regaining mobility/normal function of joints above and below, strengthening core muscles to minimise strain on a spondylolisthetic joint and postural changes.
Poor posture – caused by normal postural adaptation to pregnancy which is unresolved following birth - caesarian section - weak abdominals - obesity, sedentary occupation - sitting at computers - wearing high-heels.
Mechanical low back pain – lumbar facet joint pain or sacro-iliac joint pain and dysfunction - sciatic referred leg pain - athrosis - leg-length difference, muscle spasm or joint locking.
Sacrococcygeal syndrome – chronic or acute coccygeal pain – coccyx hypomobility (stiffness), minor dislocation or arthrosis causing muscular pain, spasm or weakness to coccygeus, gluteal, obturator externus / internus with typically unilateral Arcus tendinosus tension, piriformis, gluteus minimus, quadratus femoris muscle spasms as well as internal hip rotators, gluteus medius, adductor longus and brevis, pectineus, tensor fascia lata and medial hamstrings.
Coccygeal, sacral or pudendal nerve referred pain - pelvic pudendal neuralgia PN or pudendal nerve entrapment PNE:
In women - rectal or perineum pelvic floor pain, pain in the labia, internal vaginal wall muscle pain with trigger points, burning clitoris pain and persistent hypersensitivity genital arousal disorder (PGAD) or clitoral hypo-sensitivity and numbness, lower abdominal and inner thigh pain.
Constant and intense pelvic muscle spasm is central in vulvar pain via hypertonic, over-contracted perivaginal and pelvic floor muscles maintaining vaginal spasm, tension and pain with constant constrictive pressure on pelvic and pudendal nerves. Neurological pudendal and vestibular nerve compression, with the overload of arousal, intensifies pain through pain- anticipation or fear of pain as a conditioned reflex.
In men, chronic referred pain to the inner thigh, groin, pelvic floor, testicles and penis.
Muscular strains and injuries of gluteal medius, gluteus minimus or maximus muscles with hip or buttock pain or piriformis spasms may entrap the pudendal nerve or sciatic nerve. Coccygeus muscles spasm can compress the rectal branch of the nerve causing proctalgia fugax, fleeting, agonising and occasionally long-term rectal spasm and pain.
Chronic pelvic muscle spasm or tightness is often implicated in vulvar pain via hypertonic perivaginal muscles maintaining vaginal tightness and pain. Neurological pudendal and vestibular nerve compression plus desire and arousal stresses may aggravate pain through pain anticipation as a conditioned reflex.
Fractures of the sacrum or coccyx following trauma or childbirth - especially after obstetric intervention with Ventouse or forceps delivery in childbirth.
PPGP, SPD OR PSD - Pubic Symphysis Diastasis causing severe pain at the symphysis pubis in the later stages of pregnancy linked to sacroiliac joint dysfunction or subluxation is only effectively, easily and efficiently treated with chiropractic sacroiliac joint specialist manipulation.
Sayer Clinics chiropractors in London and our leading pelvic pain physiotherapists in London are the real experts in treating the agony of sacroiliac - SI joint or SIJ dysfunction - PPGP (pregnancy-related pelvic girdle pain) SPD (symphysis pubis diastasis or PSD (pubic symphysis dysfunction) and are able to treat this disabling condition very safely, swiftly and effectively - without pelvic belts, oral analgesics, injections or other largely ineffective conventional and outdated therapies.
Rectus Femoris tendon strain.
Disc bulge / herniation.
Compensatory Scoliosis associated with significant leg-length difference
Help during Pregnancy
Tailbone Mobility vs Position - We are frequently asked: Can you manipulate my coccyx back into the right position?
'It's not about a 'right position' but about regaining a pain-free, fully-functional 'range of movement' which also allows the pelvic floor and spine to function properly again to free sufferers from the grip of nerve-pain and protective muscle spasm.
If you suffer debilitating tailbone or pelvic pain, it is not unusual for a hospital specialist to tell you there is nothing wrong after an x-ray or MRI. Most doctors are not trained to, and do not, examine the coccyx properly or at all for tailbone injuries and having seen a radiology report which says there is no fracture, tumour or cancer often dismiss or misdiagnose it and label the problem as psychosomatic.
Static x-rays and MRIs show coccyx position, but not the fixed, limited or disturbed range of motion which causes coccyx pain. At Sayer Clinics, we properly examine and, having accurately assessed your digital coccyx x-rays, treat you to restore coccyx mobility and achieve excellent function of the coccyx and pelvic joints, muscles, posture and fitness.
Contact us to ask any questions or just Book Online for painless treatment to regain your health at our West London, Central London and City of London coccyx and pelvic pain clinics.
Sayer Pelvic & Coccyx Pain specialists
Our chiropractors and physical therapists are all highly qualified and fully registered health practitioners who diagnose using neurological and orthopaedic tests, chiropractic or osteopathic spinal examination and digital radiology or diagnostic Ultrasound in order to treat our patients with safe and effective manipulation, physical therapy modalities and postural rehabilitation.
Sayer Women's Health Physical Therapy Team:
Sofia Ornellas Pinto, Marta Dias De Oliveira, Karolina Krzaczek and Katy Goncalves are exceptionally skilled specialist Pelvic Pain Physical Therapists with expertise in trigger point and myofascial release for coccyx - tailbone pain, pudendal neuralgia and pelvic floor rehabilitation. We treat women from teenagers to post-menopausal. Treatments are conducted in private treatment rooms with focused hands-on therapy. Our specialist women's health physical therapists evaluate and treat pelvic pain and dysfunction with the active participation of the patient through the treatment and healing process.
We are specialised in rehabilitation treatment programmes for pelvic floor pain, abdominal muscle diastisis, incontinence, pre-natal and post-partum pelvic girdle pain, pelvic organ prolapse, sexual pain and dysfunction.
Symptoms of musculoskeletal Coccyx and Pelvic Pain we routinely and successfully treat at Sayer Clinics London:
Our patients typically suffer from 2 or more of these symptoms:
Coccyx - tailbone pain
Low back pain
Pain with sitting
Urinary Frequency - Urgency - Hesitancy
Rectal pain / Perineum pain
Male Genital Pain - parasthesia / numbness - gluteals, buttocks, pelvis, perineum, testicles, penis, lower abdomen, inner thighs.
Female Genital Pain or parasthesia / numbness - gluteals, anal pain, buttock pain, pelvic floor muscle tightness or tension or weakness, perineal burning nerve pain, vulval and labial inflammation, one or both sides internal vaginal muscle pain, contraction or weakness, clitoral hypersensitivity PGAD or insensitive, loss of clitoral sensation, clitoris pain with anorgasmia / inability to climax, lower abdomen or inner thigh pain or altered sensations - parasthesia.
Lower abdominal pain - parasthesia - tingling altered sensations in lower legs
Pelvic pain during or after sex
Pain or relief after bowel movement
Stress increases pain
Depression, anxiety or catastrophising about chronic pain
Medical tests find no pathology or disease
Drug treatments ineffective with miserable side effects
Reduced quality of life.
We describe and list below in specific detail the initial real-life experiences and symptoms of Sayer Clinics' coccyx and pelvic patients successfully treated at our clinics in London. It will help you to understand how it feels to suffer these musculoskeletal coccyx and pelvic pains syndromes.
If you suffer the symptoms below then please ask for our help at Sayer Clinics:
Almost everyone sits constantly throughout every day in cars, trains, all day at work and then socialising or at home for most waking hours. Sitting can trigger or aggravate coccyx and pelvic pain discomfort and flare all pain symptoms which worsen through the day. Travelling, flights and driving aggravates coccyx and pelvic pain.
Coccyx Pain - Tailbone pain - Coccigodynia - Coccydynia
Tailbone / coccyx pain is the most common cause of pelvic floor pain and typically refers sharp or burning pain to the anal area via the rectal nerve branch, and / or via the labial and clitoral branches and also potentially to the lower abdomen and inner thigh via the sacral or coccygeal branches of the compressed, entrapped or inflamed pudendal nerve.
The simple mechanism of pelvic pain progression is that almost everybody with coccyx pain or musculoskeletal pelvic pain sits sideways long-term to avoid the primary pain which then causes thickening and spasm of the pelvic muscles through which the pudendal nerves pass with chronic compression of the pudendal nerve/s with the whole gamut of potential and secondary referred pain along the pudendal nerve pathway.
Coccyx pain is often associated with bowel movement pain.
Low back pain is a normal part of the whole scenario in patients with pelvic pain as they all typically sit or lie awkwardly and twisted sideways on one or other buttock to avoid their pain in the pelvic floor or coccyx. This creates a torsion and imbalance with asymmetrical tension in the pelvic muscles and the lumbar spine which often leads to sacroiliac-iliac pain, facet joint pain, compensatory spinal curvature and poor posture with nerve root irritation.
Coccyx and Pudendal nerve irritation can make the sufferer feel the need to urinate and defecate multiple times a day without resolution of the sensation. This is readily curable by regaining coccyx and pelvic function along with coccygeal and sacral nerve function. It is essential to retrain our patients to stop interfering in the autonomic (automatic) control of their pelvic functions.
We heal pelvic pain at Sayer Clinics by assessing and treating the body's entire musculoskeletal structure which includes, posture, mobility, symmetry, tone and strength as well as addressing and dissolving dysfunctional thought patterns. We teach and help every patient perfect the unique 'Sayer Clinics perfect Posture' method of sitting and standing for lifelong postural perfection .
Males: pain in the perineum and at the tip and shaft of the penis or testicular pain felt in one or both testicles.
Females: pain superficially or deep inside the vagina, vulvar vestibulitis, vestibulodynia, labial-vulvar pain on both or one side or Clitorodynia, clitoral burning pain or altered sensation, parasthesia or numbness.
Pain is commonly felt along with urinary frequency and urgency.
Coccyx /pelvic muscle trigger points may refer as perineum, pelvic floor, rectal, inner thigh and lower abdominal pain.
Patients also frequently suffer thigh, calf and foot pains or paraesthesia as altered sensation - formication - like ants crawling or a sensation of water trickling on the skin. These symptoms are usually the first to go once treatment has started.
Genital pain is best resolved using a combination of specialist manipulation to correct pelvic or coccyx joint torsion or dislocation. We treat muscle / nerve compression using specialist physical therapy stretches, trigger point therapy or medical acupuncture.
Groin, pelvic, hip or abdominal pain
Groin pain needs to be diagnosed accurately and not confused with a hernia, muscle, tendon-bone insertion inflammation or hip joint CAM or PINCER pain.
Bowel movement pain
Relief after a bowel movement is experienced when tight pelvic muscles relax but often pain after a bowel movement may be stronger for many hours afterwards.
The need to defaecate sends a nerve impulse to the internal anal sphincter and puborectalis muscles to relax, triggering a bowel movement. Once the stool passes through the relaxed anal sphincter the internal anal sphincter may reflexively ‘over tighten' into painful spasm.
After-bowel-movement pain occurs less if you can learn to relax and usually resolves fully with specialist pelvic physiotherapy and pelvic muscle tension releases.
Pain symptoms can move or migrate to different parts of the pelvis as the condition progresses with pain and altered sensation in the pelvic floor, genitals, lower abdomen, inner thighs and legs.
Hot baths, showers or heat packs help whereas cold can aggravate symptoms.
Urinary frequency can range from a worry to an overwhelming urge.
A feeling of a constant subtle ache in your bladder/urethra/genitals, not feeling 'empty’ after urination and feeling a need to urinate again despite an empty bladder. The relaxed resolution normally felt after urination is often absent with pelvic pain.
Urgency - difficulty 'holding' once urge starts.
Frequency/urgency means constant worry and planning ahead to be near a toilet for fear of leaking or loss of control when the urge comes.
Urinary urgency and frequency can cause sleep deprivation with frequent waking to urinate throughout the night.
Burning or pain with urination, often with pelvic floor weakness.
When the chronic spasm and myofascial contraction of the pelvic muscles is resolved, in most of our patients, dysuria is also resolved
Pain during or after urination - Dysuria can be severely painful which refers a variety of acute pelvic pains.
Nocturia causes disturbed sleep which quickly impacts on chronic tiredness and exhaustion, irritability with increased stress, tension, guarding and anxiety.
In men a reduced stream or urinary flow may be due to prostate enlargement or neuro-musculoskeletal conditions.
Hesitancy of initiating urination can be worsened when urine is held longer than comfortable and can be a contributory symptom to low self-esteem and hypochondriasis particularly in younger males.
When urinary symptoms are muscular in origin, after relaxing the pelvic floor, the flow of urine usually improves.
Those with neuro-muscular pelvic pain may have to consciously focus on muscle relaxation until urinary flow can start.
Chronic pain in the perineum is very common in females especially after episiotomy where scar tissue is trapping nerves.
The perineum is the focal point of many pelvic floor muscle attachments and may be the endpoint or the source of referred pain.
The perineum is often injured by prolonged cycling with saddle pain and compression of the pudendal nerve/s.
Perineal pain is usually aggravated by sitting but also by standing.
Abdominal and pelvic muscles can refer pain to the perineum (rectus abdominus, adductor magnus, and coccygeus).
Irritation of the perineum and anal sphincter can feel like you're “sitting on a golf ball".
Increased discomfort for hours or even the next day after sexual activity is common as orgasm causes strong contractions of the pelvic, prostate and seminal vesicle muscles with significant nervous system arousal which tightens pelvic muscles, pushing the patient above the symptom threshold.
PERSISTENT GENITAL AROUSAL DISORDER (PGAD)
Persistent genital arousal disorder (PGAD) is felt as spontaneous sensations of clitoral or vulval arousal with engorgement, pulsing or throbbing sensations in the vulva, perineum or anus without conscious sexual thoughts or desire.
PGAD ranges from mild to severely incapacitating.
Assessment and diagnosis of PGAD requires care and consideration of the patient. PGAD may be linked with neurological, vascular, physiological, pharmacological and psychologic factors.
PGAD may follow trauma, or surgery, pudendal nerve entrapment, spinal disc bulges or compressed nerves and pelvic blood vessels.
Effective Physical Manual PGAD Treatment
Once PGAD has been diagnosed, often with pudendal nerve involvement or local clitoral phimosis or constriction, expert manual release of constrictive tissues around the clitoris and the highly complex pudendal nerve pathway to release tissue entrapment results in rapid resolution of PGAD symptoms in some cases and more gradual improvement in others. Pelvic floor physical therapy and rehabilitation with practical advice and support is essential.
Pain with sexual activity either during or after sex -pain is felt on the outside of the vagina, inside or both with potential clitoral hypersensitivity or complete insensitivity or numbness.
Pelvic examination in which trigger points are palpated can recreate symptoms of pain during sex but are resolved by trigger point release physical therapy.
Reduced or a total lack of interest in sex is common with chronic pelvic pain.
In musculoskeletal pelvic pain, there is dysfunction but rarely any pathology of the anatomy involved in sexual activity.
Low libido is often associated with anxiety, low self-esteem and pain in the pelvis which reduces sexual arousal and interest.
Effective physical treatment of pelvic pain and dysfunction of the pelvic muscles usually resolves low libido.
When sex is chronically painful, fear and avoidance of sex follows.
Pain can cause difficulty with erection which worsens already low esteem and confidence. Anxiety with pain and sex is a major reason for performance anxiety and is ‘medicalised’ as erectile dysfunction.
Resolution of pelvic pain usually cures the anxiety and erectile dysfunction normalises.
Pelvic and coccyx pain patients are usually worried that they will never improve and catastrophise, fixate and over-focus on the pain which leads to an increasingly powerful and chronic 'centralisation of pain in the brain' which is harder to cure, needing a great deal of practitioner support and focus to break through the fear-pain cycle.
Experiencing severe chronic pelvic pain leads to depression, low esteem and hopelessness, with helplessness and the inability to act to move forward, research, find the right treatment and follow through to resolution.
Sexual and social withdrawal with chronic coccyx or pelvic pain is common and also affects their partners who suffer the loss of sex, socialising, holidays and travel. Preoccupation with pain kills any fun and social enjoyment.
Disturbed Sleep with frequent waking during the night to pee or from pain and anxiety means each day starting with tiredness and anxiety.
Normal daily activity as well as unexpected stresses, specific physical activities such as bowel movements or orgasm can initiate severe pain flares with deep pelvic muscle protective spasms for many hours after the initial stress has passed. Long term these protective spasms make muscles fibrotic and hypersensitive to pain.
Helplessness naturally follows the seemingly permanent lack of control of the chronic pain which makes you feel hopeless, demoralised, fearful and banishes most of your enjoyment of life.
Benzodiazepines are associated with an increased risk of Alzheimer’s disease while tricyclic antidepressants like Amitryptalline and neural drugs called Gabapentin, Neurontin or Pregabalin have potentially disturbing side effects and when used regularly for chronic pelvic pain, become less effective with time and can cause tiredness, lethargy and large weight gain.
Psychological factors can cause anorgasmia.
• Performance anxiety
• Cultural beliefs
• Religious 'shame or guilt'.
• Stress, relationship, work or money problems
• Fear of pregnancy or sexually transmitted diseases.
• Dysfunctional pubococcygeus (PC) muscles inhibited by coccyx pain or sacroiliac joint and pelvic muscular dysfunction.
• Sexual abuse
Anorgasmia - Total inability to orgasm or difficulty achieving orgasm is a complex reaction to multiple physical and emotional factors:
Simple neuromusculoskeletal nerve compression and muscle spasm due to pelvic joint and muscle asymmetry may compress or constrict the blood and nerve supply to the pelvis leading to pudendal neuralgia or neuropathy as one of many pelvic symptoms or signs of pudendal neuralgia.Spinal nerve compression or irritation in the lumbosacral spine may also cause pelvic neuralgia and impede orgasm.
Hypothyroidism, Addison disease, Cushing syndrome, hyperprolactinemia, hypopituitarism, decreased oestrogen and androgen levels and a whole host of commonly prescribed medications commonly negatively affect libido.
Climax may be impacted by pregnancy, gynecologic surgeries and hysterectomy. Anorgasmia can result from painful intercourse as well as female genital mutilation (FGM), pelvic trauma, hormonal imbalances, vulvodynia, and childbirth trauma.
The following pelvic disorders may also give rise to anorgasmia:
Vaginal dryness occurs in menopause due to lowered estrogen level with poor lubrication and the side-effects of commonly-prescribed medications which can inhibit arousal and making intercourse painful.
Vaginismus – is painful spasm and tightening of muscles at the vaginal opening which prevents or make penetration extremely painful. Vaginismus may also follow surgical scars or injury, abuse, chronic infection, childbirth trauma, anxiety and fear.
Nerve damage following surgery
During pelvic surgery and hysterectomy, small nerves will be cut which may decrease sexual response and sensation.
Many prescription medications impede orgasm. These include drugs for blood pressure antihistamines, anxiolitics, anticonvulsants and barbiturates, Venlafaxine and many antidepressants especially selective serotonin reuptake inhibitors (SSRIs) like Prozac and Zoloft.
Post-SSRI sexual dysfunction causes up to 41% of women taking SSRIs to experience lowered libido up to anorgasmia.
Research has shown a sexual and orgasm dysfunction rate of 16-27% for quietiapine, aripiprazole, ziprasidone and perphenazine with 40-60% for haloperidol, clozapine, olanzapine, thioridazine and risperidone. Decreased libido and anorgasmia are reported for beta-blockers as well as carbamazepine, benzodiazepines, phenytoin, gabapentin, pregabalin and topiramate.
Alcohol and cocaine, marijuana, amphetamines, opiates, heroin, street drugs and tobacco cause vascular and neurological damage which can affect sexual function and ability to orgasm.
Ageing gradually changes neurological, hormonal and circulatory systems which impact sexuality leading up to menopause with lowering of oestrogen causing reduced sensation of nipples, clitoris and reduced blood flow to clitoris and vagina.
Psychological causes of sexual dysfunction and anorgasmia.
Performance anxiety • Embarrassment • Cultural beliefs • Religious 'shame and guilt'. • Stress, relationship, work or money problems • Fear of pregnancy or sexually transmitted diseases. • Dysfunctional pubococcygeus (PC) muscles inhibited by coccyx pain or sacroiliac joint and pelvic muscular dysfunction.• Sexual abuse • Depression.
Disagreements about money, childcare or control and issues including infidelity and lack of trust, unresolved conflict, loss of emotional connection with partner, poor communication of sexual preferences and needs and sexual boredom can often lead to chronic sexual dysfunction and anorgasmia.
In our opinion, drugs, injections and chemical or electrical burning of nerves (radio frequency ablation) is not a good way to treat chronic neuromusculoskeletal conditions. They suppress and cover up pain symptoms, allowing the patient to continue being trapped in a pain-generating cycle with continued inactivity, overweight, poor posture and progression of the condition. The patient will lose control over their health under the influence of these drugs. We help by educating you to understand how to reduce pain logically and to physically regain control and fitness.
FIRST choose neuromusculoskeletal Pelvic Pain assessment, treatment and advice at Sayer Clinics - London and Europe's leading pelvic pain clinics. The neuromusculoskeletal system is most commonly the cause of chronic and severe pelvic pain and sexual dysfunction so use Sayer Pelvic Pain Clinics physical neuromusculoskeletal manual therapy treatment FIRST for male or female pelvic pain or sexual dysfunction.
Common Symptoms of pelvic pain include:
Vulvar vestibulitis, vaginal pain, clitoral pain, perineal or anal pain
Dyspareunia - pain during sex - pain after sex
Labial, vulvar or genital pain, altered sensation - burning pain or itching
Pain on urination, urinary hesitancy, urgency and/or frequency
Lower abdominal, groin, inner thigh pain or altered sensation
Sacroiliac joint pain, locking or instability
Pain on wearing jeans or underwear
Pain with sitting
Muscular pelvic pain with exercise
Associated or alternate Diagnoses:
Interstitial Cystitis - Painful Bladder Syndrome
Vulvodynia - Vestibulitis - Vestibulodynia
Clitorodynia, clitoral burning pain or altered sensation, parasthesia or numbness
Persistent Genital Arousal Disorder (PGAD)
Proctalgia Fugax - stabbing or shooting rectal pain
Irritable Bowel Syndrome
Tailbone pain - Coccydynia
Sacroiliac Joint Dysfunction
Pelvic Girdle Pain
Evaluation and Treatment at Sayer Clinics:
During your first "evaluation appointment,” we take your extensive medical history and perform a thorough musculoskeletal examination.
Your initial evaluation includes:
-- Postural, pelvic joints, spinal and structural assessment
-- Evaluation of fascia and connective tissue in the abdomen, back, pelvis and lower extremities
-- Myofascial evaluation of the pelvic girdle muscles
-- Examination to identify myofascial trigger points in the pelvic girdle and pelvic floor muscles
-- Pelvic floor examination by gently assessing muscle tone, motor control and tenderness.
-- Evaluation of pelvic floor muscle strength
-- Pelvic skin inspection
Following your physical examination, our therapist discusses your physical findings, assesses and explains the treatment frequency and probable duration of therapy.
Initially, treatments are 60-90 minutes long over eight weekly sessions. We then re-evaluate, and set further treatment plans and goals depending on progress. Patients with pelvic pain are typically seen for a minimum of 12 visits but the duration may vary based on the severity and chronicity of the problem.
Treatment at Sayer Pelvic Pain Clinics is one-on-one manual physical therapy with a multidisciplinary treatment approach with email access to your therapist to answer questions, address your concerns and provide you with ongoing support. We are committed to ensure that you receive the best treatment possible to help you to get well.
Sayer Clinics Manipulation and Pelvic Physical Therapy Treatments include:
Trigger point release
Musculoskeletal pelvic joints manipulation
Dry needling, Medical or Japanese Acupuncture
Scar massage, mobilisation & de-sensitisation
Re-education of pelvic floor and nerve function
Restoring tone and function of abdominal core muscles
Sayer Clinics Physiotherapists are HCPC registered with Health & Care Professions Council and registered with most insurers.
Michael Durtnall is registered with Bupa, BUPA International, Aviva and most international insurance companies.
Please check with us and with your insurers before starting treatment.
Please choose from the three Sayer Clinics in London W8, W1 or EC2, research at www.sayerclinics.com and choose your practitioner/s, choose dates and times and then book and pay online at www.sayerclinics.com for your treatment appointments. We will email you a confirmation email and issue you receipts to help you to reclaim from your insurers.
Book Online 24/7 here for Sayer Clinic Kensington W8, Moorgate EC2 in the City or Welbeck Street W1
Please call Alexandra or Lucie on 020 7937 8978 from 8am-8pm Monday to Friday and Saturdays 9am-2pm or email firstname.lastname@example.org to ask us any questions.
Sayer Pelvic Pain Clinics' unique neuromusculoskeletal approach to Pelvic pain.
Pelvic pain is often the result of nerves becoming chronically compressed, irritated and inflamed. This is commonly due to long-term, slumped sitting positions, compressing nerve pathways where they exit the lower sacrum and coccyx, with burning nerve pain into the deep and superficial pelvis, which is served by a multitude of nerves including the rectal, perineal and pudendal nerves. This nerve damage instructs the coccygeus, piriformis and deep gluteal muscles to contract to protect the nerves with resulting self-perpetuating, deep muscle spasms deep in the ischium or “sitting bones” area of the pelvis. Chronic referred pain or neuralgia may be felt in the genitals, perineum, abdomen and buttocks. Pain is increased by sitting,usually one-sided but often both sides are involved. Symptoms may include pain, burning, numbness and paraesthesia in the pelvis near the sacrum and coccyx, which can radiate throughout the pelvic floor, inner thigh, lower abdomen and groin.
The first step, in consultation with your GP, is obviously to exclude any previous pathological, urological or gynaecological causes of your pelvic pain. Once these have been eliminated as a source or cause of the problem, the persistent symptoms of pelvic pain can be examined and often successfully treated by a multi-disciplinary team of manipulation therapists and physiotherapists.
Diagnosis depends on a thorough history and physical examination of the complex interaction between all structures leading inevitably to complex dysfunction throughout the body. Leg-length differences of a centimetre or more, for example, can cause significant pelvic tilt and shearing forces at the sacro-iliac and hip joints which in time can cause degenerative changes in these joints. We can address this with graduated heel-lifts to balance the leg-length and spine.
Following a thorough initial chiropractic musculoskeletal evaluation and digital standing x-ray's to confirm your diagnosis we use specific connective tissue manipulation, acupuncture or myofascial release to reduce muscle spasm and nerve compression and consequent inflammation. Specific joint manipulation, physical therapy ‘nerve tissue tension releases’, neural mobilisation and local medical acupuncture help regain function. Misalignment or fixation of the pelvis, sacro-iliac joints, facet or sacro-coccygeal joints with associated muscular spasms are usually interrelated factors.
The compression or irritation of obturator, ilioinguinal or genito-femoral nerves can cause intermittent and poorly localised shooting or burning pain in the pelvis, front and inner thighs aggravated even by light touch in the nerve distribution. Treatment with pelvic joint mobilisation, deep muscle trigger points and acupuncture, stretches and exercises help to resolve this nerve irritation. Referral for surgery to release a trapped nerve is extremely rarely necessary.
A variety of medical terms exist to describe Chronic Pelvic Pain Syndromes (CPPS): these include Pudendal Neuralgia; Pudendal Nerve Entrapment; Chronic Prostatitis; Interstitial Cystitis; Proctalgia fugax, Levator Ani syndrome, as well as Vulvodynia and Clitoral pain, hypo-sensitivity or hypersensitivity. However, these pain syndromes are often over-confidently and simplistically labelled yet poorly understood with vague diagnostic tests and pain-masking treatment.
Sufferers consult urologists, neurologists, gynaecologists, dermatologists, proctologists, rheumatologists and orthopaedic surgeons to treat their symptoms which are in most cases secondary to inter-dependent neuro-musculoskeletal causes. As a result, symptoms almost always return in some form or are never completely eliminated. Urinary symptoms, for example, are often treated with antibiotics, despite no positive culture, but symptoms will return if they are secondary to biomechanical, neurological or visceral dysfunction.
A diagnosis of pudendal nerve entrapment (PNE) by a neurologist usually leads to nerve block injections and drugs to dull the brain's perception of pain. This will temporarily mask symptoms yet allow the patient to keep compressing and damaging their nerves, while unaware of the pain. Invasive surgery may cause fibrotic scar tissue in skin, muscle and fascia and cutting of pelvic ligaments can permanently lessen pelvic stability. There are multiple entrapment sites within the pelvis which are not best addressed by surgery but by expert manual therapy.
Our unique clinical experience over the years has shown us that these pelvic pain conditions are very closely interrelated and associated with often simple factors such as: connective tissue, fascia and ligament laxity; prolonged sitting and physical inactivity (due to job/lifestyle); pelvic asymmetry; previous (forgotten) falls and other injuries from years before. Biomechanical muscular imbalance from prolonged slumped, asymmetrical sitting, cycling, weight-training and repetitive strains to the pelvic floor, sacroiliac and coccygeal joints can cause muscular spasm, hypertonicity and painful thickened, fibrotic myofascial adhesions with the potential to trap the pudendal and perineal nerves within these deep pelvic muscles. The Pudendal nerve is extremely specialised, controlling a complex web of urogenital sexual sensation and function, control of bladder and pelvic floor muscular function plus fascial connections to pelvic and abdominal viscera. The pudendal nerves as well as the urethra pass through pelvic fascial structures and may be compressed or irritated if pelvic fascia, internal pelvic muscles or ligaments to the bladder, prostate, urethra, rectum, anus, pubis, sacrum and coccyx are in pain and spasm.
We have found that complex and varied pelvic pain syndromes respond best when each and every patient is treated individually and differently at each treatment visit according to their current situation. Some need very specific manipulation of the sacroiliac and coccyx joints, others need firm external treatment to regain flexion of their almost fused and extended sacro-coccygeal joint. Most also need very deep tissue trigger point work to usually one-sided gluteal, coccygeus and deep pelvic muscles which have thickened and are compressing pelvic nerves. These muscles have usually become deeply fibrotic and pain sensitive, after years or decades of sitting sideways (usually on the same side). Some are so exquisitely painful that they can hardly be touched, so we start using light medical acupuncture, gradual and super-gentle soft tissue work and, finally, progress to internal or external pelvic joint, muscle and ligament manipulation.
We use a flexible, inquiring approach in our clinical practice without preconceptions or foregone conclusions about how treatment has to be. Our treatment is based on clear musculoskeletal findings following experienced physical examination and digital standing x-rays. We treat in a multi-disciplinary way, with a combination of chiropractic, acupuncture, osteopathy and pelvic physical therapy. We use localised medical acupuncture with very specific, frequent and increasingly intensive rehabilitation exercises.
For example, we recommend specific active movement every half hour throughout each day to regain fitness of joints, muscles, ligaments, tendons and nerves. We ask patients to stand and move while working, to adapt so that they stop sitting so much for prolonged hours. “Sofa surfing” after work is discouraged, as is taking prescription drugs to mask pain, putting on weight, becoming morbidly inactive and losing hope.
Our experience over 35 years allows us also to use words, ideas and motivation - what some would now call “mindfulness” - to increase confidence and fitness by degrees, empowering our patients to become pain-free and regain control over their bodies and general well-being. We certainly do not believe in covering or blocking pain as a short-term goal for short-term pain relief.
Patients describe pelvic pain as like being in an abyss; it is very dark, deep and depressing but the need for mental clarity to climb out of this is an imperative. Our role as therapists is to help in this struggle for recovery. I ask my patients why they think we are successful in treating their pelvic and pudendal pain. They tell me that Sayer Clinics are incredibly “hands-on”; that we are comprehensive in our musculoskeletal diagnostics; that we ceaselessly re-examine and reappraise the symptoms of joint locking, muscle spasms, asymmetry and range of movement of the pelvis and coccyx; and that we search out and firmly tackle poor health behaviour and bad ergonomics that largely cause the maelstrom of pelvic pain.
Everybody who suffers from pelvic pain is overwhelmed with diagnostic words: pudendal neuralgia, interstitial cystitis, proctalgia, vulvodynia. Let's keep it simple: the pelvis is a basin, served by nerves and blood vessels and moved by muscles with complex stresses shared between joints and ligaments. There are only so many things that can cause pain; if it isn’t infection, if it isn't a skin disorder and if it isn't cancer then the chances are that it has a neuro-musculoskeletal basis. This means that most pelvic pain can be physically solved and effectively treated.
Michael Durtnall DC MSc (UCL) FRCC (Orth)
Chairman Sayer Clinics: London
Fellow Royal Society of Medicine
Sayer Clinics Summary of Intense Treatment
Generally, patient treatment may range from daily or 2-3 visits per week if fairly local to those who visit weekly, fortnightly or monthly.
Sayer Clinics' intense protocol condenses therapy traditionally spread over the course of months into 1-3 weeks, to keep it practicable for those travelling from very distant locations and reducing the need for subsequent trips. The initial intense treatment protocol comprises one to three weeks of daily therapy for those travelling from afar with:
• Spinal and Pelvic Manipulative Therapy 5 days/week, depending on patient response and tolerance.
• Manual Physical Therapy and Pelvic Active Release Techniques 5 days/week, depending on patient response and tolerance.
• Lifestyle Modifications.
• Exercises and Dietary Interventions.
• Education of causes, aggravating factors, strategies for management and prevention.
• Biomechanical Correction of lower limb, spinal and pelvic biomechanical gait anomalies.
Each of the above therapies follow scientific evidence in the treatment of pelvic pain syndromes, however none have been combined in such an intensive, focussed way which we find to be extremely successful in patient pain scores and improvement of tissue and joint function outcomes.
Sayer Clinics are world-leading Pudendal Neuralgia, Coccyx pain and Pelvic Pain Specialist Manual Clinics
First book at Sayer Clinic: Kensington W8 to see Dr Michael Durtnall for your initial consultation, x-rays or diagnostic ultrasound and to start effective treatment. Michael combines specific rehabilitation with our highly skilled specialist pelvic and coccyx pain Physical Therapists, Sofia Ornellas Pinto, Katy Goncalves, Karolina Krzaczek and Marta Dias de Oliveira at Sayer Clinics EC2, W1 or W8.
If you suffer coccyx or musculoskeletal pelvic pain or sexual dysfunction Michael Durtnall and his specialist colleagues will do everything to help you. We successfully treat patients every day who travel to us from all over the globe. If we consider that we are unable to help you ourselves, we will rapidly refer you to specialists best able to help you.
We are sure the sooner you start treatment and change your flexibility, posture, mentality, lose pain, gain positivity, exercise and fitness the sooner you will achieve and maintain great future health!
Book online 24/7 here or email email@example.com or call Alexandra or Lucie on 0207 937 8978.
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