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Chronic Pelvic Pain

Chronic pelvic pain affects millions of men and women worldwide and unfortunately can be difficult to treat. It is typically defined as pain that occurs in the pelvis or lower abdomen for more than six months in duration. There are a wide variety of conditions that may lead to chronic pelvic pain. Many of these conditions can be treated by your primary care provider or gynecologist, but more complex conditions may require more specialized training. 

It is well known that chronic pain causes stress on the body and the mind. Chronic pain can interfere with work, relationships, sleep, exercise, and one’s ability to enjoy life. Over time, this can result in anxiety, depression, feelings of isolation, or conflict within relationships.

The Rowan Center for Chronic Pelvic Pain will thoroughly evaluate and make treatment recommendations best suited to your individual needs. The Center will also be able to connect you with physical therapists in the area that have expertise in caring for patients with pelvic floor dysfunction and a number of other conditions. Although not all causes of pelvic pain can be cured, most patients can find ways to better control their pain and improve their quality of life. 

The Rowan Center for Chronic Pelvic Pain specializes in treating conditions leading to chronic pelvic pain including:

  • Adenomyosis
  • Adhesions
  • Endometriosis
  • Interstitial cystitis
  • Nerve-related pain (neuralgias)
  • Ovarian cysts
  • Pelvic congestion syndrome
  • Pelvic floor tension myalgia

Treatment for pelvic pain will vary for each patient, but can include:

  • Medications to treat specific conditions and/or manage pain
  • Physical therapy to stretch and retrain muscles and also improve your ability to function
  • Behavioral therapy focused on pain coping skills and reducing how pain interferes with your life
  • Surgery
  • Injections or nerve blocks
  • Referrals to other specialists including pain anesthesiology, gastroenterology, urology, and interventional radiology

Dr. Spivack is a gynecologic surgeon with specific training in chronic pelvic pain and minimally invasive gynecologic surgery. Her biography can be found here

Schedule an appointment

Download our New Patient Packet for detailed information and forms you can complete prior to your visit.

Download New Patient Packet

More Information for Patients

If you would like to request an appointment with the Rowan Center for Chronic Pelvic Pain, please call 856-566-2710 to schedule an appointment. A questionnaire can be emailed, mailed or downloaded. The questionnaire has been developed to provide us with important information about your symptoms as well as your overall health. It may seem long, but the more accurate information we have, the better we are able to care for you. You do not have to complete it in one sitting.  You may feel like you have been asked some of these questions before, but chronic diseases change over time so it is important that we understand what is happening now as well as in the past. We realize that these disorders are private in nature. You do not have to answer any questions that you don’t want to; however the questions are there because they are important to help us understand your experience.  The information that we gather will be treated with confidentiality and will not be released without your consent. 

Additionally, we would appreciate any operative notes, imaging studies (ultrasound, CT, MRI), and/or pathology results related to your symptoms. If you do not have copies of these, please complete the enclosed records release form so that we may obtain them.  (You may make copies of this form if needed.) The information that you provide will help us schedule your appointment with the most appropriate provider(s) and ultimately will help us make an accurate diagnosis. We kindly request that you complete the enclosed questionnaire to the best of your ability. Once you complete the questionnaire and all supporting medical records to our office, we will contact you to schedule an appointment.

Your new patient evaluation will include consultation with a gynecologist (pelvic pain specialist). The assessment allows us to develop a comprehensive treatment plan addressing gynecologic sources of pain, musculoskeletal sources of pain, and pain interference in daily functioning. The gynecologist will formulate a treatment plan which will be discussed during your appointment to ensure agreement on the best plan of care for your individual needs. 

Gynecology/Gynecologic Surgery

The gynecologist will evaluate your pain history along with your medical and surgical histories to get a precise idea of the potential cause(s) for your pain. In some patients, this may be fairly clear. However, in others, it may take multiple appointments or evaluations to determine the cause of the pain. A thorough physical exam will be performed, and additional imaging studies may be ordered if deemed necessary by the provider. These may include ultrasound, MRI, and diagnostic nerve blocks. Typically, your physician will provide you with an initial individualized treatment plan at the end of your first visit. This may include medications, surgery, physical therapy, nerve blocks, or counseling. Follow up will be dependent on treatments recommended. Our comprehensive evaluation will be sent to your referring provider for continuity of care.

Physical Therapy

Physical therapy is often a cornerstone of treatment. We will help to connect you with physical therapists in the area that specialize in the treatment of chronic pelvic pain.

The physical therapist will perform a thorough evaluation to identify contributing causes of your pelvic pain. The initial evaluation will consist of a complete musculoskeletal assessment including posture, range of motion, strength testing, and neurologic assessment. It may also include an internal exam of the pelvic floor. An individualized treatment plan will be developed together with the patient. The treatment plan may include manual therapy/stretching, breathing exercises, therapeutic exercises, posture training, neuromuscular re-education, neuroscience education, and a detailed home exercise program. The goals of treatment will be to improve your physical function and provide symptom management strategies for you to implement on a daily basis. 

 

Episodes of worsening pain (ie pain flares) are common, especially following procedures. Try to identify if anything specific may have triggered your pain, such as an activity or change in your stress level. If you are having an increase in your chronic pain, try the following prior to calling the office:

  • Make sure you are taking all of your scheduled medications as prescribed.
  • Add in scheduled Tylenol/Acetaminophen (500mg every 6 hours) and Motrin/Ibuprofen (600mg every 6 hours) if you do not routinely take these and do not have a reason that you can’t take them.
  • Use any “as needed medications” such as muscle relaxants. You can also use Salonpas patches, Biofreeze, lidocaine patches, or a TENS unit. All of these are available over the counter. These can be useful for musculoskeletal pain. Pyridium/AZO tablets can help with bladder pain.
  • Apply heat, take a hot shower, or warm bath.
  • If you have burning pain, apply ice for no more than 20 minutes at a time. Ensure the ice is not directly in contact with your skin.
  • Distracting your mind from the pain can aid in getting through a flare. Call a friend, step outside and listen to the birds, utilize a deep breathing app (see list in the resource section).
  • Avoid long periods of rest or inactivity during a flare. Activity is good in small doses. Go for a short walk if you can or engage in stretches. Try not to rest or sleep too much during the day as this can affect your nighttime sleep and can actually make your pain worse.
  • If you are having severe pain not responding to the treatments above or if you are having fevers, heavy vaginal bleeding, chest pain, or shortness of breath, please call the office or go to the emergency room.
Online Resources for Chronic Pain Information

International Pelvic Pain Society:  
www.pelvicpain.org

Endometriosis Association:  
www.endometriosisassn.org

Interstitial Cystitis Association:   
www.ichelp.org
https://www.ichelp.org/wp-content/uploads/2015/05/AUA-IC-Guideline-September-2014-Update-final.pdf

Interstitial Cystitis Network:  
www.ic-network.com

National Vulvodynia Association:  
www.nva.org
https://www.nva.org/for-patients/
https://www.nva.org/learnpatient/

Health Organization for Pudendal Education
http://www.pudendalhope.info 

The America Chronic Pain Association
https://www.theacpa.org/
https://www.theacpa.org/pain-management-tools/

American Physical Therapy Association; Women's Health: 
https://www.moveforwardpt.com/Default.aspx

International Foundation for Functional Gastrointestinal Disorders: 
www.iffgd.org
https://www.iffgd.org/symptoms-causes/chronic-pain/8-step-approach-to-chronic-pain-management.html

TED Talk: The Mystery of Chronic Pain
An 8-minute presentation by Dr. Elliot Krane explaining how the human body can malfunction and turn the sensation of pain into the disease of chronic pain.
https://www.ted.com/talks/elliot_krane_the_mystery_of_chronic_pain

“Riddles of Chronic Pain” – a series of 5-minute presentations explaining the science of pain. https://www.youtube.com/playlist?list=PLTZj1QuWIsglkHjkAs2o6yiA-6ASaYkj6

Professional Pelvic Health-Pelvic Exercises
https://www.pelvicexercises.com.au/pelvic-floor-muscle-tension-article/

 

Online and App-based Resources for Behavioral Management of Pain

UCLA Mindful Awareness Research Center
Free guided meditations
https://www.uclahealth.org/marc/default.cfm

Guided Meditation for Pelvic Floor Relaxation | FemFusion Fitness
https://www.youtube.com/watch?v=4syPT8gMDDA

Pelvic Floor Release Stretches | FemFusion Fitness
https://www.youtube.com/watch?v=R3Rydb1nZU4

Pelvic Floor Release Stretches | FemFusion Fitness
https://www.youtube.com/watch?v=ntP8eQY74Cw

Calm Meditations

Guided meditations on a variety of topics, such as anxiety, stress management, and sleep issues. Contains mood checks, progress tracking, and non-meditation activities like deep breathing.
https://blog.calm.com/take-a-deep-breath

Stop, Breath, and Think app

Free guided activities including meditation, deep breathing, yoga, and acupressure.

Your Pace Yoga (specific for pelvic pain conditions)
https://www.youtube.com/user/PTPerspective

Guided high resonant frequency breathing
https://www.youtube.com/watch?v=eBMDwGB4HHM&t=400s

Progressive muscle relaxation:
https://www.youtube.com/watch?v=ihO02wUzgkc

Fibro-guide
https://fibroguide.med.umich.edu/

Interactive App for patients with fibromyalgia, may be useful in other pain conditions as well
Symple
https://www.sympleapp.com/

Symptom tracker

Clear Fear app (lots of CBT skills for managing anxiety)
https://www.mindful.org/

 

 

Our Providers

 
Adam S Holzberg DO FACOG Urogynecology and Pelvic Surgery Behavioral and Lifestyle Modifications Urinary Incontinence, Accidental Loss of Urine, Intertitial Cystitis, Painful Bladder Syndrome, Bowel Incontinence, Accidental Loss of Stool Urogynecology and Pelvic Surgery Botox Urinary Incontinence, Accidental Loss of Urine, Urinary Frequency, Urinary Urgency, Urinary Retention, Difficulty Urinating, Overactive Bladder, Frequent Bathroon Use, Urgent Bathroom Use Urogynecology and Pelvic Surgery Interstim Neuromodulation Urinary Incontinence, Accidental Loss of Urine, Urinary Frequency, Urinary Urgency, Urinary Retention, Difficulty Urinating, Overactive Bladder, Frequent Bathroon Use, Urgent Bathroom Use Urogynecology and Pelvic Surgery Medication Urinary Incontinence, Accidental Loss of Urine, Urinary Frequency, Urinary Urgency, Urinary Retention, Difficulty Urinating, Overactive Bladder, Frequent Bathroom Use, Urgent Bathroom Use, Intertitial Cystitis, Painful Bladder Syndrome Urogynecology and Pelvic Surgery Targeted Physical Therapy Pelvic Organ Prolapse, Dropped Bladder, Displaced Bladder, Rectocele, Cystocele, Stress Incontinence, Accidental Loss of Urine, Urinary Incontinence, Urinary Retention, Difficulty Urinating, Intertitial Cystitis, Painful Bladder Syndrome, Bowel Incontinence, Accidental Loss of Stool, Sexual Dysfunction Urogynecology and Pelvic Surgery Vaginal Slings Urinary Incontinence, Accidental Loss of Urine, Stress Incontinence Urogynecology and Pelvic Surgery Vaginal Surgery with Grafts Pelvic Organ Prolapse, Dropped Bladder, Displaced Bladder, Rectocele, Cystocele, Stress Incontinence, Accidental Loss of Urine, Urinary Incontinence Urogynecology and Pelvic Surgery Vaginal Surgery without Grafts Pelvic Organ Prolapse, Dropped Bladder, Displaced Bladder, Rectocele, Cystocele, Stress Incontinence, Accidental Loss of Urine, Urinary Incontinence Urogynecology and Pelvic Surgery Vaginal Surgery with Grafts Pelvic Organ Prolapse, Dropped Bladder, Displaced Bladder, Rectocele, Cystocele, Stress Incontinence, Accidental Loss of Urine, Urinary Incontinence Urogynecology and Pelvic Surgery Vaginal Surgery without Grafts Pelvic Organ Prolapse, Dropped Bladder, Displaced Bladder, Rectocele, Cystocele, Stress Incontinence, Accidental Loss of Urine, Urinary Incontinence