Advanced Pelvic Pain Management: Beyond Traditional Treatments

If you're one of the millions of women suffering from chronic pelvic pain, you know how frustrating it can be when conventional treatments fall short. You've likely tried pain medications, hormones, physical therapy, and perhaps even surgery—yet the pain persists, affecting your quality of life, relationships, and ability to work or enjoy daily activities.

As a board-certified gynecologist with fellowship training in minimally invasive surgery, I've performed hundreds of surgeries for pelvic pain. But I've also learned that surgery isn't always the answer. Sometimes, the most effective treatments target the nervous system and fascial planes directly, addressing the pain signals at their source.

At OrthoLiving, I now offer advanced interventional techniques for pelvic pain that many gynecologists don't provide, including Frankenhauser plexus blocks, pelvic trigger point injections, and hydrodissection techniques. These treatments can provide significant relief—often immediately—for women who have been told "there's nothing more we can do."

Understanding Chronic Pelvic Pain

Chronic pelvic pain is defined as non-cyclic pain lasting more than six months that is severe enough to cause functional disability or require medical treatment. It affects approximately 15-20% of women and accounts for significant healthcare costs, lost productivity, and diminished quality of life.

The causes are often multifactorial:

• Endometriosis

• Pelvic inflammatory disease

• Adhesions from previous surgery or infection

• Pelvic floor dysfunction

• Nerve entrapment or irritation

• Interstitial cystitis/bladder pain syndrome

• Vulvodynia

• Central sensitization (the nervous system becomes hypersensitive)

One of the challenges with chronic pelvic pain is that even after the initial cause is treated, the nervous system may continue generating pain signals. The nerves themselves become irritated, inflamed, or hypersensitized, creating a cycle of pain that persists independently of the original problem.

This is where targeted nerve blocks and interventional techniques become invaluable.

Frankenhauser Plexus Block: Targeting the Pain at Its Source

The Frankenhauser plexus, also called the uterovaginal plexus or inferior hypogastric plexus, is a complex network of autonomic nerves located deep in the pelvis. This nerve plexus innervates:

• The uterus and cervix

• Upper vagina

• Bladder

• Rectum and lower bowel

• Pelvic floor structures

When this plexus becomes irritated—whether from endometriosis, adhesions, infection, surgery, or other causes—it can generate significant chronic pain that affects all of these structures.

Why This Plexus Matters

The Frankenhauser plexus is rich in both sympathetic and parasympathetic nerve fibers. When functioning normally, it coordinates the complex interactions between pelvic organs. When dysfunctional, it can create:

• Deep, aching pelvic pain

• Pain with menstruation (dysmenorrhea)

• Painful intercourse (dyspareunia)

• Bladder urgency and pain

• Bowel discomfort

• Pain that radiates to the lower back, hips, or thighs

• Sensation of pelvic heaviness or pressure

The pain pattern can be constant or intermittent, and often worsens with activities that increase pelvic pressure such as intercourse, bowel movements, or prolonged sitting.

The Frankenhauser Plexus Block Procedure

This procedure involves carefully injecting local anesthetic into the area where the Frankenhauser plexus is located, typically approached transvaginally under ultrasound guidance or using anatomical landmarks.

The Process:

1. Positioning: You'll be positioned similarly to a pelvic exam

2. Preparation: The vaginal area is cleaned and prepared

3. Injection: Using precise anatomical knowledge or ultrasound guidance, local anesthetic is injected into the posterolateral vaginal fornix where the plexus is located

4. Duration: The procedure takes just minutes

5. Recovery: You can typically return to normal activities the same day

What to Expect:

Many women experience immediate pain relief as the anesthetic blocks the pain signals from this nerve plexus. This can be both diagnostic (confirming that this plexus is involved in your pain) and therapeutic.

The relief may last from several days to several weeks or even months. With repeated treatments, the nervous system can establish new patterns, and the duration of relief often extends. Some women experience long-lasting relief after a series of treatments.

Evidence for Effectiveness

Research on pelvic nerve blocks has shown promising results:

• A 2018 study in Pain Physician found that superior hypogastric plexus blocks (a related technique) provided significant pain relief in patients with chronic pelvic pain, with effects lasting several months in many cases

• A 2020 review in Journal of Minimally Invasive Gynecology noted that targeted nerve blocks can be highly effective for chronic pelvic pain, particularly in patients who haven't responded to conservative treatments

• Clinical experience in pain management and integrative gynecology demonstrates that these blocks can provide substantial relief for women suffering from debilitating pelvic pain

• The technique is increasingly recognized as an important tool in the comprehensive management of chronic pelvic pain syndromes

Pelvic Trigger Point Injections: Releasing Muscle-Based Pain

While nerve blocks address the nervous system, trigger point injections target another common source of pelvic pain: myofascial trigger points in the pelvic floor and surrounding muscles.

Understanding Pelvic Floor Trigger Points

Trigger points are hyperirritable spots in taut bands of muscle that can cause local and referred pain. In the pelvis, these commonly develop in:

• Levator ani muscles

• Obturator internus

• Piriformis

• Iliopsoas

• Pelvic sidewall muscles

These trigger points can develop from:

• Chronic muscle tension and guarding (often in response to pain)

• Direct trauma (including childbirth)

• Surgical procedures

• Chronic inflammation

• Poor posture and movement patterns

• Stress and anxiety (which increase muscle tension)

How Trigger Points Create Pain

Pelvic floor trigger points can cause:

• Deep pelvic pain

• Pain with sitting

• Painful intercourse

• Urinary urgency and frequency

• Bowel dysfunction

• Pain that radiates to the lower back, hips, or inner thighs

• Sensation of pelvic pressure or "something there"

The pain from trigger points is often described as deep, aching, and persistent. It may worsen with activities that engage the affected muscles.

The Trigger Point Injection Technique

Pelvic trigger point injections can be performed transvaginally or transrectally, depending on which muscles are involved.

The Process:

1. Identification: Through careful examination, I identify the specific trigger points causing pain

2. Preparation: The area is cleaned and prepared

3. Injection: A small amount of local anesthetic is injected directly into each trigger point

4. Release: The needle insertion itself, combined with the anesthetic, helps release the taut muscle band

5. Follow-up: Often combined with pelvic floor physical therapy for lasting results

What Makes This Different:

Unlike external trigger point injections, pelvic floor trigger points must be accessed internally. This requires specialized training in pelvic anatomy and careful technique to ensure safety and effectiveness.

Evidence Base

Research supports the use of trigger point injections for pelvic pain:

• A 2014 study in Clinical Journal of Pain found that pelvic floor trigger point injections significantly reduced pain in women with chronic pelvic pain

• A 2016 review noted that trigger point therapy (including injections) can be highly effective for myofascial pelvic pain, especially when combined with physical therapy

• Multiple case series have documented improvements in pain scores, sexual function, and quality of life following pelvic floor trigger point treatment

Hydrodissection: Creating Space for Healing

Hydrodissection is an advanced technique that involves injecting fluid (typically normal saline combined with local anesthetic) to separate tissue planes that have become stuck together due to adhesions, scarring, or inflammation.

The Problem with Adhesions

Adhesions are bands of scar-like tissue that form between surfaces that should normally glide freely past each other. In the pelvis, adhesions can develop from:

• Previous surgery

• Endometriosis

• Pelvic inflammatory disease

• Radiation therapy

• Chronic inflammation

These adhesions can:

• Cause organs to stick together or to the pelvic sidewall

• Trap or compress nerves

• Restrict normal movement and function

• Create chronic pain

How Hydrodissection Works

Hydrodissection uses the mechanical force of fluid injection to gently separate adhered tissue planes. The process:

1. Identifies areas where tissues are abnormally stuck together

2. Injects fluid at the interface between tissues to mechanically separate them

3. Creates space for tissues to move independently again

4. Delivers local anesthetic to reduce pain and inflammation in the separated area

5. Promotes healing by improving blood flow and reducing chronic inflammation

The Technique:

Using ultrasound guidance or anatomical landmarks, I inject a solution of saline and local anesthetic into the fascial planes where adhesions are suspected. The fluid creates separation, allowing tissues that were stuck to glide freely again.

This can be particularly effective for:

• Post-surgical pain related to adhesions

• Endometriosis-related adhesions

• Nerve entrapment by scar tissue

• Painful cesarean section scars

• Pain from previous pelvic surgery

Why This Approach Works

Traditional surgery to release adhesions often creates new adhesions—it's a frustrating cycle. Hydrodissection offers a non-surgical approach to address adhesions without creating new scar tissue. The local anesthetic also provides immediate pain relief while the mechanical separation addresses the underlying problem.

Combining Techniques for Comprehensive Pain Management

The most effective approach to chronic pelvic pain often involves combining these techniques based on your specific pain patterns and underlying causes:

For Nerve-Mediated Pain:

• Frankenhauser plexus blocks for deep uterine/vaginal pain

• Additional nerve blocks for specific nerve entrapments (pudendal, ilioinguinal, genitofemoral)

For Muscle-Based Pain:

• Trigger point injections in affected pelvic floor muscles

• Combined with pelvic floor physical therapy for lasting relief

For Adhesion-Related Pain:

• Hydrodissection to separate adhered tissues

• Serial treatments to maintain tissue mobility

For Complex Pain:

• A combination of all techniques targeting different pain generators

• Integration with hormone optimization, anti-inflammatory nutrition, and stress management

What to Expect from Treatment

Initial Consultation

During your first visit, I'll conduct a comprehensive evaluation including:

• Detailed pain history (location, quality, timing, triggers)

• Thorough pelvic examination to identify tender areas, trigger points, and potential nerve involvement

• Review of previous treatments and their effectiveness

• Discussion of your goals and expectations

Treatment Plan

Based on this evaluation, I'll develop a personalized treatment plan that may include:

• One or more types of injections targeting your specific pain sources

• Number of treatments anticipated (often a series is most effective)

• Complementary therapies (pelvic floor physical therapy, hormone optimization, nutritional support)

• Timeline for expected improvement

During Treatment

Most women tolerate these procedures well. You may experience:

• Brief discomfort during the injection (similar to a pelvic exam)

• Immediate pain relief in many cases

• Mild cramping or soreness afterward (typically resolves within 24 hours)

• Ability to return to normal activities the same day

After Treatment

Short-term:

• Many women notice immediate improvement

• Some experience a "honeymoon period" of significant relief followed by gradual return of some pain (this is normal and often improves with repeated treatments)

• Mild spotting or discharge is normal after transvaginal procedures

Long-term:

• Progressive improvement with repeated treatments

• Decreasing frequency of pain episodes

• Improved function and quality of life

• Many women can reduce or eliminate pain medications

• Better response to other therapies (physical therapy, exercises)

Who Are Good Candidates?

These interventional techniques may be particularly helpful if you have:

• Chronic pelvic pain lasting more than 6 months

• Pain that hasn't adequately responded to conventional treatments

• Specific pain patterns suggesting nerve or muscle involvement

• History of pelvic surgery, endometriosis, or pelvic inflammatory disease

• Desire to reduce reliance on pain medications

• Willingness to participate actively in your treatment (including follow-up physical therapy when indicated)

Safety and Side Effects

These procedures are generally very safe when performed by an experienced practitioner. Potential side effects are typically mild and may include:

• Temporary increase in pain at injection sites

• Mild bleeding or spotting

• Bruising

• Lightheadedness (uncommon)

• Infection (rare with proper technique)

Serious complications are extremely rare.

Beyond Pain Management: Comprehensive Women's Health

At OrthoLiving, I view pelvic pain as one component of overall health. The most successful outcomes occur when pain management is integrated with:

Hormone Optimization: Proper estrogen, progesterone, and testosterone levels can significantly impact pain perception, tissue health, and healing capacity.

Anti-Inflammatory Nutrition: What you eat directly affects inflammation levels and pain sensitivity.

Stress Management: Chronic stress increases muscle tension, amplifies pain signals, and impairs healing.

Sleep Optimization: Poor sleep worsens pain and reduces your body's ability to heal.

Movement and Exercise: Appropriate movement helps maintain tissue mobility and reduces pain, while excessive or improper movement can worsen it.

Pelvic Floor Physical Therapy: Often essential for maintaining the benefits of trigger point injections and addressing underlying muscle dysfunction.

A New Approach to Pelvic Pain

For too long, women with chronic pelvic pain have been told that their only options are pain medications, hormones, or surgery. While these certainly have their place, many women need and deserve more targeted, less invasive options.

The interventional techniques I offer—Frankenhauser plexus blocks, trigger point injections, and hydrodissection—provide powerful tools for addressing the underlying causes of pelvic pain without the risks and recovery time of surgery.

Ready to Find Relief?

If you've been suffering from chronic pelvic pain and conventional treatments haven't provided adequate relief, these advanced techniques may offer the solution you've been seeking.

Contact OrthoLiving to schedule a consultation. Together, we'll develop a comprehensive, personalized plan to address your pain and help you reclaim your quality of life.

You don't have to live with chronic pelvic pain. Let's find a better path forward.

Dr. Salomé is a board-certified obstetrician-gynecologist with fellowship training in Minimally Invasive Gynecologic Surgery (MIGS) who focuses on integrative women's health. Her unique background combining surgical expertise with advanced interventional pain management techniques allows her to offer comprehensive solutions for women suffering from chronic pelvic pain.

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