An estimated 50% of women experience pelvic floor dysfunction at some point in their lives.  This dysfunction can cause a variety of symptoms, but one of the most common complaints is that of lower abdominal or pelvic pain after eating, also known as post-prandial pelvic pain.

This type of pain is typically centered around the symphysis pubis area and can be accompanied by bladder, bowel, or sexual dysfunction. The pain is usually at its worst within 15 to 30 minutes after eating and the severity can range from mild discomfort to very intense pain that prevents movement.

In this article, we will review the common causes for this type of pain, treatment options, and guidelines for prevention.

The Pelvic Floor

The pelvic floor is a group of muscles, nerves, and connective tissues that attach to the bones of the pelvis. The pelvic floor does not act by itself but rather has an interworking relationship. Dysfunction of this region is often accompanied by pain and other secondary symptoms such as urinary leakage, bowel dysfunction, and sexual dysfunction.

Up to 50% of women will experience pelvic floor dysfunction during their lives. The cause can be attributed to several different factors including:

• Childbirth (especially vaginal deliveries)
• Repetitive straining from activities such as weight lifting, running, coughing, or sneezing
• Pelvic tissue infection
• Endometriosis
• Bladder problems such as cystitis or overactive bladder syndrome

Additionally, the following medications have been linked to pelvic floor dysfunction:

• Narcotics and nausea medication
• Antidepressants
• Diuretics

Why Are You Experiencing Pain After Eating?

There are many causes of pelvic pain after eating. Some of the most common include:

• Appendicitis: Appendicitis is an inflammation of the appendix that can cause severe symptoms such as nausea, vomiting, and right-sided abdominal pain.
• Acute Pancreatitis: Acute pancreatitis is an inflammation of the pancreas that can develop from several different causes including gallstones, hypertriglyceridemia, or biliary tract infections.
• Gastroenteritis: Gastroenteritis is an inflammation of the stomach, small intestine, or large intestine that causes vomiting and diarrhea.
• Gallstones: A gallstone is a small stone made of cholesterol that can form in the gallbladder. If this stone becomes large enough, it can cause inflammation and pain (biliary colic) between meals.
• Achalasia: Achalasia is a disorder that affects the muscles of the esophagus. The lower end of the esophagus does not relax to allow food to enter into the stomach which can cause pain after eating.
• Irritable Bowel Syndrome: Some people with irritable bowel syndrome experience pain that radiates to the back after eating.
• Endometriosis: Pelvic endometriosis is a condition where endometrial tissue grows outside the uterus and into other pelvic structures. This abnormal tissue growth can cause pain after eating, often with diarrhea or constipation as well.
• Ovarian Cysts: Some ovarian cysts are not harmful but others can twist or rupture which causes severe abdominal pain that typically resolves within several days.
• Pelvic Inflammatory Disease: Pelvic inflammatory disease is an infection of the uterus, fallopian tubes, and/or ovaries.
• Uterine Fibroids: Some uterine fibroids are not harmful but others can cause severe pain that often radiates to the back or rectum.
• It is important to see your doctor if the cause of the pelvic pain cannot be traced to any of these conditions. Your doctor will ask about your symptoms, medical history, and do a physical examination.

Symptoms of Pelvic Pain

Pelvic pain after a meal is a common complaint in the physical therapy clinic.  This type of pain can often be mistaken for ovulation or menstrual cycle pain since it occurs right around the time when patients would have their period if they were pre-menopausal. The symptoms of pelvic pain after eating include:

• Lower abdominal pain
• Pelvic pain while sitting or leaning forward
• Dysmenorrhea or painful menstrual cramps
• Bladder dysfunction such as urinary frequency, urgency, and nocturia

Post-prandial pelvic pain can be severe enough to interfere with daily activities and may cause the patient to become fatigued and irritable.

The following activities may exacerbate symptoms:

• Squatting and getting up from a squatting position
• Driving or sitting for long periods
• Moving the legs apart or crossing them while standing
• Doing Kegel exercises (pelvic floor muscle strengthening)
• Valsalva maneuver (holding your breath and bearing down)

Pelvic Discomfort After Eating: Treatment Options

The first step in treating post-prandial pain is to determine the underlying cause.  A patient’s medical history and a physical examination will help guide treatment. If an internal organ, such as the bladder or bowel, is causing symptoms it may be necessary for a doctor to perform tests to diagnose the problem.  In some cases, a thorough gynecological examination may be necessary to rule out endometriosis or ovarian cysts.

In most cases of post-prandial pain, the patient’s physician will determine that the patient is experiencing pelvic floor dysfunction and recommend treatment by a physical therapist. Pelvic floor physical therapy uses a multi-disciplinary approach to treat pain and restore function. Treatment may include:

• Pelvic floor muscle strengthening exercises (Kegel)
• Correction of faulty movement patterns by a women’s health physical therapist
• A specialized biofeedback device that provides real-time feedback on pelvic floor muscle function
• Pelvic floor myofascial release (massage) to break up scar tissue and adhesions

A physical therapist will also provide education on how to modify activities at home. During stretching exercises, the patient may be told to work gently past the point of slight tension in order to encourage lengthening of the tissues.

Conclusion

Pelvic pain after eating is a common complaint among people of all ages. This type of pain can be difficult to diagnose but treatment is often successful with help from an experienced physical therapist.

The post-prandial state, in which blood glucose levels rise after food intake, has been shown to affect the synthesis and breakdown of the extracellular matrix in the ovarian epithelium. This, along with other factors associated with metabolic syndrome, including obesity and inflammation, may contribute to the development of polycystic ovarian disease (PCOD).

If you experience post-prandial pain, please contact your physician for a referral to physical therapy. You can also visit www.lakecitypt.com for more information about pelvic floor dysfunction and related conditions.