Perineum Pain is the pain in the Perineum region. The perineum is the little patch of skin between the genitals and the anus. In men, this region is the region between the anus and the testicles while in women it is the region between anus and vagina. Perineum Pain is focused on this area. Perineum Pain can occur to different degrees or levels.
Most of the muscles of the lower part are attached with perineum. This is one of the common areas of pain for both men and women who tend to suffer from any pelvic pain. In men, the pain in perineum may also radiate to other parts like abdomen and rectum. The causes of this are entirely different in men and women due to the difference in the anatomy. (1)
Causes of Perineum Pain:
There are multiple causes of Perineum Pain. But the major ones fall into these following buckets:
- Duct obstruction
- Entrapment of pudendal nerve: This nerve is located in the pelvis and is sometimes compressed leading to extreme pain in certain positions.
- Abscess prostatitis: It is the formation of an abscess in the prostate gland due to bacterial reasons.
- Perineural cyst: It is the cyst or formation of fluid-filled sacs in the nerve root sheath usually the sacral part of the spine.
- Ischiorectal abscess: It is the accumulation of abscess around the anus, it occurs due to the infection in one of the anal sinuses leading to inflammation and acute pain.
- Benign prostatic hypertrophy: It is the non-cancerous increase in the size of the prostate.
- Prostatitis: it is the swelling and inflammation of the prostate gland.
- Obstructive Defecation: Obstructive defecation or severe constipation is also found as one of the causes of Perineum Pain. (2)
- Ovarian Cysts: Ovarian cysts are the formation of cysts or fluid-filled sac around the ovaries. These are usually not harmful. However, pain in Ovary cysts is associated with Perineum Pain. Women often come across at least one instance of developing a cyst in their lifetime.
- Pelvic inflammatory disease: Pelvic inflammatory disease or PID is the infection of the upper part of the female reproductive system which includes reproductive organs namely, Uterus, fallopian tubes or ovaries.
- Dysmenorrhea: Dysmenorrhea also known as painful periods or menstrual cramps is the pain associated with the menstrual cycle, and it usually starts with the onset of menstruation The pain is observed in the lower pelvis or abdomen.
- Endometriosis: It is associated with the inner lining of the uterus. In this, the tissue that forms the inner lining of the uterus grows outside the womb. It is one of the causes of Perineum Pain.
- Ovarian Torsion: This leads to acute pain in the lower abdomen and is characterised by little venous return from ovary as a result of oedema, internal haemorrhage or hyperstimulation
- Ectopic Pregnancy: This occurs when the fertilised egg attaches itself outside of uterus usually to the fallopian tubes. This leads to the acute abdominal pain and vaginal bleeding
- Colitis: Colitis is the swelling or inflammation of the inner lining of the colon which is further associated with infection, ischemic colitis, allergic reactions, and microscopic colitis.
- Appendicitis: It is the inflammation of the appendix which may be due to a reaction to an infection in the stomach or intestine.
- Proctitis: Proctitis is the inflammation of the inner lining of the rectum. The rectum is the part which is connected to end part of the colon. Proctitis causes rectal pain and urge to have a bowel movement.
Symptoms of Perineum Pain:
It is associated with many varied symptoms as the causes of the Perineum Pain are also extensive. However, there are some of the common symptoms of Perineum Pain which includes:
- Genital Pain
- Urinary frequency or urgency to pass urine
- Pain while sitting or during sitting position
- Inflamed Perineum or swollen Perineum
- Rectal/Perineum pain
- Lower Abdominal Pain
- Tailbone or Low back pain
- Pain during or after Sex
- Pain or relief after the bowel movement
- Many of the symptoms of Perineum Pain may lead to other problems like depression, anxiety, lower back pain etc.
Diagnosis of Perineum Pain:
The determination of the causes of Perineum Pain starts with looking at the patient history like checking if the patient has any medical history related to the perineum or the associated organs which at a later stage could have lead to perineum pain.
The discussion over medical history is followed by a physical exam which will help detect the intensity of the pain for the patient and if there is a direct cause of the pain. There are specific other tests as well to diagnose the Perineum Pain:
The doctor will do a physical exam to check the standing and sitting posture
The doctor can also check if there are any signs of the swollen perineum or sore perineum
Press points around the abdomen and the pelvic and perineal area to check if anything hurts around that area
Check if the patient tenses and relaxes his pelvic muscles
Check if there is anything unusual in the vagina, uterus or rectum
Tests including Blood count tests, Pregnancy test, testing for an infection like chlamydia or gonorrhoea etc. The urine test can also be done to see if there is any urinary infection as the underlying cause.
Transvaginal ultrasound, CT scan or an MRI scan for a complete picture of the abdomen and the pelvic region.
Apart from these radiological tests are also done which can help in diagnosing Endometriosis, Pelvic congestion, Adhesions, Fibroids, or Pelvic Inflammatory disease (PID)
In case all these tests are unable to find the underlying cause of Perineum Pain then the doctor may advise laparoscopy for the patient. Laparoscopy is a procedure which involves inserting a small camera by making an incision in the lower abdomen area to look at the pelvic organs or take tissue samples and see if there is any abnormality.
Hysteroscopy is also done in case of females which includes inserting of a small camera through the vagina to see if there is any abnormality in the uterus area. (3)
Accurate diagnosis of the underlying cause of the perineum can help avoid unnecessary surgeries to alleviate the pain (4)
Treatment of Perineum Pain:
The Perineal area is connected to so many body organs that pain there can cause difficulty in so many routine activities like sitting, standing, walking etc. While doing all these daily activities a person feels mild or acute pain. Treatment of Perineal or Pelvic pain may be associated with trying numerous treatment approaches sequentially or trying a combination of methods to find out which of the approaches works best for the individual. The treatment options for Perineum Pain include:
The Perineum Pain may be because of the perineal area is stretched, bruised or there is a perineum tear. Bed rest for three to four days can help the perineal muscles to relax and help the bruise to heal it. So, while trying this, it is important to lie down in a position that provides comfort to the perineal area.
Massaging the area affected can help to soothe out anyone who is experiencing Perineum Pain. This is particularly effective in women who are having pain due to pregnancy. The basic technique is to massage the affected area for best results. Using of Massage for treatment should be first discussed with the doctor to avoid the condition becoming worse.
A doctor may prescribe antibiotics for the treatment to prevent the situation from getting worse. Analgesics can help reduce the pain. But in case of persistent pain doctor may go for antibiotic therapy.
This treatment is specific for Women who are experiencing pain after giving birth to a child or during pregnancy. In such cases, Doctor may prescribe the use of irrigation bottle after urination. Irrigation bottle is filled with warm water which is used for cleansing, rinsing and soothing the perineum area.
The treatment and management of chronic Perineum Pain have helped in better understanding of the mechanism of pain and better treatment approach for the patient. The painful symptoms also vary from person to person depending on the individual’s capacity to control or activate the pain. (5)
Risk factors related to Perineum pain:
There are lots of issues/risks that are associated with the diagnosis of Perineum pain. As the causes of Perineum pain are varied, so there are huge chances of misdiagnosing. There are other causes as well as hernias that can cause similar symptoms and can lead the doctor to give a wrong treatment.
Perineum Pain can hurt and can cause a lot of discomforts. Perineal area is attached to so many lower body parts which are used for everyday routine activities; it needs figuring out the right cause, as the reasons can be varied.
The important part from the patient’s perspective is to visit the doctor as soon as possible. The earlier the doctor starts diagnosis, the better it is for the patient.