Experiencing pain in the perineum, the area between the genitals and the anus, can be an unsettling symptom, particularly when it occurs during activities like coughing. This discomfort can range from a dull ache to sharp pain. Understanding the underlying reasons for this pain is the first step toward finding relief and addressing any potential health issues.
Why Coughing Causes Pain in the Perineum
Coughing creates a sudden and forceful increase in intra-abdominal pressure (IAP). This pressure is exerted within the abdominal cavity, bounded by muscles like the diaphragm, abdominal wall, and pelvic floor. When you cough, the diaphragm contracts rapidly, pushing down on the abdominal contents.
This surge in IAP places a significant load on the pelvic floor muscles and surrounding tissues in the perineum. The pelvic floor muscles act like a hammock, supporting the pelvic organs and maintaining continence. If these muscles are already weakened, strained, or irritated, the increased pressure from a cough can exacerbate existing pain or cause new discomfort.
Common Causes of Perineal Pain
Perineal pain exacerbated by coughing can stem from various conditions affecting the muscles, nerves, and organs in the pelvic region.
Muscle Strains
One frequent cause involves muscle strains within the pelvic floor. The pelvic floor muscles, such as the levator ani, can become strained or weakened, especially after childbirth or due to chronic tension, making them susceptible to pain when sudden pressure like a cough occurs. Muscle strain in the lower abdominal area can also contribute, as these muscles are directly involved in coughing and connect to the pelvic region.
Nerve Irritation
Nerve irritation is another significant cause of perineal pain, with pudendal neuralgia being a notable example. The pudendal nerve supplies sensation to the perineum and can become compressed or irritated, leading to burning, shooting, or throbbing pain that worsens with activities increasing abdominal pressure. This nerve pain can be particularly debilitating.
Hernias
Hernias, such as inguinal or femoral hernias, can also manifest as perineal pain that intensifies with coughing. These occur when tissue protrudes through a weak spot in the abdominal wall, and the increased IAP during a cough pushes on the hernia, causing discomfort or a visible bulge.
Inflammation and Infection
For men, inflammation of the prostate, known as prostatitis, can lead to perineal pain. This condition can cause referred pain to the perineum, which may be aggravated by the pressure changes associated with coughing. Conditions like urinary tract infections (UTIs) can also cause discomfort in the pelvic region that worsens with coughing due to inflammation and irritation.
Post-Surgical Pain
Post-surgical pain is a common factor, especially following procedures in the pelvic area like hemorrhoidectomy or episiotomy. Scar tissue formation or nerve damage from these interventions can make the perineum sensitive, leading to pain when subjected to the force of a cough. Childbirth itself is a common cause of perineal pain, with tears or an episiotomy often causing pain that can last for weeks.
When to Consult a Doctor
While some perineal discomfort might be temporary, certain symptoms warrant professional medical evaluation to ensure proper diagnosis and treatment. You should seek medical attention if the perineal pain is severe, persistent, or worsening over time. Pain that significantly impacts your daily activities, such as sitting, walking, or urinating, also indicates a need for medical advice.
Specific “red flag” symptoms require immediate medical attention. These include perineal pain accompanied by fever, chills, or a general feeling of illness. The inability to urinate or have a bowel movement, new numbness or weakness in the area, or the presence of blood in your urine or stool are urgent signs. If you notice a new bulge in the groin or perineal area that becomes more prominent with coughing, have it evaluated by a healthcare provider.
Approaches to Relief and Treatment
Managing perineal pain often begins with self-care measures, though treatment ultimately depends on the underlying cause identified by a healthcare professional.
Self-Care Measures
For immediate relief, applying ice packs to the perineal area for 10-20 minutes can help reduce swelling and numb the pain. Warm sitz baths can promote healing and provide comfort. Over-the-counter pain relievers like ibuprofen or acetaminophen may help manage discomfort and inflammation. Avoiding activities that worsen the pain, along with adequate rest, is beneficial. Using a donut pillow or perineal support cushion can reduce pressure when sitting. Maintaining good hygiene and wearing loose, cotton underwear can prevent irritation.
Medical Interventions
Medical interventions are tailored to the specific diagnosis. Physical therapy, particularly pelvic floor therapy, is a common and effective approach. A specialized therapist can teach exercises to strengthen or relax pelvic floor muscles, address muscle imbalances, and improve coordination. This therapy can be particularly helpful for muscle strains, pelvic floor dysfunction, and some nerve-related pain. Prescription medications may be used to manage pain and inflammation. These can include muscle relaxants for muscle spasms, anti-inflammatory drugs, or nerve pain medications like gabapentin or pregabalin for conditions such as pudendal neuralgia. In some cases, localized injections of anesthetics or corticosteroids can provide temporary relief by blocking nerve signals or reducing inflammation. For conditions like hernias, surgical repair might be necessary to correct the structural defect causing the pain.