The perineum is the area of soft tissue located between the anus and the genitals. This region contains muscles, ligaments, and nerves that form part of the pelvic floor, providing support for the bladder, bowels, and, in women, the uterus. Experiencing discomfort or pain in this area, particularly when coughing, can be a concerning sensation. This article aims to help you understand why this pain occurs.
Understanding Perineum Pain During Coughing
The perineum and pelvic floor muscles form a supportive hammock. These muscles, including the levator ani and coccygeus, coordinate with abdominal and back muscles to maintain continence, support organs, and contribute to sexual function and core stability.
Coughing, sneezing, or laughing causes a sudden increase in intra-abdominal pressure. This pressure transmits downwards, straining the pelvic floor and perineal muscles. If these structures are compromised, weakened, or irritated, this sudden pressure can lead to sharp or aching perineum pain.
The physiological response involves rapid contraction of the diaphragm and abdominal muscles, pushing down on abdominal contents. Pelvic floor muscles counteract this pressure, but if not optimal, they can overstretch or strain, causing pain. Nerves in the region, such as the pudendal nerve, can also be irritated by this mechanical stress.
Common Causes of Perineum Pain When Coughing
Pelvic Floor Dysfunction
Pelvic floor dysfunction, where muscles are too weak, tight, or uncoordinated, is a frequent cause. A weakened pelvic floor may not withstand downward pressure, causing strain. Overly tight muscles can be painful, lacking elasticity to absorb force.
Muscle Strain or Injury
Muscle strain or injury from strenuous activities or sudden movements can cause discomfort. Increased intra-abdominal pressure from coughing can worsen the existing injury, causing localized pain.
Postpartum Recovery
Postpartum recovery, especially after vaginal delivery, is a common cause. Stretching, tearing, or an episiotomy during birth can leave tissues sensitive. Coughing pressure can pull on healing stitches or inflamed tissues, causing sharp pain.
Nerve Irritation
Nerve irritation, like pudendal neuralgia, can cause perineum pain that worsens with coughing. If the pudendal nerve, which supplies sensation to the perineum, becomes compressed or irritated, coughing can aggravate it, leading to burning, shooting, or aching pain.
Post-Surgical Pain
Pain after pelvic or perineal surgeries (e.g., prostatectomy, hysterectomy, hemorrhoidectomy) is common. Healing tissues and nerves are sensitive, and coughing pressure can stress the surgical site, causing discomfort during recovery.
Infections
Urinary tract infections (UTIs) or other pelvic infections can cause referred perineum pain. Inflammation from an infection can irritate nearby nerves, and coughing pressure changes may aggravate this discomfort, which stems from the underlying inflammatory process.
Prostate Issues (in Men)
In men, prostate issues like prostatitis (inflammation) or benign prostatic hyperplasia (BPH, enlargement) can cause perineal discomfort. An inflamed or enlarged prostate can pressure nerves, and coughing can intensify this, leading to pain.
Hernias
Hernias, such as inguinal or femoral, can cause referred perineum pain, especially when straining. These involve tissue protrusion through a weak abdominal wall spot. Increased intra-abdominal pressure during a cough can push against the hernia, causing discomfort that may radiate to the perineal area.
When to Seek Medical Advice
Consult a healthcare professional if perineum pain when coughing is persistent or worsening. Pain not improving with self-care or becoming more severe warrants evaluation, as it may indicate an underlying issue requiring specific diagnosis and treatment.
Seek medical advice if pain accompanies other concerning symptoms like fever, chills, or general unwellness, suggesting infection. New bleeding, unusual discharge, or significant changes in bowel or bladder habits (e.g., difficulty urinating, frequent urges) also warrant a doctor’s visit.
If pain significantly interferes with daily activities like walking, sitting, or sleeping, seek professional help. Pain limiting normal function impacts quality of life. Any sudden perineum pain after injury or recent surgery also requires prompt medical assessment to rule out complications.
Relief and Treatment Strategies
Managing perineum pain from coughing involves self-care and professional interventions.
Self-Care Strategies
Simple home remedies include resting the area, applying ice for acute pain or warmth for muscle relaxation. Over-the-counter pain relievers like NSAIDs (e.g., ibuprofen) can reduce pain and inflammation.
Gentle stretching of pelvic floor and hip muscles can alleviate tension and improve flexibility. Proper posture, especially when sitting, reduces perineal strain. Avoiding prolonged straining activities like heavy lifting or chronic coughing prevents symptom exacerbation.
Lifestyle adjustments help manage perineum pain. Addressing constipation with fiber and hydration prevents straining. Maintaining a healthy weight reduces pelvic floor pressure.
Pelvic Floor Physical Therapy
Pelvic floor physical therapy is an effective professional intervention. A specialized therapist assesses muscle strength, coordination, and flexibility. They guide targeted exercises, including Kegels or relaxation techniques, and may use biofeedback for better muscle control.
Prescription Medications
Prescription medications may be necessary. Muscle relaxants reduce pelvic floor spasms and tightness. For nerve-related pain, medications like certain antidepressants or anticonvulsants might be prescribed.
Advanced Interventions
More advanced interventions are for severe conditions. Nerve blocks, injecting anesthetic near an irritated nerve (e.g., pudendal nerve), offer temporary relief. In rare cases, after other treatments fail, surgery might address structural issues or nerve entrapments.