What is Pelvic Pain?
Pelvic pain for women is a term that relates to a pain problem in the structures related to the pelvis such as lower abdomen (below the belly button), bladder, bowel, inside or outside the vagina, the perineum (region between the vagina and anus) and clitoris.
Common examples of pelvic pain conditions in women are pudendal neuralgia, bladder or urethral pain syndrome, irritable bowel, vulval pain or vulvodynia, dyspareunia or pain with intercourse, and coccydynia or tailbone pain. Pelvic pain can vary throughout the menstrual cycle and may be associated with endometriosis.
Pelvic pain for men is a term that relates to a pain problem in structures related to the pelvis including lower abdomen, bladder, bowel, penis or testicles, coccyx or tailbone. Pain may start as a result of an injury or come on gradually. Symptoms may vary but many men describe pain when sitting. Pelvic pain is often described as a throbbing or pressure pain in the rectal area, penis or testicles. This pain may be associated with bladder and bowel problems and sexual pain during intercourse or orgasm. It is sometimes termed chronic prostatitis but, if infection has been ruled out, it is often not due to the prostate.
Both women and men with pelvic pain may experience more than one pelvic pain condition. Urinary symptoms such as urgency to get to the toilet and going to the toilet more often commonly coexist. Pain may be associated with the bladder filling or pain with urinating. Similarly, pain may be aggravated with a full bowel or opening the bowels and can be aggravated by either irritable bowel syndrome or constipation.
Persistent pain can be very distressing, exhausting, and disrupt many important aspects of a person’s life.
How common is it?
Approximately 25% of women and 5% of men experience pelvic pain and for some individuals this is severe and significantly affects their quality of life.
Pelvic floor muscle tension and difficulty relaxing the pelvic floor muscles is found in up to 80% of individuals with persistent pelvic pain.
The pelvic floor muscles tighten to control the bladder or bowel and they relax when you urinate or defaecate (open your bowels).
Pelvic pain often makes the pelvic floor muscles tense up sub-consciously. Most people do not realise that it’s happening. Muscles that are constantly clenched, become tight and shortened – then they start hurting.
If you have pelvic pain, you need to learn to relax your pelvic floor. These exercises are sometimes called pelvic floor muscle down-training or ‘Reverse Kegels’. Your physiotherapist can teach you how to perform pelvic floor exercises correctly.
Exercises that tighten the pelvic floor are often called ‘Kegel Exercises’. You should avoid these exercises.
Research shows that physiotherapy management strategies to restore normal function of the muscles around the abdomen, hips and the pelvic floor muscles can help to reduce pain.
✖ Pelvic pain is something you have to just live with
✖ Pain in the bladder and bowel cannot be helped
✖ Pelvic pain means you cannot go back to having pleasurable sex
✖ Pelvic pain means you can’t exercise
✖ Pelvic pain means you should just lay down and rest
✖ Pelvic pain can only be helped by surgery or injections
✔ Pelvic pain is complex linked to sensitivity of the pelvic organs and muscles in the pelvis
✔ Pelvic pain often worsens when things get out of balance in our lives
✔ Pelvic pain is linked to many things like increased stress, low mood, poor sleep, fatigue, poor exercise habits and in some cases a history of trauma
✔ Pelvic pain is often linked to too much pelvic floor muscle tension
✔ Pelvic pain is often linked to reversible muscle changes and may not need surgery
Risk factors for developing pelvic pain:
In many cases pelvic pain and pelvic floor muscle problems may emerge at a time of increased stress, emotional distress, poor sleep and fatigue causing sensitisation of the muscles and organs of the pelvis.
A person’s response to pain such as fear of pain, depressed mood, activity and movement avoidance, can set up a vicious cycle of distress and ongoing sensitisation.
Management of pelvic pain and bladder, bowel and sexual dysfunction:
It’s important to understand that pelvic pain is complex and often multiple factors need to be considered.
At Body Logic Physiotherapy our Pelvic Health physiotherapists have completed postgraduate advanced training in the treatment of pelvic pain, bladder, bowel and sexual problems.
To understand each individual, it is important to understand all the factors that are involved in your presentation and the impact that your symptoms are having on your life. Our physiotherapists will take a thorough history, screen for factors that could be influencing your problem and establish your goals for treatment.
Following this we will conduct a comprehensive assessment of your condition including assessment of all the muscles around the lower abdomen, hips, pelvis and pelvic floor muscles.
Assessment of the pelvic floor muscles can be done fully clothed using real-time ultrasound. For a more comprehensive assessment of pelvic floor muscles a direct assessment can be performed via a vaginal or rectal assessment. This method is recommended for an accurate assessment of the pelvic floor muscles if you have pain and sexual dysfunction. The method of assessing your pelvic floor muscles is always your choice and will be thoroughly explained and based on your consent.
Following the assessment, we will explain to you in simple terms the factors that may be impacting on your problem and design a collaborative treatment plan to help you achieve your goals.
Physiotherapy management includes bladder or bowel habit retraining, pelvic floor and abdominal muscle retraining. Most individuals with pelvic pain and pelvic floor muscle dysfunction need to learn to relax their pelvic floor muscles fully. Any management program includes identifying the key factors linked to your symptoms, coaching you in body relaxation, breathing techniques, relaxed fearless movement, graded activity and sleep rehabilitation.
A long-term plan is the key to managing your pain and it may take up to 3-6 months to make this plan work. We also work with your doctor and or a clinical psychologist if additional care is needed.
The pelvic pain foundation is a not-for-profit that helps to improve the quality of life of people with pelvic pain. Find out more here: https://www.pelvicpain.org.au/
Professor Peter O’Sullivan talks on pelvic pain, inaccurate ideas about it, and how Cognitive Functional Therapy can help: https://youtu.be/RbSF3-_b7bI