Pelvic Pain Prevention and Treatment

Pelvic pain is a complex condition. As women, we all feel pain at some time or another in our pelvic region, such as with our monthly menstrual cycle. Some of us experience pain in our pelvis at other times, and this is when it becomes a little more complicated.

We can help treat and prevent pelvic pain

Pain felt for short period of time, such as with menstruation is known as acute pelvic pain. This pain differs for all women and perhaps may involve conditions such as endometriosis that cause very painful periods. Pain that exists for a long time, often of varying degrees and a mix of different types of pain is defined as chronic pelvic pain. This pain may really wear you down, make you feel anxious and tired from it.

Chronic pelvic pain can originate from a variety of sources in the pelvis, including the painful or irritable bowel, a painful bladder, pelvic muscle pain, pelvic nerve sensitivities, endometriosis, sexual pain, referred pain from the lower back and pelvic joints, anxiety and low mood.

Pelvic pain of this type needs an excellent assessment and diagnosis. As we’ve mentioned, there are many probable sources of your pain, and to find the right mix of causes for how you are feeling will mean a better outcome.

What are the causes of chronic pelvic pain?

Chronic pelvic pain can be classified into groups and refer to the probable causes of pain in women. These are:

• Urological pain disorders, relating to bladder conditions such as painful bladder, interstitial cystitis and urethritis
• Anorectal pain disorders, relating to painful conditions of the bowel and rectum
• Neuropathic disorders, relating to hyper-sensitivity of the pelvic nerves
• Sexual dysfunctions, relating to pain with sex or penetration, including dyspareunia and vaginismus
• Endometriosis and other pathological conditions such as urinary tract infections (UTIs) and pelvic inflammatory disease (PID) , relating to changes within the cells and tissues of the pelvic organs

Often women will have a combination or mix of these types of pain, and it is good to keep a diary to note your pain frequency, location and type. Chronic pelvic pain can often be accompanied by other pelvic floor symptoms such as:

• changes in urinary and faecal frequency
• urgency
• voiding problems of both the bladder and bowel
• painful voiding
• signs of vaginal prolapse

How do I know if you have chronic pelvic pain?

As chronic pelvic pain is often very complicated and you may be feeling a mix of different types of pain, it would help to keep a diary to note your symptoms. Perhaps some of these questions are you?

If you have answered yes to any or all of these questions, and you feel pain almost most days, then seeking help is the next step. Assessment by a gynaecologist will help to understand your pain and the causes. Women’s health physiotherapy has been shown to be most helpful in most causes of chronic pelvic pain.

How do women’s health physiotherapists treat chronic pelvic pain?

A thorough assessment and tests to eliminate any infections and other conditions of the pelvis is the first step. This is best done by your gynaecologist.

Referral to our women’s health physiotherapists is then most common. We will assess for structural and alignment changes to the spinal and pelvic joints, pelvic floor weakness or spasm and vaginal structure. Our physiotherapists need to work closely with your gynaecologist, GP, musculo-skeletal physiotherapist and psychologist, if you are seeing one.

After an internal vaginal examination, treatments from our physiotherapist may involve

• massage and trigger point releases of your pelvic floor muscles
• electrical stimulation to ‘relax’ the nerves and decrease their over–sensitivity
• education and instruction on how to use vaginal dilators to help to stretch and release your pelvic floor muscles at home
• re-alignment techniques and exercises to correct poor pelvic and spinal postures that contribute to your pelvic pain

How is The FITMUMs Program different in the treatment of chronic pelvic pain?

At The FITMUMs Program, we understand that every woman is different and that no one treatment will work with each woman.

Our women’s health physiotherapy assessment will always involve an internal vaginal examination. This, along with extensive questioning about your gynaecological history, pelvic floor function and habits will allow for the best diagnosis of the cause and treatment of your pelvic pain and symptoms. We will always work together with you to provide you with the right help that you need to take control over your chronic pelvic pain.

What should I expect?

After the initial visit and internal vaginal examination, it is expected that you will require regular visits with our physiotherapist. Initially, intensive treatment is required twice per week before reducing to weekly session over 6-12 weeks. Remember, every woman is different, so this is a guide only.

Typically in women with chronic pelvic pain, pelvic floor muscles may be found to be tight or in spasm, much like a muscle in your neck can spasm or feel very tense after a long day in front of the computer. This tightness within your pelvic floor muscles can cause pain. The best treatment is to release these muscles manually though massage or teach you how to use a vaginal dilator to relax and stretch these muscles yourself at home. Our physiotherapist will release this tightness at your visits, both internally from within your vagina or externally about the hip and buttock areas. Relaxation exercises for your pelvic floor muscles, advice and education on pelvic floor function and toileting habits and reassurance compliment the manual approach.

If we feel you need to address anxieties, feelings of depression or hopelessness because of your pelvic pain, then we may chat with you about referral on to a psychologist. We know that help with all of these factors, in addition to the muscle tightness and spasm can better your overall outcome.