‘Persistent pelvic pain’ can sound a bit vague and mysterious – so what exactly is it?
Pelvic pain is not a disease or condition on its own but really an umbrella term to describe pain anywhere between the belly button and the upper thighs both on the surface and the “inside” (bladder, uterus, ovaries, rectum, genitals). It is called persistent or chronic if it has been present (continuously or intermittently) for longer than 6 months. The pain might be part of a diagnosed condition such as endometriosis, bladder pain syndrome or irritable bowel syndrome. It could be following an injury – such as a bruised or broken coccyx or a childbirth related tear. Or it may have begun with an infection such as thrush or a urinary tract infection.
The pain might feel like it is coming from somewhere internal like the bladder, rectum, uterus or ovaries. Or it might feel more superficial – in the tailbone, or the vagina in women or penis in men. It might come and go in intensity. It might be sharp, burning or stabbing or it might be a dull ache. It might be more like a pressure than a pain. It can be associated with urinating, emptying the bowels, inserting a tampon or having sex. It might be associated with other symptoms such as bloating, nausea, a frequent or urgent need to urinate, constipation or diarrhoea.
Wherever it is felt there is no doubt that pelvic pain can have a large impact on your daily life – both on how you function and how you feel.
What you need to know about pelvic pain:
- You are not alone – chronic or persistent pelvic pain affects up to 1 in 5 women and up to one in 12 men.
- Pain is always real – you can’t imagine pain. As mentioned above, the symptoms of pelvic pain can be hard to explain and sometimes hard to diagnose. Sometimes there will be a diagnosis e.g. endometriosis in women or prostatitis in men and sometimes it will just be called “persistent pelvic pain.” We often hear people say that medical professionals have told them “we can’t find anything wrong, so it must be in your brain.” While it is true that the brain can play a part in pain it definitely does not mean that you have imagined it.
- Pelvic pain can be complicated and treating it is like solving a puzzle. It is the job of the health professionals including the expertly trained pelvic health physiotherapist to solve that puzzle. The pain will often begin with a small problem that the body does not deal with well – we often don’t know why that is. The nerves in the area will then start to send more messages to the brain saying “hey, you haven’t fixed this yet.” The brain then pays more attention to that area and starts to become overprotective. You might then start to think more about the pain and move differently to protect the area. This could include the pelvic floor muscles becoming tight and protective. Before you know it there is a vicious cycle going on between painful area, the nerves and the brain that has little to do with the original problem.
So what do I do about my pelvic pain?
- See your GP. Book a long appointment so you can carefully explain your symptoms. They will know if there are any tests or investigations that need to be performed to find a source of pain and prescribe any medication that you might need.
- Once the doctor has given the all clear of anything serious or advised if the pain can be treated simply with medication, then see your pelvic health physiotherapist. Your physio will ask a lot of questions – sometimes about things that seem unrelated such as your bladder and bowel. They will do some physical assessment. Often this starts with how you breathe, how you move in the back and hips and they may want to understand how your pelvic floor muscles work. The pelvic floor muscles are the ones at the base of the pelvis and they are often not relaxing well in people who have had pain for a long while. Your physio will talk to you about the best way to assess your pelvic floor muscles. This may be with the ultrasound used over the lower abdomen (option for women and men) or the perineum which is the external area at the base of the pelvis (more useful for men). For women it might be helpful to observe the vulval area or assess the muscles with an internal vaginal assessment. Your physiotherapist will discuss this with you and only proceed if you are comfortable.
- Read some helpful resources such as those on the links below. Try to avoid going down an internet rabbit hole without speaking to a health professional who is expert in the area of pelvic health. Treatment of pelvic pain is different for every individual– following the advice of one person on TikTok may not be the right solution for you!
At Total Physiotherapy Manly Vale our team of experienced Women’s, Men’s and Pelvic Health physiotherapists are ready to help you take the first step in resolving your pelvic pain. One of the team would be happy to speak to you if have any questions about the appointment. You can make your appointment by calling our team on 9907 0321 or click here to book online.