Years ago, when I worked as a Physiotherapist in the UK, I remember being bemused when patients would describe any particularly nagging or unpleasant aching pain as “like toothache”, even when they were describing a pain in their back or leg. However, on reflection I think it is a good description, which could well be applied to chronic pelvic pain.
Like toothache, chronic pelvic pain often feels like a deep nagging ache, which sometimes gets sharper and stronger. It won’t kill you, but it’s really hard to ignore and can make your life absolutely miserable. American doctors, Dr Rodney Anderson and Dr David Wise also coined the term “A Headache in the Pelvis” in their book of the same name. This is another useful way of describing pelvic pain, although some of the ideas in their book have been superseded by modern pain science.
It is any pain in the pelvis, which occurs daily or almost daily, and has been going on for more than 3-6 months. The diagnosis can only be made after other possible causes (cancer, fibroids etc) have been ruled out. It is estimated 12-21% of all men and women may suffer from chronic pelvic pain.
While a “cause” is often not found, in some cases chronic pelvic pain can be related to various pelvic syndromes, including endometriosis, irritable bowel syndrome and prostatitis. However, many with chronic pelvic pain report that while their pain may have started in one area, it has since spread to other areas of the pelvis.
The symptoms of chronic pelvic pain can vary a lot from person to person. Low abdominal and low back pain are common. Many women with chronic pelvic pain report extremely painful menstrual periods, which keep them away from school or work for several days at a time.
Other possible symptoms include:
One of the common associated symptoms with chronic pelvic pain is over-activity of the pelvic floor muscles – that is, they always feel tight, tense and “switched on”. The pelvic floor muscles do this as a protective response in reaction to pain in the pelvic region. However, like any other tight and tense muscle in the body, over-active pelvic floor muscles can become tender or painful. They can also contribute to other symptoms, such as painful sex, a strong urge to urinate or problems with opening your bowels.
While there is no known cure for chronic pelvic pain, there are lots of different ways to manage the various symptoms, so pelvic pain no longer dominates your life.
One common treatment method involves helping the pelvic floor muscles to relax and become less tight and tense. A Women’s or Pelvic Health Physiotherapist can teach pelvic floor muscle down-training exercises, which are like the opposite of pelvic floor strength training. The focus is on learning how to relax the pelvic floor muscles and recognise when they feel tense. Sometimes gentle massage or pressure on these muscles can help, as can using vaginal trainers to help desensitise the pelvic floor muscles and the rest of the genital region to normal touch and pressure.
However, if that was all you did for chronic pelvic pain, you wouldn’t get too far! Pain is the body’s response when the nervous system decides you are in danger. However, unlike acute pain, when there may have been some tissue damage, with chronic pain, any tissue damage has long since resolved, but the pain persists. For some reason, the nervous system has decided there is still some danger, yet it is now producing pain with normal body functions like touch, movement, or bladder filling. I liken it to an over-sensitive car alarm. Yes it goes off when the car is broken into, but it also goes off when a cat jumps on the bonnet, a truck rumbles down the road or there is a strong wind. So how do we deal with that?
A vital part of learning to overcome any chronic pain condition is learning about chronic pain and how it responds differently, as in the example above. It is often very reassuring to know that while you still have pain, you are not doing yourself any damage or harm by doing normal activities. In fact gradually reintroducing yourself to normal activities is often part of the treatment. Some people even like to use that idea as a mantra – something like, “I am sensitive, but I am not doing any harm” can be a helpful thought to remember.
Along with learning about pain, knowing how to calm the sensitive nervous system is also essential. This often involves a team of different health professionals. Physiotherapists and psychologists can help with mindfulness and other techniques to reduce overall stress, which is a very common part of chronic pelvic pain. Physiotherapists can also recommend general exercises and stretches to perform. Gynaecologists and GPs can offer specialised pain medications and other medical management of your symptoms as needed. A dietitian can review your diet and see if certain foods may be contributing to your pain.
The important things to remember if you have chronic pelvic pain are, firstly that you are not alone, and secondly that help is available. The pelvic pain website has some excellent further information.
If you or someone you know has chronic pelvic pain, please feel free to contact us at firstname.lastname@example.org for further advice or an appointment.