A women's health physio can help manage pelvic pain problems including:
Pelvic pain is any pain felt in the region of the pelvis. It is a diagnosis made after other problems (eg, cancers, or fibroids) have been excluded. The pain is considered to be chronic if it occurs on most or all days and persists for longer than 3 months. About 12-21% of the population may have chronic pelvic pain, and it affects both men and women.
Chronic Pelvic Pain (CPP) can have many different causes, and the term covers many possible diagnoses. The pain may be coming from any one of the pelvic organs – for example the bladder (eg, painful bladder syndrome), the bowel (eg, irritable bowel syndrome), the uterus in women (eg, painful periods) or the prostate in men (eg, prostatitis). The pain may also be coming from one of the pelvic nerves (eg, pudendal neuralgia).
Often CPP starts in one area and then spreads to other areas in the pelvis. Many with CPP report a combination of bladder, bowel and sexual problems. It is very common to also have pelvic floor muscle overactivity with CPP. CPP can be debilitating and affect the lives of sufferers in multiple ways. However, there are good treatment options available.
The best treatment approach is multi-faceted. Your GP can co-ordinate a team of people to help.
The pelvic pain website has further information about chronic pelvic pain.
Pelvic floor muscle overactivity refers to pelvic floor muscles that cannot relax completely, or at all, when necessary. To work at their best, all muscles need to be able to contract and relax well. Pelvic floor muscles that cannot relax properly are often painful. People with pelvic floor muscle overactivity will also commonly report problems with emptying their bladder or bowels fully, and pain with intercourse.
The causes of pelvic floor muscle overactivity are not always clear. Sometimes it can be related to other pelvic pain disorders, such as endometriosis or irritable bowel syndrome. Sometimes it may be the result of trauma to the pelvic region, such as from childbirth injury or a repeated infection.
Once other causes of pelvic floor muscle overactivity have been cleared by your doctor (eg, infections, skin problems) treatment can involve several elements.
A Women’s Health Physiotherapist can guide you with all of these treatment options.
Many with pelvic floor muscle overactivity may have had pain for a long time, so a multi-disciplinary approach to pain management is very important. See the information above on chronic pelvic pain.
Painful sex (or dyspareunia) is unfortunately quite common, but rarely spoken about. It often goes hand-in-hand with many chronic pelvic pain disorders. An associated problem is vaginismus, which can prevent intercourse altogether. The two problems are often grouped together, and called genito-pelvic pain/penetration disorder.
Some women with sexual pain have never been able to have pain-free intercourse, and some have developed pain later, after previously being able to have comfortable intercourse. It is a common misconception that painful sex is related to a history of abuse. This may be the case for some, but certainly not all, with dyspareunia.
Commonly, the pelvic floor muscles are overactive and tender in women with dyspareunia. In those with vaginismus, the pelvic floor muscles may spasm so strongly that penetration becomes impossible. This spasm and overactivity is generally not under the woman’s control. However, there can be other causes for painful sex, such as infection and skin disorders, so it is best to have a check with a GP specialising in Women’s Health to rule out these problems.
Painful sex is best managed with a multi-faceted treatment approach.
The pelvic pain website has further information on painful sex.
The cells lining the inside of the uterus (or womb) are called endometrial cells, and are usually only found inside the uterus. When these cells appear elsewhere in the pelvis – on pelvic organs, ligaments or other connective tissue – this is called endometriosis.
Endometriosis can be associated with a range of symptoms. The most common one is abnormally painful, and sometimes heavy, periods. However, many women or girls with endometriosis will report other symptoms as well, including bladder pain or urgency, bowel pain and genital pain. Many with endometriosis also have pelvic floor muscle overactivity, likely as a protective response to pain in the pelvic region.
Endometriosis cannot be cured, but there are treatments available.
The best treatment is a laparoscopy (exploratory surgery through the abdomen) to find and remove the endometrial lesions. However, this will not necessarily change all of the other associated symptoms.
Various conservative treatment options for the symptoms associated with endometriosis exist. These include:
A Women’s Health Physiotherapist can guide you through these treatment options.