Pelvic Pain Problems

A women's health physio can help manage pelvic pain problems including:

Chronic Pelvic Pain

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.

  • A Women’s Health Physio can teach pelvic floor muscle down-training (relaxation) exercises, give advice about general exercise, and teach relaxation and mindfulness techniques. They can also provide education on chronic pain management, and help manage associated bladder and bowel symptoms.
  • Some specific medication for chronic pain can also be useful – paracetamol and anti-inflammatories will often be of little or no benefit.
  • A psychologist can also help with pain and stress management.

The pelvic pain website has further information about chronic pelvic pain.

Pelvic Floor Muscle Overactivity

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.

  • Pelvic floor muscle down-training – also called reverse kegels, involves learning how to relax the pelvic floor muscles properly.
  • Vaginal trainers - can help to desensitise the area and return to intercourse.
  • Mindfulness and general relaxation techniques can be helpful for some women.
  • Treatment and stretches for other tight muscles around the hips and pelvis can also be beneficial.

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

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.

  • Rule out other causes – it is always recommended to see your GP first. They may refer on to a gynaecologist or a sexual health doctor for further investigation or management.
  • Specialised pain medications or topical lotions can help with pain management, and are prescribed by a GP or specialist.
  • Pelvic floor muscle down-training (relaxation) exercises are recommended for pelvic floor muscles that are tight and overactive. A Women’s Health Physiotherapist can check the pelvic floor muscles, and teach these exercises.
  • Vaginal trainers help desensitise the genital region in preparation for resuming intercourse. A Women’s Health Physiotherapist can teach you how to use these properly.
  • Many women with painful intercourse find it helpful to see a psychologist who specialises in sexual dysfunction, to help work through any fear, worry or relationship difficulties that may be associated with sexual pain.

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:

  • Chronic pain management, including relaxation, mindfulness, general exercise therapy and some medications.
  • Addressing any associated symptoms, such as pelvic floor muscle overactivity is also important. A Women’s Health Physio can teach you pelvic floor muscle down-training exercises – also called reverse kegels, to learn how to relax tight pelvic floor muscles.
  • Vaginal trainers - can help to desensitise the pelvic area to allow pain-free intercourse, if painful sex has been a problem.
  • Treatment and stretches for other tight muscles around the hips and pelvis can also be beneficial.
  • Managing associated bladder and bowel symptoms is also important.

A Women’s Health Physiotherapist can guide you through these treatment options.

  • Improving your general diet to limit processed foods and sugars, and increasing your intake of “anti-inflammatory” foods such as leafy greens, cucumin and turmeric can also be helpful.

Next Steps

Contact Us for more information on how a Women’s Health Physiotherapist can help you with these problems.

Make A Booking or call us on 8132 0566, or 0404 296 069 to see a Women’s Health Physiotherapist about your condition.

About Us

Jenny Phillips is a Titled Continence and Women’s Health Physiotherapist. She offers skilled advice and management for all types of pelvic floor and pre- and post-natal problems.

Life Cycle Physiotherapy also offers 1:1 exercise sessions for women at all stages of life.

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92 Carrington St, Adelaide, SA 5000
+61 404 296 069
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