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Pelvic pain – 6 things you need to know

Pelvic pain can arise in women and men at any time.

Pelvic pain can arise in women and men at any time.

Pain levels can range in severity and be attributed to a variety of causes – often which resolve themselves – but on other occasions specialist intervention is required.

When is it important to seek professional help for pelvic pain? Our Pelvic Health Physio Jenni Davies tells us here.

What are some common pelvic pain symptoms?

My patients experience both internal and external pelvic pain symptoms of any kind, including:

  • Pain with intercourse or when using a tampon
  • Pain after specific activities such as prolonged sitting, riding a bike, lifting and carrying or rolling in bed
  • Pain after traumatic injuries (both internal and external)
  • Sports injuries that cause pelvic pain (internal or external)
  • Pain secondary to endometriosis, adenomyosis etc
  • Discomfort or pain when wearing tight clothing
  • Pain related to pregnancy or the post-partum period
  • Pain when emptying their bladder or bowel
  • Pain on the coccyx (tail bone)
  • Rectal spasms at random times of day or night
  • ‘normal’ back, pelvic or hip pains not responding to standard Physio/Chiro/Osteo treatment.

What signs can’t be ignored needing professional help?

Any pain or symptom that doesn’t spontaneously resolve within a few days, or does resolve but then repeatedly reoccurs, needs to be assessed professionally.

This includes ‘period pains’ or symptoms around your menstrual cycle that are strong enough that they don’t respond to basic over the counter medication such as panadol and ibuprofen, or that interfere with your normal activities.

For example, needing time off work or school, being unable to participate in usual activities or avoiding social engagements etc.

Any symptoms like this, despite what you may have been told by family members or medical practitioners, is not normal and needs investigating.

This includes other symptoms around the menstrual cycle such as nausea, marked bloating, dizziness, feeling faint and so on.

What could be the possible causes of pelvic pain?

Internal pelvic pain may be due to a multitude of factors including:

  • referral from the lower back or pelvis
  • nerve impingements/compressions such as pudendal neuralgia
  • muscle dysfunction (tight, weak, spasming etc)
  • internal trauma/injury (sexual abuse, sexual injury, penetrative injuries from falls)
  • other pathologies such is Lichen’s Schlerosis, infections, cancers, endometriosis, adenomyosis, cysts, thrush, inflammatory changes and so on.

External pelvic pain can also be due to a multitude of factors including:

  • hormonal and physical changes associated with pregnancy
  • referral from the nerves of the mid and low back
  • sacroiliac joint dysfunction, infection or inflammation
  • pubic symphysis dysfunction, infection or inflammation
  • stress fractures
  • traumatic injury (falls, blows etc) hip pathologies or dysfunction.

How do you treat those issues?

As Pelvic Health Physiotherapists, we ‘marry’ the internal with the external.

We assess externally for any muscle, nerve, joint, or movement dysfunction that may be contributing to the problem.

Then we also assess internally (when appropriate) to diagnose any musculoskeletal factors that could be contributing to the pain.

For example, with any syndrome that causes pain, such as endometriosis, there is usually a degree of protective muscle spasm that occurs.  This in turn can cause secondary pain, which ‘turns the volume up’ on your overall pain levels.

If the muscle dysfunction has been there long enough (average time to diagnosis for endometriosis is still approximately 9yrs which equates to a long period of chronic pain and symptoms), then there is usually also some stiffness/tightness/pain in the local joints and sensitisation of the neural system.

Both of these issues further exacerbate the overall sensation of pain.

Our treatments are aimed at ‘winding down’ the pain by releasing tight muscles, restoring normal motion to joints and the neural system, and restoring normal muscle function and control.

We obviously can’t alter the underlying pathology of something like endometriosis, but we can have a significant impact on your pain levels, thus restoring a level of empowerment over your symptoms, which in turn significantly improves your quality of life.

The actual techniques we use vary from person to person but may include:

  • manual release or mobilisation
  • education about pain physiology and the power of the brain
  • lifestyle alterations (nutrition, sleep, exercise, stress management etc)
  • learning self-management techniques including self-release, breathwork, mindfulness, activity modification/pacing
  • exercise programs that incorporate a multitude of techniques such as yoga and pilates to rebalance the body
  • other techniques such as TENS and acupuncture for pain management.

For the more external problems such as pelvic girdle pain from the sacroiliac joints or the pubic symphysis, besides the specific manual treatment techniques to restore normal movement and function to the body, we do progressive retraining programmes to correct any imbalances in the body.

These take you from a basic level, right through to high level training, lifting weights, sprinting etc and are aimed at not only resolving your problem, but also preventing it recurring.

Does pelvic pain affect men as well as women?

Yes, pelvic pain in men is one of the most under-treated areas of pelvic health problems.

It is most common in the 20-40yr old age group, but can occur at any age.

Typical pelvic pain symptoms for men (besides the ones as noted above) are:

  • pain or altered sensations in the groin, penis or scrotum
  • pain with intercourse
  • generalised internal pelvic pain – often diagnosed as prostatitis, but very commonly caused by pelvic floor muscle pain and dysfunction
  • pain or difficulty passing a bowel motion.

When do you suggest people see you – as opposed to their GP for pelvic pain?

If the pain is secondary to an injury, or mechanical cause I would recommend seeing a Pelvic Health Physio first.

However, for most other causes of pelvic pain we usually work hand in hand with the medical team. This may include the GP, and/or specialists.

Specific pathologies, such as cysts, infections etc often need to be ruled out as a cause of the pain. They can therefore see either of us first and we’ll cross-refer as necessary.

The most important thing to be aware of is that pelvic pain, traditionally, is very poorly managed or misdiagnosed.

It is not uncommon, for women especially, to be dismissed with ‘it’s just period pain’, or ‘it’s nothing to worry about’.

If you know that it’s not normal, seek a second opinion from someone specialising in pelvic pain.  Likewise, if you’re given a diagnosis, but it’s not responding to the treatment given, it may be that the diagnosis is incorrect.

Again, I would advise seeking a second opinion from a specialist.

This article is for information purposes only. It does not constitute medical advice, is general in nature, not tailored to your personal circumstances and you should seek your own medical advice from an independent medical professional with regards to what options are best for you.