Pelvic pain is a complex condition. As women, we all feel pain at some time or another
in our pelvic region, such as with our monthly menstrual cycle. Some of us experience
pain in our pelvis at other times, and this is when it becomes a little more complicated.
We can help treat and prevent pelvic pain
Pain felt for short period of time, such as with menstruation is known as acute
pelvic pain. This pain differs for all women and perhaps may involve conditions
such as endometriosis that cause very painful periods. Pain that exists for a long
time, often of varying degrees and a mix of different types of pain is defined as
chronic pelvic pain. This pain may really wear you down, make you feel anxious and
tired from it.
Chronic pelvic pain can originate from a variety of sources in the pelvis, including
the painful or irritable bowel, a painful bladder, pelvic muscle pain, pelvic nerve
sensitivities, endometriosis, sexual pain, referred pain from the lower back and
pelvic joints, anxiety and low mood.
Pelvic pain of this type needs an excellent assessment and diagnosis. As we've mentioned,
there are many probable sources of your pain, and to find the right mix of causes
for how you are feeling will mean a better outcome.
What are the causes of chronic pelvic pain?
Chronic pelvic pain can be classified into groups and refer to the probable causes
of pain in women. These are:
Urological pain disorders, relating to bladder conditions such
as painful bladder, interstitial cystitis and urethritis
Anorectal pain disorders, relating to painful conditions of the
bowel and rectum
Neuropathic disorders, relating to hyper-sensitivity of the pelvic
Sexual dysfunctions, relating to pain with sex or penetration,
including dyspareunia and vaginismus
Endometriosis and other pathological conditions such as urinary tract infections
(UTIs) and pelvic inflammatory disease (PID)
, relating to changes within
the cells and tissues of the pelvic organs
Often women will have a combination or mix of these types of pain, and it is good
to keep a diary to note your pain frequency, location and type. Chronic pelvic pain
can often be accompanied by other pelvic floor symptoms such as:
As chronic pelvic pain is often very complicated and you may be feeling a mix of
different types of pain, it would help to keep a diary to note your symptoms. Perhaps
some of these questions are you?
If you have answered yes to any or all of these questions, and you feel pain almost
most days, then seeking help is the next step. Assessment by a gynaecologist will
help to understand your pain and the causes. Women's health physiotherapy has been
shown to be most helpful in most causes of chronic pelvic pain.
How do women’s health physiotherapists treat chronic pelvic pain?
A thorough assessment and tests to eliminate any infections and other conditions
of the pelvis is the first step. This is best done by your gynaecologist.
Referral to our women's health physiotherapists is then most common. We will assess
for structural and alignment changes to the spinal and pelvic joints, pelvic floor
weakness or spasm and vaginal structure. Our physiotherapists need to work closely
with your gynaecologist, GP, musculo-skeletal physiotherapist and psychologist,
if you are seeing one.
After an internal vaginal examination, treatments from our physiotherapist may involve
massage and trigger point releases of your pelvic floor muscles
electrical stimulation to 'relax' the nerves and decrease their over–sensitivity
education and instruction on how to use vaginal dilators to help to stretch and
release your pelvic floor muscles at home
re-alignment techniques and exercises to correct poor pelvic and spinal postures
that contribute to your pelvic pain
How is The Fix Program different in the treatment of chronic pelvic pain?
At The Fix Program, we understand that every woman is different and that no one
treatment will work with each woman.
Our women's health physiotherapy assessment will always involve an internal vaginal
examination. This, along with extensive questioning about your gynaecological history,
pelvic floor function and habits will allow for the best diagnosis of the cause
and treatment of your pelvic pain and symptoms. We will always work together with
you to provide you with the right help that you need to take control over your chronic
What should I expect?
After the initial visit and internal vaginal examination, it is expected that you
will require regular visits with our physiotherapist. Initially, intensive treatment
is required twice per week before reducing to weekly session over 6-12 weeks. Remember,
every woman is different, so this is a guide only.
Typically in women with chronic pelvic pain, pelvic floor muscles may be found to
be tight or in spasm, much like a muscle in your neck can spasm or feel very tense
after a long day in front of the computer. This tightness within your pelvic floor
muscles can cause pain. The best treatment is to release these muscles manually
though massage or teach you how to use a vaginal dilator to relax and stretch these
muscles yourself at home. Our physiotherapist will release this tightness at your
visits, both internally from within your vagina or externally about the hip and
buttock areas. Relaxation exercises for your pelvic floor muscles, advice and education
on pelvic floor function and toileting habits and reassurance compliment the manual
If we feel you need to address anxieties, feelings of depression or hopelessness
because of your pelvic pain, then we may chat with you about referral on to a psychologist.
We know that help with all of these factors, in addition to the muscle tightness
and spasm can better your overall outcome.
Did you know
Millions of women around the world suffer from chronic pelvic pain, you are not
alone, we can help you.
If you have any questions about pelvic floor dysfunction, or any of its presentations
such as incontinence,
vaginal prolapse or pelvic pain,
please call us on 02 9264 0077 to discuss your concerns with our women's
health physiotherapists. We will be very happy to talk privately with you or to
arrange your initial assessment.