Female Pelvic Pain
Some studies report that ¼ of women experience or have experienced persistent pelvic pain. This is pain that has continued for most days for 6 months, in the area below the belly button and above the legs. Pelvic pain, is undeniably hard work! It takes its toll on your body both physically, emotionally, and psychologically. It can be frightening and frustrating when there is no clear diagnosis. The complexities around diagnosis can be related to the proximity of the organs responsible. The uterus, ovaries, bladder and bowel, the muscles, ligaments and nerves all sit very close to each other inside the pelvis. And they talk to each other!
Possible intrinsic organ pain can come from one or a combination of period pain, endometriosis, vulva pain, irritable bowel syndrome, bladder pain syndrome, tight pelvic floor muscles and pudendal neuralgia. This is why it is imperative to seek advice from medical professionals to rule out pathology and start to determine an accurate diagnosis of why you are experiencing this pain.
Pain is initially used as a warning sign for us to act on; we need it to survive. However, once it has continued for most days for 3-6 months, it becomes persistent pelvic pain. The brain has decided for whatever reason that it needs to continue to protect you from the actual or potential threat it once had, regardless of tissue damage being present. Central sensitization is when there have been physical changes to the nerves, which causes a heightened pain response. This is due to the brain processing pain inaccurately. Unfortunately, this itself causes more pain and these chronic conditions such as endometriosis, tight pelvic floor muscles, vulva pain, irritable bowel syndrome etc can all cause this central sensitisation.
When understanding pelvic pain, we need to acknowledge all of the components of the pelvis plus the spine, hip joint, abdominal muscles and the input of the brain. Pelvic floor physiotherapists can assess your pelvic floor muscles to determine their involvement in your pelvic pain. Often these muscles can be sore to touch, and sometimes tight. We use specific techniques to help relax and de-sensitise these muscles such as
· yoga with mindfulness
· gentle stretches
· other movement-based therapy
· vaginal trainers
We also teach techniques to empty your bladder and bowel optimally. But it’s not just the pelvic floor we are looking at as we also assess how well your whole spine moves, your breathing techniques, abdominal muscle function etc. as these are all intertwined into pelvic pain issues. We establish non-threatening movement as this helps resolve pain through the healing qualities of endorphins produced during exercise. We retrain the brain to say THIS movement is ok for you and is actually really GOOD for you.
The psychosocial consequences of pelvic pain can be debilitating for some. Persistent pain can cause low mood and social isolation. Your work, hobbies, relationships can all be affected, including your sexual health as pelvic pain can often mean painful sex. Some people may find it hard to even start intimate relationships for the fear of the consequences. Pelvic floor physiotherapists aim to understand your whole sexual health story right from the beginning and when pain or other issues became apparent. Once medical reasons have been cleared we then determine if and how much the
pelvic floor muscles are involved. We can then discuss certain techniques to help relax the pelvic floor muscles and make sex less painful and fun again!
We assess and treat the whole person, looking at past experiences of pain, medical and surgical histories, hormonal history, past and present trauma, and whole body movement patterns. By piecing together your whole story and body movements help us help you conquer your persistent pain.
Remember, pain is personal. It is a physical AND an emotional response and is influenced by many factors including:
· emotional wellbeing
· biological factors
· religion and culture
· environment (for example the room temperature)
· gender and
Living with persistent pain is hard, but it is manageable with the right team. The team firstly involves you and then can include many other helpers. Your team could be as big as this:
· General practitioner
· pelvic floor physiotherapist
· colorectal surgeon
There are a few there! Treatment is a team effort.
Please don’t suffer in silence, we are here to help.