Pelvic Pain

Pelvic pain is a common yet complex condition that affects many women, with a variety of underlying causes. It can range from mild discomfort to severe chronic pain and can significantly impact a woman’s quality of life. The pain may be localised to the pelvic area or radiate to other parts of the body, and it may be intermittent or constant. Pelvic floor physiotherapy can play a critical role in the assessment and management of pelvic pain, offering a range of treatment options that aim to alleviate pain, restore function, and improve quality of life. Pelvic pain is multifactorial and benefits from a holistic, multidisciplinary treatment approach from other fields that may include gynaecologists, pain specialists, dieticians, acupuncturists, urologists, colorectal surgeons/gastroenterologists, psychologists/counsellors, and chiropractors.

COMMON PELVIC PAIN CONDITIONS IN WOMEN:

- A chronic condition where tissue similar to the lining of the inside of the uterus (endometrium) grows outside the uterus. This can be found on the ovaries, fallopian tubes, the outer surface of the uterus, and other organs within the pelvis. This can cause significant inflammation, scarring, and adhesions, resulting in pelvic pain.
- Symptoms:
  - Severe menstrual pain
  - Heavy menstrual bleeding
  - Chronic pelvic pain
  - Pain during or after intercourse
  - Pain with urination or bowel movements
  - Infertility
- A condition where your pelvic floor muscles involuntarily tighten upon the attempt of vaginal penetration. This can happen before or during intercourse, when inserting a tampon or sex toy, or during a vaginal examination.
- Symptoms:
  - Pain and discomfort on attempt of vaginal penetration
  - Burning or stinging
  - Complete inability of achieving penetration
- The exact cause of vaginismus is not fully understood, but it is believed that several factors may contribute, including:
  - Recurrent vaginal conditions (e.g. thrush) or infections (e.g. UTIs)
  - Sexually transmitted infections (STIs)
  - Endometriosis
  - Mental health conditions e.g. stress, anxiety, depression
  - History of sexual abuse, assault, or violence
  - Birth trauma
  - Post surgery
  - Personal or religious beliefs about sexuality
  - Fear of pain based on previous experiences
  - Other psychological factors e.g. relationship problems, feeling self-conscious, fear of intimacy, fear of pregnancy, lack of arousal
  - In some cases, no identifiable cause
- Vulvodynia:
  - Chronic pain or discomfort around the vulva (the external genital area) when no other cause is found.
  - Symptoms include burning, stinging, or itching sensations around the vulva, especially during sex, physical activity, with urination, or prolonged sitting.
  - The cause is unknown however it can be associated with injury or tissue damage (childbirth, surgery, sexual abuse), skin conditions, or chronic yeast infections.
- Pudendal Neuralgia:
  - Chronic pain caused by irritation or compression of the pudendal nerve, which affects the pelvic region. It can be a result from injury, childbirth, or pressure on the nerve
  - Symptoms include:
    Pain in the perineum (between the genitals and anus)
    Burning or stabbing sensations
    Discomfort worsens with sitting
    Issues with sexual, urinary, or bowel functions
- Pain localised to the coccyx (tailbone) and can be caused by injury, such as a fall or trauma, prolonged sitting on hard surfaces, childbirth, or infection.
- Symptoms include aching, sharp, or throbbing coccyx pain, especially when sitting, standing up, or during certain movements.

Pelvic floor physiotherapy can be a key resource in managing chronic pelvic pain. Through targeted treatments like pelvic floor muscle training, manual therapy, posture correction, and pain management techniques, pelvic floor physiotherapy can help reduce pain, improve muscle function, and restore mobility.