Understanding Pelvic Pain: Causes and Treatment Options
Pain in the pelvis can be very distressing, especially if it is persistent, and can impact quality of life significantly. 1 in 5 women experience pelvic pain worldwide. But there is a lot that can be done to help - pelvic health physio to the rescue!
Common causes of pelvic pain in women
Pelvic pain can be caused by a number of things, for instance:
• If there is an underlying medical condition such as endometriosis, adenomyosis, polycystic ovarian syndrome (PCOS), bladder pain syndrome and bladder cystitis.
• Pain can be caused by the presence of an infection, such as thrush, bacterial vaginosis, a urinary tract infection (UTI) or sexually transmitted infection (STI). Pain can sometimes persist beyond the initial infection, even after it has been treated and isn’t active anymore.
• Other, more rare conditions, such as lichen sclerosus or lichen planus that have an immune system component can also contribute to pain.
• Pudendal nerve compression or irritation (pudendal neuralgia) can also cause dysfunction and pain in the pelvis and saddle area.
But pelvic pain can also occur in the absence of pathology or disease.
• Conditions such as vulvodynia (vulval pain syndrome) and vaginismus are very commonly-occurring in women of all phases of life.
• Peri-menopausal and post-menopausal women are also at risk of developing pelvic pain due to biological and tissues changes linked to the reduction or absence of oestrogen in the system.
Genito-urinary syndrome refers to symptoms in the genitals and urinary tract: new onset of urinary leakage, vaginal dryness and/or irritation and can lead to pelvic pain and pain with sex.
• Bowel dysfunction and digestive system issues can also lead to pain with defecation, and pelvic pain.
How physiotherapy can help pelvic pain
Education is a large part of what pelvic health physio’s help with - understanding clearly the neurophysiology and contributing factors to your pain and understanding how to address them can make a huge impact on your pain experience. Learning more about your anatomy and establishing clearly the severity of the condition can often be a great starting point to alleviate fear and anxiety.
Providing manual therapy when indicated can aid restore optimal muscle and joint function, free circulation to key areas and help organ function close to the pelvis (such as digestion and bladder function).
The physiotherapist can also guide you through helpful lifestyle modification to ensure you continue working towards pain reduction and prevent aggravating the condition. Simple things such as work station set-up, implementing a couple of simple and regular stretches, and establishing a regular routine of weekly exercise can help a lot.
The physiotherapist can create a global exercise program to build strength in relevant supportive muscles surrounding the pelvis, and incorporate stretches to reduce excess tension and load on key structures and joints. Designing a tailored and individualised exercise program that addresses your specific needs and biomechanics is key to progress.
Pelvic health physiotherapists have the expertise to assess and manage pelvic floor muscle function. It is very often the case that pelvic floor muscle dysfunction can feed into the vicious cycle of pelvic pain - bracing the localised muscles and getting into protective mode is a natural response to pain, but the increased muscle tension can in turn flare the inflammatory response, compromise blood flow to the area and increase tissue irritation. Pelvic floor physiotherapy and rehabilitation can help break that cycle and restore optimal function, and hence reduce pelvic pain. Bladder and bowel management, defecation mechanics retraining and sexual rehabilitation are other key aspects of pelvic floor physiotherapy management.
So, if you are experiencing pelvic pain or know anyone who is, let them know of pelvic health physiotherapy and call us at Hatched House - we can definitely help!
Why a multidisciplinary approach can be important
A multidisciplinary team approach is recommended for managing any pelvic pain and, in addition to physiotherapy, can also include the following:
Topical medication treatment
Oral medication treatment
Surgical intervention
Psychological therapy
Sexual and relationship counselling
Dietician management and input
Pain specialist management
FAQ About Pelvic Pain
What causes pelvic pain in women?
Pelvic pain in women can have many different causes and is often influenced by more than one factor. Common causes include pelvic floor muscle dysfunction, endometriosis, bladder or bowel conditions, painful periods, pregnancy-related changes, vulvodynia, nerve irritation, muscle tension, or previous injury or surgery. Sometimes there is a clear diagnosis, while in other cases pelvic pain can be related to a combination of physical, lifestyle and emotional factors. Understanding the underlying cause is important because treatment can vary depending on what is contributing to your symptoms.
Can pelvic floor muscles cause pelvic pain?
Yes. Pelvic floor muscles can contribute to pelvic pain when they become tight, overactive, sensitive or have difficulty relaxing. Pelvic floor dysfunction may lead to symptoms such as pain during intercourse, discomfort with sitting, bladder urgency, difficulty emptying the bowels, or persistent pain around the pelvis, hips or lower abdomen. Because pelvic floor muscles work closely with other muscles around the hips, abdomen and back, assessing the whole body is often important.
Can pelvic pain improve with physiotherapy?
Physiotherapy can help many people experiencing pelvic pain, although treatment will depend on the underlying cause of symptoms. Pelvic health physiotherapy may involve education, pelvic floor assessment, relaxation strategies, breathing techniques, movement advice, exercise, manual therapy and support with returning to daily activities or exercise. At Hatched House, treatment focuses on understanding the whole picture rather than only treating symptoms in isolation.
When should I see a pelvic health physiotherapist?
You may benefit from seeing a pelvic health physiotherapist if pelvic pain is affecting your daily activities, exercise, sleep, bladder or bowel function, or intimacy. You do not need to wait until symptoms become severe. Early assessment can sometimes help identify contributing factors and provide guidance around symptom management and treatment options. If you're in Melbourne, the team at Hatched House can help assess and guide treatment based on your individual symptoms and goals.