Persistent (Chronic) Pelvic Pain

In our line of work we meet women daily who suffer from Pelvic Pain and one of the most common emotions that is expressed by these women is frustration. Frustration of not feeling heard, frustration of the multiple medical appointments they’ve attended with very few answers, the frustration of their symptoms and the impact they have on their physical health, their emotions, their sexual function and their work and social lives, the frustration of feeling like they are running in circles getting nowhere.

As The International Association for the Study of Pain defines, pain is "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. In other words, pain is something that affects us both physically and emotionally and may be related to tissue damage e.g. a papercut, or in the absence of tissue damage, for example a headache.
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In relation to pelvic pain, determining the source can be an incredibly lengthy, difficult and emotional process. You can appreciate why when you look at the list of conditions that can cause pelvic pain: period pain, IBS, vulvodynia, endometriosis, vaginismus, bladder-related pain… the list goes on. However, you can most definitely start learning about pain, how to better manage your pain and improve your overall pelvic health before a firm diagnosis is made.

So where do we start?
Understanding pain. For women experiencing pelvic pain or anyone working with women experiencing pelvic pain we first need to understand it- what is it and why do we experience it? Pain is complex and can be influenced by a number of factors; hormones, stress, activity levels are just a few. However, when we understand the process that is involved in experiencing pain and how our body and mind perceive it we can greater recognise how it behaves and therefore start to take some of the control back.

Happy Pelvis
Pain can have a snowball effect on our overall pelvic health. As mentioned earlier, it can cause irritability of the bladder, constipation or issues defecating, pain during or after intercourse or changes to our libido. By managing these symptoms, we are helping create a healthy and well- functioning pelvis.
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Looking beyond the pelvis
Muscle spasm or tension is commonly present when we are in pain, yet another protective mechanism our body puts into place. This can impact not only the pelvic floor but other areas throughout the body; gluteals, hip flexors, abdominals etc.
The intent of this spasm or tension is to limit our movement and therefore function so as to avoid injury or damage. It’s a lovely thought by the brain but often the muscle spasm itself intensifies our pain or exacerbates our other symptoms. Massage, stretches, gentle exercise, heat therapy etc can all be utilised to assist in reducing this muscle tension.

Graded return to movement / exercise
When it comes to managing Persistent Pain – slow and steady wins the race! It is a matter of re-programming the body and the brain that movement is not harmful, and this cannot be rushed. An   experienced clinician can guide you in the return to appropriate and safe movement and exercise.
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What are realistic outcomes?
This is an incredibly difficult question to answer. I encourage women to think about some short and long term goals they would like to achieve ensuring they are realistic in terms of being attainable and the time frame set.

The outcome is often dependent on the pain condition, any diagnosis that has been made, the length of time the condition has been present and of course the individual.
If we use the example of a young lady with vaginismus, the involuntary spasm of the pelvic floor muscles often making penetrative sex difficult and painful.

An example of a short term goal

• To be able to use a tampon comfortably during my next period.

A longer term goal for a woman

• To have a comfortable and enjoyable sexual relationship with my partner.

​Every woman’s journey is unique with their own individual hurdles to overcome and goals to achieve. The frustration we are met with when first meeting these women is often replaced with hope, optimism and excitement that there is at long last, light at the end of the tunnel.

By Shea Vincent
​Pelvic Floor Physiotherapist