Persistent Pelvic Pain – Solving the Puzzle

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It is very likely that you know a girl or woman with persistent pelvic pain although you may not be aware of it. This medical condition affects approximately 15-25% of Australian women, with huge impacts on quality of life, relationships, workforce participation and mental well-being. Not many people talk about pelvic pain and there are many women who suffer in silence but this condition is more common than asthma – so we need to bring it into the conversation.

Persistent pelvic pain is pain that is localised to the area between the belly button and hips, occurring on most days for more than 6 months. The pain can take many forms, from sharp and stabbing to dull and aching. Other related symptoms can include painful periods, pain with intercourse, bowel and bladder pain as well as difficulty sitting for long periods of time. The pain can be severe and is often worse around the time of a period.

Persistent pelvic pain can be caused by conditions such as endometriosis but often there may be no definable trigger. When someone has been in pain for a long period of time, changes occur in the nerves and muscles of their pelvis. The nerves become more sensitive than usual and begin to send constant pain signals to the brain, even when the original cause of the pain is no longer present.  The muscles in the pelvic floor begin to spasm and this can further exacerbate the pain as well as leading to discomfort and difficulty with sex, bowel and bladder motions.  Spasm of the pelvic muscles can also lead to dysfunction of back and hip muscles, causing pain in these areas. Isn’t it amazing that pain in one small area of the body can have such widespread consequences?

Women with persistent pelvic pain may find it difficult just to get through the day. Sitting for long periods can be difficult, and they often find themselves on large doses of pain killers. Sometimes the pain can seem to be controlled and then can flare unexpectedly. These flares of pain can be triggered by painful stimuli such as periods, urinary tract infections, constipation, strenuous exercise or sex. Understandably this can take a toll on all aspects of a woman’s life from her mood (depression and anxiety are common) to a lack of intimacy and relationship issues and difficulty attending work or school.

Fortunately, there are solutions available. For a condition that affects so many aspects of a woman’s biological, psychological and social well-being, the treatment is equally multi-faceted. The team commonly includes a gynaecologist, pain specialist, physiotherapist, psychologist and GP.

  • The gynaecologist will aim to treat any underlying disease that may be triggering the pain such as endometriosis or painful periods. Endometriosis can be surgically removed, however it is very important that patients with pelvic pain do not undergo too many operations as this can actually worsen their pain in the long term.
  • We often aim to stop a woman’s periods all together by using a hormonal contraceptive such as the pill or Mirena as this will reduce pain related to the menstrual cycle. The pain specialist might recommend medication that can de-sensitise the nerve pathways and reduce the pain signals reaching the brain.
  • Physiotherapy is important to relax the pelvic floor muscles and maintain physical activity.

There are also many things women can do themselves to treat the pain and prevent flares. Regular, gentle, non-core exercise such as swimming helps as will dietary changes. Avoiding or reducing opioid medication is important and meditation and mindfulness can benefit some women. It is important to keep moving.

If you think you might be suffering with pelvic pain, an Eve Health specialist gynaecologist is a starting point. Eve provide an in-house multi-disciplinary approach that includes specialist gynaecologists, pain physiotherapists and a pain psychologist.  We have a team of gynaecologists with a special interest in persistent pelvic pain.


Blog post by Dr Thea Bowler

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