Persistent Pelvic Pain (PPP) is believed to affect 21.5% of women in Australia. It can be defined as experiencing pain in the area of the pelvis, specifically below the belly button on most, if not all days for more than six months.

PPP is complex and can be difficult to manage, treat and diagnose. Most women with PPP find it challenging to understand and describe their condition. Investigations performed by health professionals can come back clear and leave you feeling helpless, however it is important to know that there is help and you are not alone.

It is understood that there are four components of PPP. These include;

1. Pain from organs (bladder, uterus, bowel) – This can include Endometriosis (past or current), uterine pain associated period pain, urinary frequency and urgency, food intolerances, irritable bowel syndrome and vulvar disorders.

2. Muscle response to pain – When you experience pain muscles can tighten and spasm as a protective response. Although this is a protective response, muscle tension and spasm can cause more pain. You may feel stabbing pains in the lower abdomen and vagina, which can then spread into your thighs and lower back. Curling up in a ‘fetal position’ and using heat packs often relieves pain. Muscle pain can start to impact bladder function, which can then lead to frequency and urgency. Pain during or after sex (Dyspareunia) is a common consequence of tight muscles.

3. Increased sensitization of nerves – It is common that persistent or chronic pain can increase how sensitive your nerves and body become to pain. You may develop other symptoms such as bloating, burning, nausea, dizziness, anxiety and increased sensitization when touching your lower abdomen.

4. Psychosocial response to pain condition – Persistent pain can become very consuming. It can be debilitating and result in missing work, school and social activities. As a consequence, you may experience symptoms of anxiety, depression and low self-esteem.     

Physiotherapy is traditionally known for treating sports and muscle injuries. However, a Pelvic Floor Physiotherapist completes additional training and study to appropriately assess, diagnose, manage and treat conditions within the pelvis, including Persistent Pelvic Pain.

5 ways a Pelvic Floor Physiotherapist can help:

1. Pelvic Floor Re-Training – Pelvic Floor describes a group of muscles, ligaments and tissue that surround your vagina and back passage, starting at the pubic bone attaching to the tailbone. This makes up the floor of the pelvis. Your physiotherapist will assess your pelvic floor and determine a program that is individualized to suit your needs. It is common for programs to include treatment methods such as relaxation training for treating persistent pelvic pain. This involves increasing your awareness of your muscle tension and learning how to voluntarily relax your muscles.

2. Pelvic Floor Muscle Trigger Point Therapy – Similar to any other muscle in the body, when tightness and tension is being experienced you can develop ‘knots’. This can lead to trigger points that cause pain spontaneously. A Pelvic Floor Physiotherapist can internally release and trigger point your pelvic floor muscles to release this tension and pain. As the pelvic floor muscles are internal, this requires a vaginal assessment to treat the muscles effectively. Your physiotherapist may teach you to replicate treatment at home using a dilator, wand or finger.

3. Myofascial Release – Pain can cause muscles to spasm and tighten, not just in your pelvic floor but also in the muscles surrounding your pelvis. Your physiotherapist will assess you with a holistic approach. Massage and/or a stretching program specifically for muscles around your pelvis may be necessary to decrease muscle tightness.

4. Bowel and Bladder Management – During a consultation, your physiotherapist will ask you intimate and detailed questions about your bladder and bowel function. Pain can alter bowel and bladder function & your bowels may cause constipation or diarrhea. In order to help you manage these issues, your physiotherapist may provide detailed advice regarding fluid and food intake or advice on how to manipulate your stool by recommending supplements. When the bladder isn’t functioning correctly, you may suffer from urgency (a sudden, difficult to hold on desire to wee) or frequency (going to the toilet more than eight times in 24 hours). Your physiotherapist may ask you to complete a bladder diary to track your bladder function and provide advice on fluid intakes. Based on your symptoms you may need to re-train your bladder.

5. Exercise – It has been shown in the research that exercise programs guided by a Pelvic Floor Physiotherapist can reduce PPP. Exercise programs include walking and specific postural strengthening over six to eighteen weeks.

If you, or anyone you know suffer from Persistent Pelvic Pain please contact us at the clinic for further information about how we can help!