Pelvic Pain
Pelvic pain that's been dismissed or left unexplained for years? You deserve better.
Pelvic pain is complex and often undertreated. Many women are told it's normal, or that their tests are clear, and leave without a plan.
We take pelvic pain seriously. Our physios and clinical psychologist work together to understand your pain, whatever the cause and however long you've had it.
If you've been told "everything looks normal" but you're still in pain, you're in the right place.
What is pelvic pain?
Pelvic pain is pain below your belly button and between your hip bones. It can be short-term, or chronic, meaning it has lasted more than 3 months.
Pelvic pain can feel like:
A constant ache or pressure in the lower abdomen or pelvis
Sharp or stabbing pain, with certain movements, positions or activities
Pain with menstruation, ranging from moderate to severely debilitating
Pain with bladder or bowel function
Pain during or after sex
Referred pain, into the hips, lower back, inner thighs or tailbone
Pelvic pain rarely has one cause. Muscles, nerves, joints, connective tissue and your nervous system can all play a part, which is why a thorough assessment matters.
Endometriosis is common. Around 1 in 7 Australian women born in 1973 to 1978 had been diagnosed by age 44 to 49 (AIHW). It is one of the most common causes of chronic pelvic pain in women of reproductive age.
It happens when tissue similar to the lining of the uterus grows outside the uterus, on places like the ovaries, bowel and bladder. This causes inflammation, scarring and symptoms that vary a lot between women.
Common symptoms include:
Painful periods, ranging from moderate to severely debilitating
Pain with sex, particularly deep penetration
Pelvic pain outside of menstruation
Bowel and bladder symptoms including urgency, frequency, painful urination or defecation
Fatigue, often significant and poorly understood
Difficulty conceiving
How physio helps
Living with endometriosis pain often leads to pelvic floor changes too, such as muscle guarding, tender spots and stiffness. These can hang around even after surgery or medication.
Our physiotherapists address:
Pelvic floor muscle tension and trigger points
Scar tissue from laparoscopic surgery
Bowel and bladder symptoms associated with endometriosis
Pain with sex
Movement and load management strategies
We work with your gynaecologist, GP and other practitioners so your care is joined up.
Endometriosis
Interstitial cystitis
Interstitial cystitis, also called bladder pain syndrome, causes ongoing bladder and pelvic pain, urgency and frequency. It's often diagnosed late, and it can affect your relationships, sleep and mental health.
Many people with interstitial cystitis also have pelvic floor dysfunction, including muscle tightness, trigger points and altered nerve sensitivity. Physio is one part of a team approach to managing it.
Our treatment approach includes:
Internal pelvic floor assessment and manual therapy
Pressure point release, addressing tender areas within the pelvic floor muscles
Relaxation and down-training of the pelvic floor
Bladder retraining in collaboration with your urologist
Pain education and nervous system desensitisation strategies
See our Bladder page for more.
Chronic pain and your nervous system
For many women with long-term pelvic pain, the nervous system plays a big part in keeping the pain going.
That doesn't mean the pain is "in your head." It means your brain and nerves have learned to protect your pelvis, and can keep sending pain signals after the original injury has healed.
This is where having physio and psychology under one roof helps. Our clinical psychologist Sarah works with our physios on the things that can keep pain going, such as fear of movement, worry, and the toll pain takes on your relationships and sense of self.
Long-standing pain can often improve with the right support.
How we assess and treat
Your assessment will include:
A comprehensive pain history: onset, location, triggers, aggravating and relieving factors
A detailed medical, gynaecological and surgical history
Pelvic floor muscle assessment: tension, trigger points, coordination and sensitivity
Movement and posture assessment where relevant
Discussion of the contributing factors specific to your presentation
Treatment is highly individualised and may include:
Pelvic floor manual therapy, both internal and external
Trigger point release and myofascial techniques
Scar tissue treatment, post-surgical or post-birth
Pain education and nervous system strategies
Relaxation and breathing techniques
Movement and load management
Collaborative care with psychology
Referral to gynaecology, urology or pain specialists where appropriate
You deserve to feel better than this.
Pelvic pain is complex, but there's a lot we can do. Let's work out a plan together.