Pelvic Pain
Pain that is dismissed, minimised or left unexplained for years. You deserve better than that.
Pelvic pain is one of the most complex and undertreated conditions in women's health. It is often dismissed, normalised or attributed to conditions that have already been investigated and excluded, leaving women feeling confused, unheard and without a clear path forward.
At Fitt Physiotherapy we take pelvic pain seriously. Our physiotherapists and clinical psychologist work collaboratively to provide a thorough, compassionate and evidence-based assessment of your pelvic pain, whatever its cause and whatever its history.
If you've been told "everything looks normal" but you're still in pain, you are in the right place.
What is pelvic pain?
Pelvic pain is broadly defined as pain located below the belly button and between the hip bones. It can be acute, sudden and short-lived, or chronic, where it persists for 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 is rarely caused by one single factor. It is almost always multifactorial — involving the muscles, nerves, joints, connective tissue and often the nervous system itself. This is why a thorough assessment matters more than a diagnosis alone.
Endometriosis
Endometriosis affects approximately 1 in 9 women, yet takes an average of 7 to 10 years to diagnose. It is one of the most common causes of chronic pelvic pain in women of reproductive age.
Endometriosis occurs when tissue similar to the lining of the uterus grows outside the uterus, on the ovaries, fallopian tubes, bowel, bladder and other pelvic structures. This causes chronic inflammation, scarring and a cascade of symptoms that vary significantly 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 pelvic floor physiotherapy helps with endometriosis:
Chronic pain from endometriosis almost always leads to secondary pelvic floor dysfunction, including muscle guarding, trigger points, reduced tissue mobility and altered movement patterns. These secondary changes can persist even after surgical or medical management of the endometriosis itself.
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 collaboratively with your gynaecologist, GP and other treating specialists to ensure your care is coordinated and comprehensive.
Interstitial Cystitis
Interstitial cystitis, also known as bladder pain syndrome, is a chronic inflammatory bladder condition characterised by persistent pelvic and bladder pain, significant urgency and urinary frequency.
It is frequently misdiagnosed or diagnosed late and it has a profound impact on quality of life, relationships and mental health.
Approximately 85% of people with interstitial cystitis have associated pelvic floor dysfunction including muscle tightness, trigger points and altered nerve sensitivity. Pelvic floor physiotherapy is an evidence-based component of multidisciplinary management for this condition.
Our treatment approach includes:
✦ Internal pelvic floor assessment and manual therapy
✦ Trigger 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
For more information on bladder symptoms see our Bladder page.
Chronic pelvic pain and the nervous system
For many women with chronic pelvic pain, particularly those who have had negative investigations or whose pain has been present for years, the nervous system plays a significant role in maintaining and amplifying the pain experience.
This does not mean the pain is "in your head." It means that the brain and nervous system have learned to protect the pelvic region, sometimes continuing to generate pain signals long after the original tissue injury has healed.
This is where our integrated physiotherapy and psychology model makes a real difference.
Our clinical psychologist Sarah works alongside our physiotherapy team to address the psychological and emotional contributors to chronic pelvic pain, including fear-avoidance, pain catastrophising, anxiety and the impact of pain on identity, relationships and quality of life.
Pain that has been present for years can absolutely improve. We have seen it. The right team and the right approach make all the difference.
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 it is not untreatable. Let's find your path forward together.