Chronic pelvic pain is different for every person and may be felt anywhere between the stomach and pelvic area. The pain comes and goes and may be aggravated by bladder or bowel motions, periods, intercourse or other activities. Chronic pelvic pain has been persistent for at least 6 months.

Often chronic pelvic pain is diagnosed in the absence of other pathology. This might mean you have had some tests done that have ruled out other disease or illness that may be causing the pain. Other pain conditions you might have been diagnosed with could include:

• Endometriosis · Vulvodynia

• Vestibulitis

• Vaginismus

• Bladder pain syndrome · Interstitial cystitis

• Dyspareunia

• Lichens sclerosis

• Coccydynia

• Pudendal neuralgia · Proctalgia fugax

• Pelvic Girdle Pain

How do we assess and treat chronic pelvic pain

• Subjective Questioning
  We will ask you many questions about your early life to try and understand when and where the pain started. Getting back to the first onset of symptoms is important. Sometimes painful conditions be triggered by an event many years ago, even in childhood, such as falls, accidents, trauma, painful first periods, issues with continence or constipation. This can begin an altered pain process and affect how your body interprets pain. There may be compensatory strategies in your posture or movements that can continue to irritate structures and continue the pain cycle.

• Pelvic Floor Assessment
  We will usually assess the pelvic floor muscles with an internal assessment. Often when pain has been present for some time the body will contract the pelvic floor muscles as a protection mechanism. This increased pelvic floor tone, sometimes called hypertonic or overactive pelvic floor muscles, can increase painful symptoms and is an unhelpful response. It can take some time to relearn how to use these muscles appropriately and you may need multiple physiotherapy sessions consisting of gentle pelvic floor release work. Usually you will have some relaxation exercises and stretches to do at home as well.

• Whole Body Assessment
  We will assess your body from head to toe to see if regions of the body may have altered loading patterns. Muscular, facial and neural components can be contributing to pain. We will often do muscle releases or soft tissue massage to parts of the body we think are contributing to your pain. We want your body to move efficiently and will likely give you some specific strength exercises as well as stretches to release tight areas.

• Refer on or liase with other members of your team
  Pain processing is complex and can be influenced by stress and hormones. You may be recommended medications to help manage your symptoms in combination with physiotherapy. Referral to psychology, dietician, gynaecologist, urologist or other specialist care may be appropriate to best manage your symptoms.