Chronic Pelvic Pain
Pelvic pain is common.
Pelvic Pain affects 1 in 5 women at some time in their life – yet it’s a condition that is rarely discussed. Pelvic pain can be continual or cyclical; it can be related to periods and/or mid-cycle; it can present as pain with intercourse, bowel or bladder pain, pelvic muscle pain or pelvic nerve type pain, and commonly two or more types of pain may be present. It can also be associated with generally feeling unwell, tired, low or anxious in mood. When you first develop pain, it is important to see your doctor to check if the pain indicates something that needs immediate investigation and/or treatment. Unfortunately, even with the best care, some women still have pain. There may be nothing to find on scans or tests, but pain persists.
When pelvic pain becomes chronic.
Once you have had pain for more than 3 to 6 months we consider it to be chronic pain. At this stage the original cause of the pain may only be a minor contributor or not even be present any more yet there is still pain. Tests may be normal and there may be no abnormality to see. Yet you know there is still pain. Sometimes women worry that health care professionals do not believe them or that they think “its all in your head”. It is so important to know that you can’t imagine pelvic pain… if you experience long term pelvic pain then even if the original cause is never discovered, you by definition have chronic pelvic pain.
How our GP's can help.
Our doctors will spend quite some time with you over two or more appointments, starting by asking quite a lot of questions about you and your pain. You will also usually have an examination of your pelvic area and vagina. This will be very carefully performed by our sensitive female doctors within your limits. The doctor and you will come up with a plan of action. As there are so many different types of pelvic pain that the treatment plan will be individualised to each women. There are various medications that may be helpful in your particular case. Once pain has become chronic, it is unlikely that any one treatment will make it go away completely. However, there is hope. There are many ways to manage this pain and make it a much smaller part of your life.
We all want a cure for pain, preferably once that is quick and easy. It's understandable. One day there may well be such a treatment. For now, for the best treatment of your pelvic pain get started by making a double appointment with one of the doctors below. It will be helpful if you fill out this questionnaire and bring it to your appointment.
Other helpful health professionals.
You may need a referral to a specialist such as a gynaecologist, urologist, gastroenterologist, pain specialist, or pelvic floor physiotherapist. Sometimes a psychologist may be really helpful as thoughts and emotions can also affect your pain and of course your pain can affect your thoughts, emotions and relationship. Occassionally a specialised sex therapist may be required. Your doctor will be able to provide the appropriate referral. If you become (or are already) a regular patient of the practice, you will have a care plan where you can access allied health with a Medicare rebate.
Pelvic floor muscle involvement.
Muscles change when they are injured or when we are in pain – they tense up. Pelvic floor muscles behave like this too when there is something painful in the pelvis. They tighten up. Muscles aren’t meant to be tight all the time and after a while, they start hurting and adding to the pain. Humans are designed to move, so sitting or lying down a lot due to pain can make the pain even worse. Muscles that become even tighter can spasm, causing sudden, stabbing or crampy pains. Muscle tension can also be caused or worsened by stress and emotional tension. Many women with chronic pelvic pain will be noted to have tight tender pelvic floor muscles on examination and may benefit from pelvic floor relaxation exercises and stretches* and/or pelvic floor and general physiotherapy from a skilled physiotherapist.
Almost all women with chronic pelvic pain will benefit from very specific pain education. In a nutshell, all pain is produced by the brain, and with chronic pain there is by definition some element of what is called central sensitisation. This is where pain gets really complex. The brain and nervous system may have a much lower threshold for producing pain in the pelvic area. Things that weren’t painful before like intercourse, or wearing tight jeans, or the bowels or bladder working may become painful. Pain may be felt in a much wider area eg abdomen, back or thighs even though they are not abnormal in any way. And because the brain, nervous system, endocrine system, and immune system are all so closely related, there are also commonly effects such as on our energy levels, well being, mood, concentration, resistance to infection etc. and this can cause a vicious cycle by lowering our brains threshold for producing pain even further.
Dr Adele Stewart offers sets of 4 x 45 minute appointments to go through specific chronic pelvic pain education using the Explain Pain model**. She also runs Mindfulness Based Stress Reduction courses which have proven benefits for all types of chronic pain, depression and anxiety.
Further reading and resources on Chronic Pain
- Endometriosis and Pelvic Pain – Dr Susan Evans and Deborah Bush, QSM – A book for girls and women available from www.pelvicpain.org.au
- **Explain Pain – David Butler and Lorimer Moseley (2013) – Further explanation on Chronic Pain in general – available from www.noigroup.com
- **The Explain Pain Handbook Protectometer – David Butler and Lorimer Moseley – available from www.noigroup.com (Dr Adele will suggest you purchase this if you do her Explain Pain sessions. )
- Pelvic Pain Foundation of Australia
- *Dr Adeles Dropbox containing audios for pelvic floor relaxation and stretches