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What is Persistent Pelvic Pain?

Latest research indicates that 21.5% of women are affected by Persistent Pelvic Pain (PPP), which can be defined as experiencing pain in the area of the pelvis (below the belly button but above the legs) on most, if not all days for more than 6 months.

woman in pain
Image by gpointstudio on Freepik

PPP is complex and often difficult to diagnose, with many patients often left feeling overwhelmed and helpless, waiting months, if not years, for a formal diagnosis. It is important for these patients to know that there is help and they are not alone.

Both men and women can experience persistent pelvic pain.

Common conditions causing PPP include:

  • Period Pain (Dysmenorrhoea)

  • Endometriosis

  • Adenomyosis

  • Irritable Bowel Syndrome (IBS)

  • Pelvic Muscle Pain

  • Bladder Pain and Urinary Tract Infections

  • Genito-Pelvic Pain Disorder (pain with penetrative sex)

  • Pudendal Neuralgia

  • Prostatitis

The experience of pelvic pain is vastly different between individuals and should be treated as such. Symptoms of pelvic pain can be better understood by dividing it into components. Patients may have one, or more commonly, several components happening at the same time.

1. Pain from pelvic organs (bladder, uterus, bowel)

Your pain condition may directly affect one or more organs. For example, in the case of bladder pain or interstitial cystitis, the bladder lining becomes inflamed. Irritable bowel syndrome directly affects the lining of the digestive system, and endometriosis is a condition in which tissue similar to the uterine lining, called your endometrium, starts growing outside of the uterus. There is a lot of “crosstalk” between pelvic organs, and once one organ becomes inflamed or problematic, it is not uncommon for other organs to follow suit.

2. Pain from Muscles

A muscle's response to pain is often to tighten and spasm. This is actually a normal protective response; however, it also contributes to more pain by reducing blood flow, depriving the tissues of valuable oxygen and releasing painful chemicals into the tissues. Muscular pain may feel sharp and stabbing in nature, or can lead to dull, achey pain. Muscle pain can start to impact bladder function causing urinary frequency and urgency; or bowel function, causing abdominal and rectal pain and incomplete bowel movements. Pain during or after sex (called dyspareunia) is a common consequence of tight muscles.

3. Pain from Nerves

Increased nerve sensitivity is a hallmark of chronic pain. This means your nerves have a lower threshold, and things that normally would not be relayed to the brain as "painful" now are. It is the body’s way of protecting you, however in the presence of chronic pain, it acts to wind up the whole nervous system to a point it affects normal brain and body functions. Some common symptoms of nerve sensitisation include bloating, burning, nausea, dizziness, anxiety and pain with light touch.

4. Psychosocial Experience of Pain

Persistent pelvic pain can affect many facets of an individual’s life, including work, school, relationships, and social activities. An individual’s previous experiences, including any psychological trauma, past or present, can also affect a patient’s experience of pain- even if the pain and previous experience seem to be completely unrelated. Patient's may experience symptoms of anxiety, depression and low self-esteem as a result, further contributing to their experience of pain. It is important that a person’s psychosocial status is considered when managing their pain - all recent research indicates it is a vital piece of the puzzle that just cannot be ignored.

If you, or anyone you know suffer from persistent pelvic pain please contact Good Country Physiotherapy for more information on how we can help you.


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