What is pelvic pain?
Chronic Pelvic Pain (CPP) affects one in every six women and refers to ongoing pain that can occur anywhere in and around the pelvis, including over the perinium, buttocks, legs, lower back, hips and lower abdominals. Every woman has her own individual symptoms of CPP which can include aching, sharp and burning sensations (and everything in-between) and this can really affect a woman’s ability to function optimally. Alongside CPP, the bladder can become affected, for example, needing to urinate frequently, having hesitancy and not always feeling empty after voiding, with constipation or difficulty emptying the bowel also being a potential issue. The actual act of emptying the bladder and bowel can become painful as well. In addition, sexual intercourse can also become uncomfortable or painful, whether it is at penetration or deeper inside.
There are many reasons why pelvic pain occurs, including (but not limited to):
- endometriosis
- fibroids
- sexually transmitted diseases
- child-birth
- during pregnancy
- irritable bowel syndrome
- ovarian cysts
- hormonal or menstrual changes
- after gynaecological, gastro-intestinal or colorectal surgery
Causes of CPP can be difficult to diagnose; as pain can be multi-facetted. By looking at the whole person and taking an approach that addresses the biological, psychological and social aspect of their pain, it can lead to a full resolution of their symptoms.
Due to complexity of CPP it is really beneficial initially to speak to your GP or specialist about your symptoms, so a full investigation can be completed to explore possible medical reasons for the pain. Quite often by the time a woman consults a pelvic health physiotherapist for CPP she will have already seen multiple healthcare providers, had numerous exploratory tests and it is often the ‘last thing to try’. This scenario can be avoided; early intervention and a multi-disciplinary approach are likely to avoid symptoms worsening over time, with a higher chance of positive outcomes.
What does a pelvic health physiotherapist do to help pelvic pain?
At Positive Pelvic Health a pelvic pain physiotherapy assessment takes an ‘outside, in’ and full body approach. Pain is complex. Bodies are complex. The pelvis is complex. Time is therefore needed to explore exactly how, when, and why the pelvic pain is occurring. This is why an initial consultation is 75 minutes long, to enable a woman to have time to explain her story, explore her medical history and fully screen her pelvic function.
After working for many years with people with persistent pain and also completing post-graduate study in this area, my goal is that every woman leaves my clinic feeling better than when she arrived. Although physical intervention is important, it is also vital to provide education to help an individuals understanding of pain mechanisms and how external factors such a stress and sleep can impact symptoms. The development of a personalised pain management toolbox, that a woman can use themselves on a daily basis, makes a huge difference to CPP. By making small adjustments, positive changes frequently occur, improvements can regularly be seen and felt, with flare ups being less likely to occur.
Does the assessment include a vaginal examination?
Because an ‘outside, in’ approach is utilised at Positive Pelvic Health it is always best to explore what is happening physically throughout the body on the outside first. If a vaginal examination can cause anxiety and/or pain, it is often best to wait or possibly avoid a vaginal examination until a woman feels ready. It is important that a woman feels relaxed and comfortable with all aspects of her Positive Pelvic Health consultation; thus, when an internal assessment or muscle release work is undertaken, the body will respond in an much more optimal way.
Jennifer runs an in-home clinic in Maungaraki, Lower Hutt. She helps women from the Wellington region, including Porirua, Upper Hutt, the Kāpiti Coast and the Wairarapa, with their pelvic health physiotherapy needs, at all stages of life.