Chronic pelvic pain affects teenage girls, women (1 in 5) and men (1 in 12). It does not discriminate as it affects people of all ages, ethnicities and social backgrounds. Pelvic pain is categorised as any pain below your belly button and above your legs, the pain can also radiate into your lower back, buttocks or thighs. It can be dull or sharp; constant or intermittent; and it may be mild, moderate or severe.

Chronic (or persistant) pelvic pain (CPP) is when pain has been present for longer than 6 months and the pain is occurring either with the complete absence of tissue damage, or after the tissue has healed.

Everyone’s experience with CPP is different and how it presents for each individual is also very different depending on the systems (genitourinary, gastrointestinal & reproductive) and structures (nerves, fascia, muscles, joints & ligaments) involved:

Common Symptoms in women may include:

Pain when sitting
Pain around the anus, vulva
Painful penetrative sex, this can be at the opening or with deep penetration
Pain after sex
Involuntary pelvic floor spasms
Painful urination, urgency and/or frequency
Abdominal & groin pain
Constipation
Pelvic girdle pain
- Sacroiliac pain,
- Coccygeal pain and
- Pubic symphysis pain.

Common Symptoms in men may include:

Pain when sitting
Involuntary pelvic floor spasms
Painful urination, urgency and/or frequency
Abdominal & groin pain
Constipation
Pelvic girdle pain
- Sacroiliac pain,
- Coccygeal pain and
- Pubic symphysis pain

Headaches, migraines and TMJ pain (pain & compromised movement of the jaw & surrounding muscles) are also very common complaints for people who suffer from CPP.

Some possible causes or contributing factors of CPP include:

Overactive or non-relaxing pelvic floor muscles. Tension in these muscles can refer pain throughout your pelvic region and even mimic urgency, symptoms of thrush or bladder pain
Irritation, injury or compression of a nerve in the pelvic region, eg pudendal nerve causing pudendal neuralgia
History of infection of the prostate, bladder or even chronic thrush can cause irritation to the pelvic floor and surrounding nerves and fascia
Endometriosis, adenomyosis or PCOS. For women who suffer from these conditions, tension in the pelvic floor muscles can be a reaction to years of chronic pain and inflammation in the pelvis. This tension in the pelvic floor can refer pain throughout your pelvic region
Pelvic inflammatory disease
Injury or trauma to the area can directly impact ligaments, joints, fascia, muscle and nerves. Pain in the pelvic area can cause guarding and tension in pelvic floor muscles, impacting blood flow which may then cause local and referred pain
Surgery. Many different surgeries (hysterectomy, hip surgery, pelvic organ prolapse & prostatectomy) can impact the pelvic floor and surrounding nerves and fascia and in turn cause pelvic pain
Constipation
Pregnancy & childbirth
Crohn's disease, SIBO, Irritable bowel syndrome & Ulcerative colitis. For women who suffer from these conditions, tension in the pelvic floor muscles can be a reaction to years of chronic pain and inflammation in the abdomen. This tension can refer pain throughout their pelvic regions
Emotional factors such as mood or past or current abuse
Lifestyle considerations, such as high stress, can cause guarding and tension in the pelvic floor muscles and surrounding fascia and nerves

As osteopaths with a passion for helping both men and women with pelvic pain, we recognise the role the central nervous system (the brain and spinal cord) have in the perception of pain. The CNS is always involved to a lesser or greater extent and it is our job to identify how much of a role it plays in our patients' pain picture. Doing this helps us create a management plan to best accommodate the needs of our patients.

How can osteopathy help me with my chronic pelvic pain?

Everyone’s story is different, and everyone’s experience of pain is also very different. There is no ‘one size fits all’ approach to treating chronic pelvic pain. As osteopaths we are always searching for the WHY? The reality is that for most people with CPP, there isn’t just one incident or event that has caused their pelvic pain. There are generally a number of events or conditions that compound, to collectively contribute to, or help perpetuate their pelvic pain.

The majority of pelvic pain cases have a neuromuscular component (pelvic floor muscle, nerves, ligaments & fascia) and a nervous system component (brain & spinal cord). It is important to identify any contributing factors or events (fall to your bottom, constant sitting, previous history of infection, endometriosis, surgery to your pelvis etc.) throughout your life that could be impacting not only on your perception of pain but also directly on your pelvic floor and surrounding tissues.

CASE HISTORY

A thorough case history is taken, including the full history of your presenting complaint as well as, past medical history and any relevant traumas, surgery etc. This helps us start to create a picture of your situation and formulate an hypothesis as to why you may be experiencing CPP.

WHOLE BODY ASSESSMENT & TREATMENT.

The emphasis of our treatment is on the whole person. It is important for us to identify whole body strain patterns that may be impacting your alignment and biomechanics. We aim to identify areas that could be either directly causing your pelvic pain or predisposing you to pelvic pain.

Osteopathic treatment will also be aimed at helping remove any stress or strain through the fascia (inc visceral region), muscles, ligaments and joints that may be loading your central nervous system. We use manual therapy techniques to help relax your nervous system, therefore helping create a higher threshold for activity.

INTERNAL ASSESSMENT OF YOU PELVIC FLOOR

An internal assessment of your pelvic floor can also be an extremely useful tool in diagnosing and treating CPP. CPP more often than not will have a significant pelvic floor component that is either a driver to your pain or is helping to perpetuate your pain picture. We use manual therapy techniques to release your pelvic floor, which may include external and internal myofascial techniques.

MANAGEMENT

Chronic pelvic pain is a complex condition. Management is an essential part of your treatment plan.

Some important factors;

Education regarding how to perform relaxed diaphragmatic breathing; explaining how to use your breath to relax tension (down regulation) of your muscles including your pelvic floor and how your breath can be used to relax your sympathetic nervous system that is heightened by stress - as commonly seen with those suffering with chronic pain.
Good toilet habits; education regarding good toilet habits, including the use of the squatty potty, mindfulness and breathing when going to the toilet, can help to relax the pelvic floor, allowing for ease of bowel movement and the reduction of stress on your pelvic floor.
Mindfulness has been shown to reduce the perception of pain and stress levels
Restorative yoga can help calm your central nervous system
Movement practises. Move, move, move. Getting your body moving in a gentle way and getting back in touch with your body, can assist in your ability to trust in your body again. This is vital as it allows your brain to receive stimulus that you are moving, pain free and without fear.
Gentle Yin Yoga stretches to help any muscles and fascia that are restricting movement of your pelvic floor, abdominal and pelvic region.
Advice on sleep. When sleeping, our body has time to recharge and recover and reduce stress, so sleep patterns and behaviours are of vital importance.
Nutritional advice. Removing inflammatory ingredients such as gluten, refined sugar and dairy can have a positive impact on pain. Not to mention that good nutrition is essential for good GUT health, which can also be a very important part of your management strategies.
Chew, chew and chew some more. Mindfully and slowly chewing your food fully, can help get the gastric juices flowing, and by doing so this can help your stomach fully digest your food. This is an important first step in developing a healthy GUT which can in turn help reduce inflammation and pain.

The complex nature of CPP means that sometimes we find a multidisciplinary approach involving a variety of health and wellness practitioners is the most effective way to achieve overall health. When required, we will refer to naturopaths, acupuncturists, GP, pain psychologists as a part of our holistic approach to the management of pelvic pain.