Persistent Pelvic Pain

Persistent pelvic pain is pain felt in the lower abdomen, pelvis, hips, buttocks or genital area that lasts for three months or longer. It can affect women of all ages and often has a significant impact on work, exercise, relationships, sleep and emotional wellbeing.

For many people, persistent pelvic pain can be frustrating because it may continue even after the original cause has been treated or when medical investigations show very little. This does not mean that the pain is "imagined" or that it is not real. Persistent pain is a recognised medical condition that often involves changes to the muscles, nerves and nervous system, as well as the body's pain-processing mechanisms.

Pelvic health physiotherapy is an important part of the multidisciplinary management of persistent pelvic pain. Through a thorough assessment, we aim to understand the factors contributing to your symptoms and develop a personalised treatment plan to help you regain confidence and improve your quality of life.

Common symptoms

Persistent pelvic pain can present in many different ways, including:

• Constant or intermittent pelvic pain
• Aching or heaviness in the pelvis
• Pain in the lower abdomen, hips, buttocks or groin
• Pain during or after sexual intercourse
• Bladder or bowel discomfort
• Pain when sitting for prolonged periods
• Pain that worsens during certain activities or around your menstrual cycle
• Difficulty exercising or remaining active

Everyone's experience is different, and symptoms may change over time.

What causes persistent pelvic pain?

Persistent pelvic pain rarely has a single cause. Instead, it often develops due to a combination of factors.

These may include:

• Endometriosis or adenomyosis
• Previous pelvic surgery
• Childbirth-related injuries
• Bladder or bowel conditions
• Pelvic floor muscle dysfunction
• Musculoskeletal problems affecting the hips, lower back or pelvis
• Previous infections or inflammation
• Increased sensitivity within the nervous system following long-term pain

Living with pain over a prolonged period can also lead to changes in movement, posture and muscle tension, which may contribute to ongoing symptoms.

How is persistent pelvic pain assessed?

A detailed assessment is essential to understand your individual symptoms and identify the factors contributing to your pain.

Your pelvic health physiotherapist will discuss:

• Your medical history
• Previous investigations or treatments
• Your pain pattern and triggers
• Bladder, bowel and sexual function
• Exercise and activity levels
• Your goals for recovery

Assessment may include:

• Pelvic floor muscle assessment (with your consent)
• Assessment of posture, breathing and movement
• Examination of the lower back, hips and pelvis where appropriate
• Identification of muscle tension, weakness or altered movement patterns

Where necessary, we work closely with your GP, consultant or other healthcare professionals to ensure you receive the most appropriate care.

How can pelvic health physiotherapy help?

Treatment is always tailored to your individual needs and symptoms.

Depending on your assessment, treatment may include:

Pelvic floor rehabilitation

Many people with persistent pelvic pain have pelvic floor muscles that are overactive or unable to relax effectively.

Treatment may focus on:

• Improving muscle relaxation
• Reducing muscle tension
• Restoring normal coordination
• Gentle strengthening where appropriate

Pain education

Understanding why pain persists can often be an important step in recovery. We will explain how the muscles, joints and nervous system interact, helping you better understand your symptoms and reduce fear around movement.

Manual therapy

Hands-on treatment may help reduce muscle tension, improve tissue mobility and increase comfort where appropriate.

Exercise and rehabilitation

Remaining active is often an important part of managing persistent pain. We will work with you to develop a graded rehabilitation programme that matches your symptoms and personal goals.

What outcomes can I expect?

Recovery from persistent pelvic pain takes time and varies from person to person.

Our aim is to help you:

• Reduce pain and muscle tension
• Improve confidence with movement
• Return to work, exercise and hobbies
• Improve bladder, bowel and sexual function where affected
• Develop long-term strategies to manage your symptoms

Take the first step towards recovery

Persistent pelvic pain can feel overwhelming, but you do not have to manage it alone.

A specialist pelvic health physiotherapist can provide a thorough, one-to-one assessment to help identify the factors contributing to your pain and create a personalised rehabilitation programme.