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Woman holding her stomach from pelvic pain
By Alexandra Diggles – Women’s, Men’s and Pelvic Health and Pain Physiotherapist

Persistent pelvic pain is any pain that has been present for longer than 3 months that exists between the belly button and the knees, the centre of us! The current proposed definition of pain is ‘an aversive sensory and emotional experience typically caused by, or resembling that caused by, actual or potential tissue injury’ (International Association for the study of pain).

In other words, pain is a process modified and maintained by a combination of biological, psychological and social factors. It is a constant loop of what we have already learnt about pain through life experience, and how our body systems process the information they are constantly receiving. This is the best current working definition we have but it fails to describe the complete control that pain can have on your life, social events, school, mood, work and relationships.

When there is persistent pain in the pelvis, we know it can cause an overlap and heightened responses in the neighbouring organs, muscles, skin and nerves and this can lead to multiple symptoms occurring at once such as pain, bladder frequency and urgency, bowel changes (going too often or constipation), sexual pain and dysfunction, skin sensitivity, muscle spasm and cramping. It is also quite common to have areas of referred pain especially the lower back and hips.

So, while this means it can be hard to get on top of pain and pain management, we do know there are several things in common with many pain conditions; the nervous system has adapted and is more “edgy”, the pain increases stress and anxiety and in turn poor sleep, we move less and can be deconditioned and our immune system especially the gut are working over time. These are the big things to get right; knowledge, sleep, calming the nervous system, our gut health and movement.

  1. Knowledge is power and this has never been more relevant than for managing pain! Understanding pain has been shown to improve function by being more attune to what is happening in our body and it improves levels of fear and therefore our ability to cope and self-manage. These are my top starting points for getting information on pelvic pain:
  1. Sleep is vital to wellbeing and health. With less sleep we are more prone to infection, injury and psychological distress. In studies on back pain, a poor night sleep was linked to increase pain intensity the next day. It is important to have quality sleep and this means aiming for 7-8 hours each night, limit screens prior to bed and using a set routine. Psychologists and GPs are a great resource for improving your sleep.
  2. Calming the nervous system is a strong predictor of better outcomes in pain management but I think it also may need the most perseverance to achieve. Our nervous system and brain are always adapting and learning and to manage pain, they need repetition to become less protective over time. Daily practice of meditation, relaxation, mindfulness or relaxed breathing for 10 minutes is a great place to start. When it’s something new, using a guided program, support person or working with a medical practitioner often gets things working better sooner. A starting point can be an app-based guided program such as:
    • Calm app
    • Headspace app
    • Curable app
    • Insight Timer app
  3. The gut is the first checkpoint that foreign products entering our body have to pass. For this reason, a majority of our immune activity occurs in the gut and these immune responses can be impaired by stress, pain medications, diet choices, alcohol, anti-biotics, overtraining/undereating and toxins. Gut disturbance is associated with worsening stress, joint ache, fatigue, IBS, inflammation and pain conditions including autoimmune diseases. Getting gut health right can make a big difference but start simple, think about reducing your sugar intake, seeing a dietician and you can’t go past eating more greens!
  4. Life doesn’t stop and nor should we. Movement is a great way to help manage pain and really any movement can help. Starting out slow is best and adding a little each day will help you to continue to make and retain gains rather than going bang, bust, pain flare! In pelvic pain, yoga, stretching, walking and incorporating correct pelvic floor movement have all been shown to reduce the intensity and duration of period pain. Yoga and walking have been shown to reduce stress, anxiety and pain in many chronic pain conditions. Start little but do start and a physiotherapist or exercise physiologist can help prescribe this best kind of medicine as we may all need to start somewhere specific for our symptoms.

Getting these big things right take time, they take practice and they work better when done together. If you can find a support team including some well-trained and pain aware medical professionals, it can be a journey towards a more manageable and enjoyable future.

Alexandra Diggles is an advanced practice physiotherapist working in pelvic health. She is Australian Physiotherapy Association (APA) titled member in the fields women’s health and continence, and pain. She has extensive experience in managing pelvic pain in both women and men. A key element of her care is implementing a complete and holistic plan that provides up-to-date treatment options and focuses on achieving full recovery. She is currently consulting at Indooroopilly and Kangaroo Point Allsports Physiotherapy and Sports Medicine Clinics. For further information or to consider an appointment please click here.