Pelvic Pain Physiotherapy for Women

When pelvic pain becomes chronic

Pelvic pain that lasts more than six months is usually described as chronic. By that stage several things are often feeding into it at once. There may be a gynaecological cause such as endometriosis or adenomyosis, a bladder or bowel component such as bladder pain syndrome or irritable bowel, and almost always a musculoskeletal one: pelvic floor muscles that have been guarding for months, a stiff hip or sacroiliac joint, an irritated nerve, or tender points in the abdominal wall.

On top of that, the nervous system itself becomes more sensitive with persistent pain. That isn't imagined pain. It's a real, measurable change in how nerves process signals, and it responds to treatment.

Signs the muscles are involved

• Pain that builds with sitting, especially on hard chairs
• Pain with sex, either at entry or deep inside
• Aching after passing urine or opening the bowels, or a sense of never quite emptying
• Pain that flares after exercise, long drives or stressful weeks
• Specific tender spots in the lower abdomen, groin, inner thigh or buttock

Related problems we treat

Pain focused on the tailbone is covered on our coccydynia page. Pelvic joint pain during or after pregnancy is covered under pelvic girdle pain. Groin and pubic pain in sportswomen overlaps with female sports physiotherapy. In all of these, the pelvic floor is checked, because it's so often guarding in response to pain elsewhere.

How we treat it

Pelvic floor relaxation

Down-training with breathing, positioning and awareness, so the muscles can let go of tension they've been holding.

Manual therapy

Hands-on work to the abdomen, hips, buttock and back, and internal pelvic floor release only with your consent.

Movement

Graded pelvic mobility and stability work, so you can sit, walk and exercise with less pain.

Pain management

An explanation of what's driving your pain, pacing, flare-up planning, and heat or TENS for relief.

What to expect

Improvement with chronic pelvic pain is usually steady rather than sudden, and a typical course runs six to twelve sessions over three months or so. We agree specific goals at the start, such as sitting through a work meeting or pain-free sex, and track them. There will be flare-ups, and part of the program is having a plan for them so they don't undo your progress. The pelvic floor side of this is explained further on our pelvic floor physiotherapy page.

See your doctor first, or as well, if you have

• Fever or feeling unwell with pelvic pain
• Abnormal vaginal bleeding, or any bleeding after menopause
• Pelvic pain with a positive pregnancy test or a missed period
• Sudden, severe pain
• Blood in the urine or stool, or unexplained weight loss

Frequently asked questions