A pain in the butt….back, stomach, pelvis and pelvic floor
May is pelvic pain awareness month, so let’s take a few moments to understand what persistent pelvic pain is and what we can do about it.
Pelvic pain can be described as pain that appears to be in the area of the low back, buttock, lower stomach or pelvic floor muscles, often impacting on bladder, bowel or sexual function. It is considered chronic if it has lasted for six months or longer. Pelvic pain affects up to 26% of woman and 15% of men worldwide. This is as common as asthma and low back pain, but we hardly ever hear about it.
Pain is great, if our brain didn’t produce pain, we’d probably be dead - it’s one of our survival mechanisms. You only stick your hand in the fire or drop a heavy object on your foot once to realise you won’t do that again (well let’s hope so). But when pain persists beyond normal healing (12 weeks), that’s when pain isn’t so great. You start to notice the more you do the more it hurts? Pain becomes unpredictable and unreliable and you become more fearful as time goes on. Pain becomes like an over sensitive car alarm - you only walk past the car and the alarm goes off, not helpful.
There are many conditions that fall under the umbrella term persistent pelvic pain. Common diagnoses are dyspareunia (painful intercourse), coccyx pain, bladder pain syndrome, endometriosis, chronic prostatitis or scrotal pain syndrome. In many cases, regardless of the diagnosis there is often an emotional cause too. People commonly report low mood, thoughts, poor sleep, relationship / work commitment issues. Even with a detailed history it is sometime hard to know what came first, it can be a case of ‘the chicken or the egg’, therefore a team approach is often needed.
Pelvic pain conditions can be very distressing - but there is help. It’s hard for people in persistent pain to know who to see? The right treatment depends on the cause or causes of your pain. Your G.P will check for medical issues and refer you on as required. A psychologist is extremely beneficial to help with low mood, thoughts or beliefs - this can have a huge effect on reducing pain. Connecting with a pelvic health physiotherapist can guide treatment, think of them as the co-pilot on the journey.
A good place to start is with setting the right foundations
It has been shown in research poor sleep increases your pain levels the following day. Therefore, it is important to get good quality sleep. You can improve your sleep hygiene by establishing a regular night-time routine, this could involve reducing screen time, listening to a relaxation app, reading, exercise or having a bath.
Pacing activities gives you a way to break everyday activities and exercise into smaller manageable bits, finding the middle road between overdoing and not under doing. Pacing is because it helps you to stay active, doing the things you care about or need to do, and helps to avoid pain flares. Pacing should be based on time, rather than using pain as the guide. e.g. 20 minutes of walking or 10 minutes of housework for which to build a activity tolerance.
Stretching can be very beneficial to reduce pain levels and improve function. Start out slow and gentle, working on your paced activity tolerance approach. Speak to your G.P to find suitable classes or see your local physiotherapist for tailored exercises.
For further guidance please visit painhealth.csse.uwa.edu.au created by expert clinicians to promote better awareness and information for people with persistent pain.
Remember you’re the driver, health professionals are your co-pilots