Do you suffer from pelvic pain?

This seems like a pretty simple question, but the term ‘pelvic pain’ is often used as an umbrella term for many conditions and syndromes. Let’s break it down by starting with a quick anatomy lesson. The pelvis is the ring of bones in the centre of your body. Your pubic bone sits at the front of the bony ring, the tailbone and sacrum are at the back, and your hip bones (where you rest your hands when you’re grumpy) are at the sides. It’s also important to note that inside your pelvis is home to important organs like your bladder, bowel, uterus, ovaries and fallopian tubes. Important stuff. As well as the organs, there are other things inside the pelvis that might be the source of pain: the skin, the muscles or the nerves. And even more confusingly, often the pain can come from more than one of these sources. I like to think of pelvic pain as a jigsaw puzzle, with many pieces making up the whole pain puzzle. The first step is seeking out a health professional (with expertise in pelvic pain), who can work with you to figure out, first of all, what those pieces of the pelvic puzzle are. Then there’s the question of whether the pain is ‘persistent’ or ‘acute’…If you have acute pelvic pain (pain that comes on very suddenly and is severe), it is important to see a doctor ASAP. Persistent pelvic pain is pain experienced in the pelvis, on most days, for more than three months. Several things can lead to persistent pelvic pain. I’ll touch on some of the most common ones.

Period pain

Pain in the pelvis, stomach or lower back before or during your period is, in most cases, to be expected, and may occur from the cramping of your uterine muscles. It is not normal when:

• it lasts for more than a day or two

• it doesn’t go away with over-the-counter pain relief medication

• it causes distress and/or stops you from doing your normal daily activities

If your period pain is affecting your life, see your doctor, who’ll help you investigate the possible causes more fully.

Endometriosis and Adenomyosis

Endometriosis is when cells similar to those that line the uterus (the endometrium) grow in other parts of the body. Endometriosis can often be found in other parts of the pelvis: the peritoneum (the lining of the pelvis), the bowel, bladder or ovaries. These cells follow the menstrual cycle. However, unlike the endometrium inside the uterus, these cells have nowhere to escape to during your period, so often they build up and can cause scarring, inflammation and pain.

Not everyone with endometriosis will experience pain, but those that do can have period pain in the pelvis, belly, or lower back. It can be experienced when you poo, wee, have sex or when you’re ovulating.

Adenomyosis is kind of like endometriosis, but where the abnormal cells grow inside the muscular walls of the uterus, with symptoms quite similar to endometriosis.

Your GP will speak to you about hormonal and pain medication that can help with these conditions, and often refer you to a gynaecologist for further management.

Irritable Bowel Syndrome or IBS

The cause of IBS is not yet fully understood, but current medical research leads us to believe that IBS occurs when the muscular walls of the gut become sensitive and contract unevenly, causing pain and bloating. This pain often improves after a fart or a poo that eases all that internal pressure.

IBS is often a ‘diagnosis of exclusion’, meaning other causes of bowel pain (such as coeliac disease, bowel cancer, or inflammatory bowel disease) need to be ruled out first by examination and testing.

The good news is IBS can often be managed by working with a dietician to avoid certain food triggers whilst maintaining nutritious food intake, and managing stress levels (which can be tricky, to say the least, when pain is one of your stressors!).

Bladder pain

Painful bladder syndrome (PBS) or interstitial cystitis is pain in the pelvis that worsens when your bladder is full, and improves when the bladder empties. It’s important to have a bladder infection (UTI) ruled out, as PBS is when there is bladder irritation, but no infection.

Other signs of PBS are:

• needing to empty your bladder more than 8-10 times during the day

• needing to empty your bladder more than once a night

• pain with sex or intercourse

• a sense of urgency to urinate

Work with your GP and a pelvic health physio to help get on top of this pain.

Vulval pain

The vulva is the external genitalia (the parts we can see when we look at our genitals), namely the labia, the entrance of the vagina, the clitoral head, and the perineum. Pain in the vulva can be caused by:

• skin conditions

• infection

• irritation

• surgery

• childbirth

Vulvodynia (what’s with all these hard-to-say pelvic pain terms?!) is pain, discomfort and/or a burning sensation in the vulva that cannot be linked to the above causes. The pain is often triggered by touch and can be so severe that sometimes using tampons, having sex, wearing tight underwear/clothing, or sitting down can be difficult.

Pelvic muscle pain

Muscles inside and around the pelvis can contract and spasm, and cause pain (as a result of period pain or other pains in the pelvis), and can often be a large part of your pain puzzle. Muscle pain is often made worse with exercise or specific movements. Sex, tampons or internal pelvic exams may be excruciating or simply an impossible ask.

Muscular pain can also radiate to the hips, lower back, or down the legs.

Pelvic health physiotherapists are worth their weight in gold here.

But as with everything else previously mentioned, if you have persistent pelvic pain, first and foremost you should book an appointment with your GP. And if you feel you aren’t being heard by your doctor or health professional, please… get a second opinion. And ask for referrals to different disciplines.

Research shows that having a multi-disciplinary team is the best way to approach and manage persistent pelvic pain. Your team may be made up of your GP, a gynaecologist, pelvic health physiotherapist, a pain specialist, a gastroenterologist and a psychologist or counsellor.

I would avoid Googling your symptoms—work instead with your trusted health professionals, and spare yourself the stress of falling down rabbit holes that can affect your mental health.

And know that you are not alone. One in five women and AFAB people experience persistent pelvic pain. Help is out there!