Pelvic Pain

Persistent or Chronic Pelvic Pain causes considerable angst for women (and some men) affecting their quality of life, their ability to work and most importantly their close relationships. Sexual dysfunction, vaginal pain such as vulvodynia, bowel and anal pain, IBS, bladder pain (Painful Bladder Syndrome, formally known as Interstitial Cystitis) and endometriosis are just a few of the problems that can present.

Because of work by the Adelaide pain researchers and the authors of the wonderful book, Explain Pain, Lorimer Moseley and David Butler, which has shed a new light on how to manage chronic pain, great improvements are happening for pelvic pain disorders. I utilize these strategies in treating my pain patients and have included some pain management strategies in my Pelvic Recovery books. By adapting their wonderful principles of the central sensitization of pain rather than only focusing on the end organ (in the periphery such as the endometriosis, the vagina, the bladder etc) we are now looking at a multi-factorial approach to treatment, which importantly, includes the brain.

Understanding about this new way of treating persistent pelvic pain:

  • that the brain decides whether there is going to be pain or not
  • identifying stressors that might be releasing stress hormones such as cortisol and adrenaline which further sensitizes the already hypersensitive nervous system
  • dilators to massage the tight pelvic floor muscles and to desensitize the painful vagina
  • pelvic floor muscle training but focusing on the relaxation of the muscles rather than over-tightening them
  • relaxation and breath awareness by using general body and pelvic floor relaxation CDs, perhaps meditation, pelvic floor safe yoga
  • release of endorphins (the body’s own pain killer rather than high dose and sometimes addictive medications) through general exercise – doing it in a paced and graded way
  • a medication (which is in fact a low dose old-fashioned antidepressant which turns down the messages from the pelvic nerves)

All of these strategies plus a few more will change the outcome for these patients.