Patricia Neumann is a specialist continence and women’s health physiotherapist and a Fellow of the Australian College of Physiotherapists. She works as a clinician at Flex Rehabilitation Clinic in Adelaide and has a clinical interest in all types of pelvic floor dysfunction in men and women, including pelvic pain.
What is chronic pelvic pain? Can it lead to more than physical symptoms?
Chronic, or persistent, pelvic pain is pain that is experienced between the belly button and the buttocks and has gone on for more than three months. It is pain that is investigated by doctors and it is difficult to find a cause to explain it. That can be a very trying experience and patients can be told there’s nothing wrong with them, which can make them even more anxious and worried. It would be more correct to say that there is no pathology that can be detected on scans or blood tests to explain the pain. But this sort of pain is related to sensitive nerves rather than some pathology that you can put your finger on and cut out or take antibiotics for. There is no question that it is very real.
This lack of a diagnosis can cause huge emotional stress because patients can be led to believe that it is ‘in their head’ or they are faking their symptoms.
How is it thought that pain in the pelvis or pelvic organs starts?
Often it is not clear why or how the pain started or what triggered it, until you dig deep for an explanation. There may have been an infection, like a urinary tract infection or a viral infection that has since resolved, or maybe a period of stress in someone’s life that can lead to the nerves in the pelvis becoming ‘sensitised’ or firing off spontaneously.
Anxiety is often part of the mix. The person may have suffered with anxiety before the pain started but the whole experience of having pelvic pain will make anxiety worse and hard to cope with.
What is the relationship between pain and the brain?
That’s an interesting question because without the brain there would be no pain. The brain processes all the information at its disposal, via nerves coming from the body: the organs in the pelvis, the gut, the muscles and from other areas in the brain. These other areas in the brain will remember past bad experiences or fearful memories. If the brain concludes that all of these messages indicate that the organism (ie. the person) is under threat or in danger, then it switches on pain. Other things also happen to protect us—like our muscles tense up and we go on high alert. That adds to the experience and can increase a person’s suffering.
It’s not wrong to say that pain is made by the brain—but it doesn’t mean that pain isn’t real! It is very real and certainly not imagined.
The pelvis is a busy place with plenty of nerves connecting the organs: the bladder, the bowel and in women, the uterus and the vagina. This rich network of nerves coordinates how we urinate, defaecate and orgasm—all at the appropriate times and places!
Let’s not forget the pelvic floor muscles, which support and control all these organs. These muscles have the potential to tense up too, to protect us. So they can be tense and tender, for example around the vagina, making intercourse painful, or in men, causing pain between the testes and the anus (this area is called the perineum). This muscle pain can be hard to diagnose because the muscles are hidden from view and can only be tested by internal examination from a trained health practitioner, often a pelvic floor physiotherapist. An important message here is that pelvic floor muscles need to relax as well and it’s not all about tightening them, even if you suffer from incontinence.
What kind of help and treatment is out there for people experiencing bladder, bowel or pelvic pain?
It is really helpful to have a supportive team of health professionals, as well as family members or friends, who all understand chronic pelvic pain and can work together to help you.
The team might have different people in it depending on what the problems are. Maybe it’s more about the bladder, or the gut, or the muscles, or with anxiety - and it’s often all of these.
That makes for a lot of suffering when daily things like sitting down, sex, or emptying your bladder or bowel all cause pain. But it is possible to get your life back on track, especially when the entire team works together. I’ve seen some amazing results with happy outcomes. For people who don’t have access to this sort of help, there are some excellent resources online.