Wed 29, May 2019
Physiotherapists Shan Morrison and Patricia Neumann answer these common questions about pelvic pain.
Question1. I am 31, have no children, and enjoy going to the gym, especially doing core exercises. Recently I started having trouble emptying my bladder, and sex is painful.
Answer1. These symptoms are often caused by overactive pelvic floor muscles. Every time you tighten your abs, the pelvic floor muscles inside your pelvis tighten too. They need to relax to wee and allow penetration for sex. While most of us know strengthening the pelvic floor helps with incontinence and prolapse, not many know you can have too much of a good thing. Tight muscles that don’t relax can cause pain and the pelvic floor muscles are no exception. If they don’t relax when you go to wee, your flow may not start straight away or it may be slow. But being unable to wee may be a sign of more serious things, so see your GP first.
The next step may be a pelvic floor physiotherapist to assess your pelvic floor and teach you how to relax your muscles. You can find your nearest pelvic floor physiotherapist by phoning the National Continence Helpline (1800 33 00 66).
Question 2. I am a 40-year-old father of three in a senior management role. One year ago I started to have bladder urgency and frequency, and then pain in my pelvis when sitting. Recently I have had pain when passing a bowel motion and during sex. I have tried antibiotics, which didn’t help, and I am very distressed.
Answer 3. It sounds like you are experiencing chronic pelvic pain syndrome, a disabling condition that affects 8 per cent of Australian men, commonly around your age and vocation, who often sit for long hours and are under stress.
Typically, pain can be anywhere in the pelvis. Men can also experience problems with bladder, bowel and sexual function. Not understanding what is going on causes anxiety. It is vital that you see your GP and be checked out by a urologist to rule out anything sinister. Often tight pelvic floor muscles are the cause of the pain, and no other cause or infection is found.
You will benefit most from a team approach to management - typically a pelvic floor physiotherapist, and psychologist as well as your GP. There are usually several factors involved, such as stress and lifestyle. There are excellent online resources for pelvic floor muscle relaxation for men with chronic pelvic pain. With the right team, there is hope.
Question3. I am 18 and have had painful periods ever since I started menstruating. I was diagnosed with endometriosis, which has responded to treatment, but now I have pain in my low abdominal area when my bladder fills up. What can I do?
Answer3. About 20 per cent of teenagers suffer from pelvic pain that interrupts their schooling. Endometriosis may be a cause of pain but in some cases the nerve endings in the pelvis become sensitive, and other organs in the pelvis become touchy too, even when the endometriosis has been treated. You should see your GP and a urologist, but often no explanation can be found for the pain. However, there are some simple things that help: avoiding some foods, drinking mostly water, exercising daily and knowing how to relax your pelvic floor muscles, which can get tense with the pain. A pelvic floor physiotherapist and a psychologist can also help and there is an excellent pelvic pain e-book from the Pelvic Pain Foundation of Australia at pelvicpain.org.au
Question4. I am 26 and have never been able to use tampons. Sex has always been painful; it feels like my vagina is too tight. I have seen lots of doctors and relationships have been hard.
Answer4. You may be surprised to hear yours is a common story, which sounds like vaginismus. With vaginismus, the pelvic floor muscles spasm involuntarily, making intercourse extremely painful or impossible. It may have started with that very first, uncomfortable, attempt to use tampons. Your brain has never forgotten that and is now protecting you by switching on your pelvic floor muscles.
No infection or other cause can be found and vaginismus is very treatable and best managed by a team of healthcare professionals, including a gynaecologist (to check for problems such as dermatitis or thrush) and a pelvic floor physiotherapist (to teach you how to relax the pelvic floor muscles). A psychologist or sexual therapist may also be helpful if you have a history of any kind of abuse or anxiety.
Treatment may involve vaginal trainers (also called dilators), small plastic tubes, which can teach you how to relax your vagina to touch. With practice and time, your pelvic floor muscles will learn to relax, and you will be able to have sex and use tampons without pain.