Persistent pelvic pain

What is pelvic pain?

Pelvic pain is any type of pain that you feel in the lower part of your belly, below your belly button. There are a lot of organs, muscles, nerves, bones and joints in that part of your body. Given how connected it is, it can take time to find out what's causing the pain.

Pelvic pain is called persistent (or chronic) if you have it most days for longer than 3 months.

Signs and symptoms

Persistent pelvic pain can feel different for everyone, but common signs and symptoms can include:

• period pain that makes it hard to do your normal activities
• pressure or cramping in your lower tummy that stops you doing everyday tasks
• sharp or stabbing sensations in your vagina or bottom
• internal pain when you use a tampon, menstrual cup or disc
• pain when you have sex
• swelling and pain in your belly
• pain in your belly or bottom when you need to poo
• burning, itching or shooting pains in your vulva
• needing to use the toilet a lot or urgently
• pain when you pee
• pain that lasts for months or pain that comes and goes in cycles
• bloating or a feeling of pressure
• pain with sitting or standing
• fatigue, sleep disruption or mood changes related to ongoing pain
• low back and hip pain.

It's not normal to have any of these symptoms most or all of the time.

If you have abnormal bleeding or discharge, changes to your pee or poo, fever, skin rashes or nausea, call 13 HEALTH (13 43 25 84) for advice.

When to get help

See your GP if:

• you have pain most or all days in a month
• over the counter painkillers don’t help
• you've had any symptoms for more than 3 months
• you're missing school or work because of the pain
• your symptoms are affecting your daily life, for example stopping you seeing friends, exercising or being able to sleep
• you're struggling to get pregnant
• your symptoms are making you feel anxious or depressed.

Before your appointment

Your GP will ask about your symptoms, how long you’ve had them, and how they affect you. It’s important to give them as much information as possible. It can be a good idea to book a long appointment.

Before your appointment, write down:

• when you have pain, what it feels like, where in your body it is and what activities it's impacting
• how intense the pain is each time – give it a score out of 10 (with 10 being the worst pain)
• which symptoms cause you the most problems – you may not have time to explain all your symptoms
• how often you get your period
• how much you bleed, including how often you change your tampon, pad, cup or disc
• any changes in your weight, appearance or mental health.

Diagnosis

To help find out what's happening, your doctor might do blood and urine tests. If you're an adult, they may ask to examine your pelvis. This means to check inside your vulva, vagina and cervix. This will only happen if you feel comfortable, safe and agree to the examination. It's okay to take a trusted person with you and it's okay to say no. They might also refer you for medical imaging tests like ultrasound and MRI. Children and teenagers don’t usually need to have a pelvic exam and can have an ultrasound instead.

Some common causes for persistent pelvic pain can include:

• periods, endometriosis, adenomyosis or polycystic ovary syndrome (PCOS)
• infections like UTIs (urinary tract infections) or STIs (sexually transmitted infections)
• pelvic inflammatory disease (PID)
• digestive problems, like constipation or diarrhoea
• bowel conditions, like irritable bowel syndrome (IBS)
• pelvic muscle, joint or nerve problems
• problems with the vagina or vulva, like vulvodynia, thrush or skin issues
• painful bladder syndrome.

It might help to see a GP with a special interest in women's health when talking about pelvic pain.

Treatment

Sometimes managing pelvic pain needs a team approach. Your GP may suggest you see other specialists who can help, such as:

• women’s health doctors (gynaecologists) for womb and ovary concerns
• paediatric and adolescent gynaecologist if you're under 18
• bladder specialists (urologists) for bladder and urinary problems
• bowel specialists (gastroenterologists) for stomach and bowel issues
• pain specialists to help you to manage ongoing pain symptoms
• physiotherapists for pelvic floor and muscle support, especially muscle relaxation, strengthening and finding the 'sweet spot' for activity and exercise
• psychologists to support your wellbeing and help manage the effects of living with persistent pain, like sleep, stress and the way your feel about yourself and your mood.

Living with painful symptoms can affect your mood. Stress can make pain feel worse and past trauma might also change the way you feel pain. Understanding pain and how stress, trauma and mood can make it feel worse, can help you manage your symptoms.

Pelvic pain can get worse if you have a UTI, thrush, constipation or an STI. Treating these problems can make a big difference. Speak with your GP or pharmacist to get the treatment you need.

Managing pelvic pain

Living with pain can be challenging but there are things you can learn to help manage it. With the right support, you can live well and do the things you enjoy.

The more you know how your body works, the more you can help manage the symptoms you're having. Learn all you can about pain and why your body sends you pain signals. There's helpful information to help you understand your pain on the Pain Revolution website.

Pain relief

Heavy painful periods are usually caused by not having enough progesterone, which is common during your teenage years. Your GP can prescribe progesterone supplement tablets, which will reduce the amount of bleeding and pain you get with your periods. These aren’t the same as progesterone contraceptive pills and won’t stop you from getting pregnant.

You can also take over the counter medicine, like paracetamol and ibuprofen for general pain relief, or naproxen or mefenamic acid for targeted period pain. These are more effective if you take them a day or so before your period starts. Take them regularly for the first few days of your period. Remember to have them with food so they don't irritate your stomach.

If you find it hard to swallow tablets, your doctor might be able to give you medicine in a liquid or tablets that go in your bottom or vagina (suppositories).

Try using a TENS (transcutaneous electrical nerve stimulation) machine and a heat pack. You can read more about TENS machines on healthdirect.

Hormonal treatments like the pill or an IUD can help manage pain symptoms for some conditions.

You can use pain apps to help you track and manage your symptoms. The QENDO app is a free app specifically designed for help managing pelvic pain symptoms.

Pelvic floor care

Your pelvic floor muscles play an important role in things like pooing, peeing and sex. Sometimes with persistent pain, these muscles work too hard and add to your pain. Knowing how to relax them can help manage your pain.

Try things like:

• pelvic floor stretches
• heat packs or hot baths
• deep breathing.

They can all help encourage your pelvic floor muscles to work their best. A pelvic health physiotherapist can tailor a program just for you.

Activity

Movement is often helpful to manage pain but can be hard to do when you feel sore. There's lots of helpful advice on the Pain revolution website. Exercise like walking, swimming or yoga are all good ways to keep moving. Doing a little bit often can be helpful.

If you find movement is something that makes your pain worse not better, speak to a physiotherapist. They can help you find ways to move that don't cause you pain. It's important to keep moving and doing the things you enjoy.

Self care

Be kind to yourself. You can try:

• putting on your favourite music
• talking to your favourite people
• smelling nice things
• doing things you enjoy.

Even if it's only for 5 minutes it can help.

Stress can make pain feel much worse. Try to avoid stressful activities or events.

Having a good sleep routine is a good way of managing stress and pain. Try to go to bed and wake up at the same time each day. Try to keep daytime naps under 20 minutes. The Sleep Health Foundation website has tips for getting good quality sleep and advice about using cognitive behavioural therapy for insomnia.

Keep an eye on your mood and how you feel within yourself. If you feel unsafe or flat or anxious your pain can quite quickly escalate. There are lots of apps that can guide you through strategies like meditation or mindfulness. A psychologist can help guide you through even more strategies to help manage your mood.

Make sure you're getting a balanced diet. The Queensland Government has recipes for making healthy meals using seasonal vegetables.

Get help from support groups, online communities, friends and family. Make sure you check online sources are trustworthy. A good place to start is the Pelvic Pain Foundation of Australia, QENDO and Jean Hailes websites.

Talking to your child about pelvic pain

Your child should see a GP as soon as possible if they’re having pelvic pain.

• Don’t minimise their pain or symptoms
• Let them know they can get help
• Help them keep a symptom diary
• Help them find ways to manage their symptoms at home and at school
• Get advice from a GP with a special interest in women's health