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Pelvic floor pain is common, affecting many women. While pain can be a purely structural cause, this isn’t always the case. When there is no structural cause, scans and even surgery can come back completely normal. While this is good news, it can be very disheartening for women who have chronic pelvic pain and are told that there is no cause or surgical options for their pain.

If there is no known cause to your pelvic pain, it may be coming from your pelvic floor!

While there can be many contributors to pain, pain can also be caused by overactive or tight pelvic floor muscles. Pelvic floor muscles can become tight or develop muscle spasm for a number of reasons. This may be due to an underlying pelvic floor issue like endometriosis, due to a nerve or neurological condition, or may occur after a severe bout of thrush or other infection. Sometimes there is no known cause. In many cases, an initial painful condition, infection or stressful event can trigger pelvic floor muscle spasm, leading to worsened pain and thus commencing a vicious circle of worsening muscle spasm and pain.

How can pelvic floor physiotherapy help with pelvic pain?

Seeing a pelvic floor physiotherapist can be so helpful for pelvic pain. A pelvic floor physiotherapist will take a detailed history of your pain before assessing you and your pelvic floor. This will typically involve an internal vaginal examination, or less commonly a rectal examination. In a many cases your physiotherapist will also assess your posture, breathing patterns, lumbar spine, hips and will also assess your ability to relax your abdominal muscles. While complete assessment will often be done over multiple sessions, treatment will usually commence your first session.

Treatment techniques your physiotherapist may use for pain include pelvic floor relaxation exercises, breath work, pelvic floor stretches, manual therapy, dilator therapy, imagery, therapeutic exercise and other treatment options.

Where you also have other concerns like incontinence (bladder or bowel leakage), painful sex, constipation or difficulty emptying your bladder or bowel, your physio will assess and provide treatment for these too.

What if you have concerns about a vaginal (or rectal) exam…

Internal examination gives your physiotherapist much more information about your pain, the location of your pain, its potential causes and more effective treatment methods. This also allows your physio to better understand the deep muscles of your pelvis.

It is completely understandable that with a history of pain you may experience painful pelvic exams, or may have other concerns with a vaginal or rectal examination. Please do speak with your physiotherapist during your appointment if you have any concerns with a vaginal or rectal examination. If you do decide not to have a pelvic floor examination there are usually other ways your physio can help.

Where to seek help

If you do have pelvic pain a pelvic floor physio with experience in pelvic pain may be able to help. Also seeing a trusted GP (or family doctor) can help to rule out any other causes and point you in the right direction.

If you are in Australia you may also be eligible for Medicare subsidized appointments for up to 5 sessions. This is through the chronic disease management program. To arrange this you will need to speak to your GP, who will determine your eligibility and will complete a care plan for you if you qualify.