Endometriosis

• A condition where the cells that line the uterus grow in other parts of the body 

• Symptoms include painful periods (may be felt in abdomen, back, hips, or in other parts of the body - pain that flares with ovulation, pre-menstrually or during your bleed), painful intercourse, heavy bleeding +/- clots, bladder and bowel symptoms (urgency, hesitancy, constipation), fertility issues

• Requires a multi-disciplinary approach (including Gp, Pain Specialist, Gynaecologist, Physio)

• Physiotherapy helps you to manage your pain - including muscle release (internal and external), joint mobilisation around the back and pelvis, exercise programming, pain physiology education, mindfulness, breathwork 

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Pudendal Neuralgia 

• The pudendal nerve follows a windy course from the sacrum (back of the pelvis) to the clitoral area giving off branches along the way

• Typically experienced as one sided pain/burning/tingling/numbness that is aggravated by sitting

• Typical causes are cycling, entrapment of the pudendal nerve along it's pathway, post-radiotherapy, post-surgical trauma, polyneuropathy, compression of the nerve from tumour

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Bladder Pain Syndrome/Interstitial Cystitis (BPS/IC)

• Pain associated with bladder filling

• May also cause urinary urgency and/or frequency and/or nocturia (increased emptying of bladder at night)

• No infection present

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Urethral Pain Syndrome (UPS)

• Pain associated with passing urine

• May also cause urinary urgency and/or frequency and nocturia

• Urethritis is a type of UPS and can be an infective urethritis (e.coli, herpes, chlamydia, gonorrhoea) or an inflammatory urethritis (after catheter removal, following previous infection, chemical sensitivity, oestrogen deficiency) 

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Dyspareunia

Painful intercourse secondary to:

• Tight pelvic floor muscles

• Low oestrogen levels (when breastfeeding or when peri-/post-menopausal)

• Endometriosis

• Cysts/fibroids

• Mesh protrusion following surgery

• Birth trauma - perineal tear or episiotomy, internal vaginal wall tear

• Neural pain (sensitisation, irritation, compression)

• Vulvodynia/Vestibulodynia 

• Post-surgical pain/vaginal tightness)

• Infection (thrush, herpes, bacterial vaginosis, lichen sclerosus, lichen planus)

• Pelvic inflammatory disease

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Vaginismus

• Tightness of the pelvic floor muscles that can cause difficulties with intercourse, tampon insertion and removal, PAP smears

• Often, unfortunately, treated as a purely psychological disorder

• Very treatable with physiotherapy

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Vulvodynia/Vestibulitis

• Pain, burning, or discomfort in the vulva region that cannot be linked to a specific cause 

• It may or may not be triggered by touch

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Anorectal Pain

Dyschezia

• Pain passing a bowel motion

• Usually related to other pathologies (anal fissures, haemorrhoids or pain syndromes)

Chronic Proctalgia​

• Ongoing rectal pain or aching lasting >20mins

• Caused by tightness of one of the pelvic floor muscles (puborectalis)

Proctalgia Fugax

• Repeated episodes of pain in the anus or rectum lasting a few seconds/minutes with no pain between bouts​

• Can be related to history of chronic constipation

• May be a spasm of the anal sphincter or puborectalis

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Chronic Pelvic Pain (CPP)

This is an umbrella term used for any ongoing internal pelvic pain

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Persistent Genital Arousal Syndrome​

Not specifically a pain syndrome, but a very uncomfortable constant state of arousal that usually needs multi-disciplinary management (including Physio, Doctor, Specialist)

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For External Pelvic Pain click here