Pelvic pain is a common but often silent condition. It can manifest as pain during sexual intercourse, pain during bowel movements, a feeling of pressure or heaviness in the pelvic region, persistent pain in the lower abdomen, or discomfort with no obvious cause in complementary examinations.
Although common, it remains underestimated and sometimes misunderstood.
What is pelvic pain?
Chronic pelvic pain is generally defined as persistent or recurrent pain in the pelvic region lasting more than three months. It may involve musculoskeletal, visceral, neurological structures, or a combination of these.
The modern definition of pain recognises that it is a sensory and emotional experience associated with or similar to that associated with actual or potential tissue damage. This means that pain can exist even when there is no identifiable structural damage on examination.
Why can pain persist?
Pelvic pain can persist through different mechanisms, including:
- Changes in pelvic floor tone and coordination
- Sensitisation of the nervous system
- Previous painful experiences
- Emotional and contextual factors
Central sensitisation is a phenomenon recognised in the scientific literature and can contribute to the persistence of pain even after the initial factor has been resolved.
The role of the pelvic floor
The pelvic floor is a set of muscles, ligaments, vessels and nerves that contribute to the dynamic and static stability of the pelvic organs, urinary and faecal continence, and sexual function.
Both muscle weakness and hyperactivity can be associated with pain. Specialised assessment is essential to distinguish between these situations, as the intervention strategies are different.
Pelvic physiotherapy: an evidence-based approach
European guidelines recognise the importance of a multidisciplinary approach to chronic pelvic pain, including specialised physiotherapy.
Intervention may include:
- Pain education
- Pelvic floor re-education
- Muscle relaxation techniques
- Individualised therapeutic exercise
- Breathing work and motor control
Systematic reviews show that multimodal physiotherapy interventions can improve pain and function in women with chronic pelvic pain.
When to seek assessment?
It is advisable to seek assessment when there is:
- Persistent pelvic pain
- Pain during sexual intercourse
- Feeling of pressure or unexplained discomfort
- Impact on quality of life
Pelvic pain should not be normalised or ignored.
In conclusion
Pelvic pain is real, complex, and multifactorial. With proper assessment and an individualised approach, it is possible to reduce symptoms and restore quality of life.
At Physioclem, pelvic physiotherapy is performed with scientific rigour, respect, and confidentiality, integrating technical knowledge and human care.
Bibliographic references
Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161(9):1976–1982. doi:10.1097/j.pain.0000000000001939.
Woolf CJ. Central sensitisation: implications for the diagnosis and treatment of pain. Pain. 2011;152(3 Suppl):S2–S15. doi:10.1016/j.pain.2010.09.030.
Engeler D, Baranowski AP, Borovicka J, et al. EAU guidelines on chronic pelvic pain. Eur Urol. 2013;64(1):e77–e88. doi:10.1016/j.eururo.2013.03.034.
Morin M, Carroll MS, Bergeron S. Systematic review of the effectiveness of physical therapy modalities in women with pelvic pain. J Sex Med. 2017;14(5):631–642. doi:10.1016/j.jsxm.2017.03.249.
