Pelvic pain conditions

Avoid perfumed soap, bubble baths, shower gels, shampoos, special wipes and deodorants in this area. Instead, wash with a soap substitute which is less likely to cause skin irritation.

Abdominal massage is a useful technique to help with constipation and regulate normal bowel movements. In doing massage, peristalsis is stimulated – this is the bowel’s natural squeezing and processing that helps things shift along. When there is constipation or pain, this can be much slower.

It is easiest to do abdominal massage in a lying position to start with, as the abdominal muscles are softer. Some people find abdominal massage in sitting can also be beneficial. It can also be a soothing technique when there is bloating or lower abdominal pain as part of a chronic pain condition.

When looking at the evidence to support exactly what to do, the general principles are to start with a stroking technique, move on to kneading and then finish with stroking. The time can be variable, and it is worth exploring what works for you. Some people find 5 minutes is enough and others find it is useful to do at least 15 minutes.

Always start at the right-hand side of your body and work up from the hip bone towards the the lower ribs. Then move across towards the tummy button and over to the hip bone on the left side. Finally, down towards the left groin. This is the path of the colon - working up the ascending colon on the right-hand side, along the transverse colon and down the descending colon on the left.

Start with a stroking technique; this can be gentle or firm and should be slow. Use your
fingers or the heel of your hand, working along the areas continuously and notice any areas which feel tender or firm. Then move on to a kneading technique. These are circles, which can be clockwise or anti-clockwise, and small or large. Repeat in the same direction as above. Then finish with repeating the stroking technique.

Explore speed, pressure, large or small movements and timings.

Abdominal breathing is one of the easiest relaxation techniques to learn. When we become stressed or feel pain, one of our body’s fight or flight reactions is shallow, rapid breathing. Taking deep, slow breaths is one way we can turn off this fight or flight reaction.

Abdominal breathing and enabling your tummy muscles to release, can be a powerful technique to promote softening and lengthening of the pelvic floor system. This reset can be very useful in the management of many pelvic floor symptoms.

Practicing breathing also enables the autonomic system to moderate its activity and be better balanced. This part of the nervous system is responsible for automatic activities in the body, which includes bladder and bowel function.

Deep breathing exercises are known to be effective at removing stress hormones and chemicals rapidly; as well as promoting the release of hormones, such as endorphins which are known to enable the whole body to be more settled.

Choose a position which feels most comfortable, either lying with your knees bent or reclined sitting. Spend a moment settling your body, getting comfortable to enable you to focus on your breath. Place one hand at the top of your chest, and the other over your lower tummy.

Notice where you are breathing from. Notice which hand is doing the most movement. How quickly is it rising and falling? And think about how fast you are breathing. Sometimes the top hand moves more than the bottom hand.

See if you can change this, so the bottom hand does more of the movement. Have a soft mouth and jaw, let your shoulders soften, and let the air down to the bottom of the lungs so the ribs expand. This is called a diaphragmatic breath or a deep breath. There should be no forced movement and no active pushing out of the tummy. A gentle breath in.

It sounds simple, but it is not always easy to allow the tummy to soften. It takes practice. The diaphragm should gradually come down gently to enable the tummy to soften. This enables the pelvic floor to release and promotes a reset of the whole system.

Aim to practice for 5 to 10 minutes each day. Using little opportunities throughout the day can be effective as well.

Download this PDF to explore more pelvic floor relaxation techniques

Following assessment, your physiotherapist may guide you to work on certain techniques to promote pelvic floor relaxation.

An important stage in improving symptoms is recognising when the pelvic floor muscles are tight, knowing how to enable them to release, and to acknowledge when they are relaxed.

Download this PDF to learn techniques to encourage pelvic floor relaxation and watch the video below.

Additional self-release of pelvic floor techniques

Download this PDF to explore additional self-release of the pelvic floor techniques. You can also watch the video below to learn more.

A local anaesthetic topical ointment can be used to numb the area, reducing discomfort. Lidocaine ointment (5%) can be bought over the counter from your chemist. This can be applied as and when needed, and for some it is helpful to use prior to sex to make it less painful.

Sometimes oral medication can to be considered if the above steps fail. These include drugs which can modify the nerve pain response, and the dose can be gradually increased as necessary. Such drugs include: 

• amitriptyline or nortriptyline
• gabapentin
• pregabalin

Physiotherapy can play an important role in managing these conditions by addressing the soft tissue sensitivity and pelvic muscle behaviour. 

There are a variety of different techniques and exercises that can be suggested to help restore the normal function of the area. Some techniques can be taught to do directly to the tissues and others influence the area indirectly. 

None of the techniques or exercises are designed to provoke symptoms and the aim is to work towards self-management and normal function.

Experiencing such personal symptoms can have a profound effect on your emotions and relationships. Physiotherapists understand this and the focus of physiotherapy is about empowering you.

If sexual intercourse is painful this can have emotional and psychological effects on your relationships. It is important to recognise this, and to communicate fully with your partner, discovering techniques that are comfortable and suit you both. 

Psychosexual counselling can be helpful. Some patients may also benefit from other types of therapy including cognitive behavioural therapy or compassion focused therapy.

In rare cases, further treatment options may be considered. These include local injections to small areas or nerve block injections. Surgical excision is an option for a small minority of patients.