The Pelvic Pain Service

Persistent or chronic pelvic pain is any type of pain in the lower abdomen (tummy) or pelvis that lasts for at least six months.  

It is common and affects around one in six female adults. 

Persistent pain is associated with depression, anxiety, poor sleep, and reduced mobility. It can negatively affect work and home life including relationships. 

We recognise the impact that persistent pelvic pain can have on your life. This includes your physical health, psychological wellbeing, and social functioning.  The interaction of these factors contributes to your overall experience of pelvic pain. This is why we take a holistic bio-psycho-social approach towards your care, to maximise your quality of life and treatment options.  

There is often more than one cause for the pain including interactions between biological, psychological, and social factors. This is because the mechanisms behind chronic pain are complicated. 

It is important to know the difference between acute and persistent pain: 

• Acute pain is short-term and acts as a warning of disease or a threat to the body (like injury). It usually goes away when the cause of pain has gone away.  
• Persistent pain continues longer than 12 weeks, or after the time that healing would be expected after trauma or surgery. It can lead to changes within the central nervous system, which make normal signals feel worse than they should. Nerve damage following surgery, trauma, inflammation, fibrosis (scarring), or infection can play a part in persistent pain. The sensation and how you interpret pain can also be influenced by previous experiences.  

Causes include: 

• Endometriosis
• Adenomyosis
• Adhesions (scar tissue)
• Irritable bowel syndrome
• Painful bladder syndrome (interstitial cystitis)
• Pelvic inflammatory disease
• Musculoskeletal problems secondary to nerve entrapment, the pelvic joints or pelvic floor muscles
• Psychological and social issues such as depression and poor sleep 
• Sometimes there is no clear cause for pain. 

A doctor will explore your symptoms and pain with you in detail. They may ask about your periods, triggers, mood, how your pain affects your daily life, and whether you have any specific concerns or expectations.  

The doctor may examine your abdomen and ask to perform a vaginal examination. Swabs may be suggested to check for infection.  

An ultrasound may be suggested to complete the examination. This is likely to be an internal scan called a transvaginal ultrasound. 

The doctor will then discuss the possible causes of pain with you and may suggest further investigations such as an MRI or laparoscopy (keyhole surgery). 

Persistent pelvic pain is diagnosed based on your medical history. A specific cause may be identified such as endometriosis, but sometimes no single cause is found. It could be the pain is caused by several contributing factors. 

Your treatment plan will depend on the possible cause and may involve referral to another specialist such as a urologist, gastroenterologist, pain specialist, pelvic health physiotherapist, psychiatrist, or psychologist. Our NBT Pelvic Pain Tool Kit is designed to support our patients living with persistent pelvic pain and help them to develop strategies to help self-manage their condition. It may not cover everything but gives additional tools to improve symptoms.  

Social Prescribing

Social prescribing involves referring you to a link worker who takes the time to look at you as an individual and identify areas that you want support in beyond just your physical health.  

This includes supporting your emotional and mental wellbeing as well as connecting you to your community. A link worker may help you start trialling some of the treatments described in the toolkit, which could be hard to try on your own sometimes. 

Speak to your GP for your more information about social prescribing.   

NHS England » Social prescribing

Seeing a pain specialist

A pain specialist will explore pain management strategies that are individual to you. Any medications you are taking will be reviewed and adjusted if needed. They might suggest alternative treatments including TENS and acupuncture. Our pelvic pain management program may be recommended.   

Seeing a pelvic health physiotherapist

Our specialist pelvic health physiotherapy service offers specialist assessment and rehabilitation for pelvic, bladder and bowel pain and dysfunction. 

Treatments offered include:  

• Advice on lifestyle changes. 
• Individual exercise programmes to improve movement, increase flexibility and strengthen muscles.
• Core stability work.
• Mobilisation and manipulation techniques to reduce pain and improve movement.
• Soft tissue techniques to reduce pain and increase flexibility of a muscle. 

Seeing a psychiatrist or psychologist

Living with a chronic health condition like persistent pelvic pain can have an impact on your emotional wellbeing and day to day life.  

These effects include: 

• Emotional impacts, including feelings of anxiety, grief, sadness, frustration, and anger. 
• Impacts on your ability to socialise and work. This can sometimes lead to feelings of loss, isolation, and changes to your sense of identity and quality of life. 
• There is research that suggests some people with persistent pelvic pain have experienced trauma in their lives. This is not the case for everyone, but if you have experienced trauma, then appropriate support could have a significant impact. 
• Medical treatments have risks, and sometimes people with persistent pelvic pain have been on a long journey with their treatment. In some cases, this journey is not an easy one, and this can contribute to the overall emotional and social impact of having a condition like this.  

It is important that your care considers all these factors, and this is why our holistic assessments sometime include psychologists and psychiatrists to ensure we properly understand your overall experience of pain. They can also consider whether you might benefit from any further support to help you cope when things are feeling particularly difficult. Support includes a range of talking therapies and/or medications.  

The Pelvic Pain Management Programme

The programme supports you to understand your pelvic health and develop strategies for managing the pain and other symptoms you are living with. There will be input from pelvic health physiotherapy, occupational therapy, psychology, nurse specialists, nutritionists, and gynaecology. It also provides an opportunity to meet other people facing similar challenges.   

The programme takes place for one session a week and it lasts for 12 weeks. In each session, you will be given information on evidence-based approaches to managing pelvic pain and other associated symptoms, there will be group discussions and some movement-based activities. 

Before your appointment it may be helpful if you:

• Keep a pain diary, a daily record of your pain for 2-3 menstrual cycles (or 2-3 months if you do not have periods or they are irregular).
• Write down other significant symptoms that you may be experiencing like heavy bleeding, tiredness, change in mood etc.
• Think about having a sexual health screen if appropriate, particularly to screen for chlamydia and gonorrhoea.
• Consider assessing your mood by taking the Patient Health Questionnaire (PHQ-9) and/or Generalised Anxiety Disorder Assessment (GAD-7) online or asking your GP to do this with you. 

There are many apps that may be helpful in recording your periods and symptoms. These are a few examples:

• Flo My Cycle & Period Tracker
• Clue Period, Ovulation Tracker
• Period Tracker Period Calendar 

• NHS.UK provide suggestions on ways to manage chronic pain: 
  Ways to manage chronic pain - NHS (www.nhs.uk)
• The Pain Toolkit website helps people manage persistent pain. It includes videos on managing pain and many other resources.
  12 Practical Pain Self-management Tools - Pain Toolkit
• Action on Pain provides practical help and support to people living with or affected by chronic pain. The charity is run by a team of people who have direct experience of living and dealing with long-term pain conditions. 
  Action On Pain (action-on-pain.co.uk)
• The Pelvic Pain Support Network provides support, information, and advocacy for those with pelvic pain, their families and carers.
  Pelvic Pain Support Network | Support, Information and Advocacy for those with Pelvic Pain
• Endometriosis UK supports women and their families living with endometriosis. Their information is hugely helpful to pelvic pain in general and not just endometriosis. 
  Ending endometriosis starts by saying it | Endometriosis UK (endometriosis-uk.org)