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Women's Health

What is pelvic floor pain – and is it normal?

Tue 19th May, 2020

Kate Iselin

The pelvic floor is the group of muscles around the vagina, urethra, and anus. They're located between your pubic bone and your tailbone. Like a trampoline stretching across the base of our torso, they also support the organs around that area: your uterus, bladder, and bowel. Essentially, the pelvic floor exists to keep everything in our pelvis contained and supported.

We often hear about the pelvic floor in relation to how weak or strong it is: things like childbirth, constipation, some medical conditions, and even just the process of ageing can weaken the pelvic floor, making it more difficult for it to do its job.

There are plenty of simple exercises out there to help you strengthen your pelvic floor. Kegels are among the more well-known, and involve tensing and squeezing your pelvic floor muscles for a few seconds at a time, a few times a day. But one thing we don't often discuss is pelvic floor pain.

Most of us have probably experienced pelvic floor pain at least once or twice in our lives—but what exactly is it? What causes it? And more importantly, what can stop it?

What causes pelvic floor pain?

“Pelvic floor pain can be associated with any number of symptoms,” says the CEO of Pain Australia, Carol Bennett.

Those who experience pelvic floor pain can experience it alongside fatigue, anxiety, depression, muscle pain and spasms, bloating, and difficulty going to the toilet, Bennett tells Kin. “But there isn't just one cause of it. There are generally about three main causes, and they are period pain, endometriosis, and irritable bowel syndrome.”

Period pain is maybe the most common way to experience pelvic floor pain. During our periods, the pelvic floor can cramp and contract along with the uterus, causing pain that can spread out across our abdomen, back, and vulva. Although it's never pleasant, the good news is that if this kind of pain only lasts for a day or two, and can be relieved with painkillers, it's pretty normal.

Pelvic floor pain can also be caused by endometriosis, a condition where the tissue that would normally line the uterus grows outside the uterus, like on your ovaries, bowels, or bladder. Endometriosis can be agonising, and can cause further pain in the tissues of the pelvic floor if they become inflamed.

For those with irritable bowel syndrome, or IBS, pelvic floor pain can happen alongside things like bloating, diarrhoea, and constipation. While it's not known exactly what causes IBS, it can be treated and managed, just like pelvic floor pain can.

It's worth noting that pelvic floor pain isn't just something that occurs in women—everyone has a pelvic floor. “It can occur in men, but it's not as common,” says Bennett. “[Pelvic floor pain] affects about twenty percent of women, or one in five—and about one in twelve men.”

How is pelvic floor pain diagnosed?

The term “pelvic floor pain” can sound pretty broad. The number of things that can cause it, and the ways in which we can experience it, can also make it tricky to decide if what we're feeling is just a random, once-off pain or something that needs to be investigated further. Bennett says that pelvic floor pain can be difficult to diagnose, even for medical professionals—but we shouldn't let that put us off speaking to a doctor if we're concerned.

“One of the issues around why these conditions are not always quickly diagnosed is because they tend to be things that are difficult to diagnose,” she says. “It can be difficult to diagnose, and it can be difficult to treat. It's a bit of a journey in terms of identifying the source of the pain and getting a proper diagnosis, and [finding] good management as well which is a very individual thing. It's not simple, but if people can get effective treatment it can be huge in terms of the impact on their quality of life.”

When it comes to seeking medical advice, Bennett says it's always worth seeing a doctor, just in case the pain is caused by an underlying condition. “The more these things develop,” she says, “The harder it is to manage once it takes hold.”

How is it treated?

“With most forms of pain, whether it's pelvic or other forms, the most effective form of management is multi-disciplinary care. That basically means, individual treatment tailored to the person's needs,” Bennett says.

For those suffering from period pain, endometriosis, or IBS, this would involve not only treating and managing pelvic floor pain, but treating and managing the underlying condition as well.

Bennett also mentions that physiotherapy can be 'incredibly effective', as can counselling and therapy to help people understand the cause of their pain and manage it accordingly. At home, stretching and heat-packs can be useful, as can some medications.

“A lot of approaches are about self-management depending on how significant the pain is,” she says. “Some people do use medication and that can be useful as a short-term treatment for pain, but it's generally not recommended in the long term. Medications are generally used in combinations with other treatments.”

“And, obviously, with all of these conditions, one of the other recommendations is that people have a good diet, exercise, and good sleep, as those things will impact your overall health.”

Pelvic floor pain is a common thing. For most of us, it might be a once-in-a-blue-moon ache that we can dismiss pretty easily, but anyone experiencing it regularly would be doing themselves a favour by mentioning it to their doctor, especially if there's no obvious cause behind the pain.

Pelvic floor pain can be annoying, frustrating, and, well, painful—but it's important to know that it can be diagnosed, it can be treated, and it's not something we have to put up with forever.