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Pelvic pain

Persistent pelvic pain lasts more than six months, affects people of all genders, and usually has more than one contributor — nerves, pelvic floor muscles, joints and organs can all be involved. Assessment that considers all of them, rather than one specialty's view, is what moves treatment forward.

Persistent pelvic pain is common, and the path most people travel with it is long: multiple specialists, multiple normal investigations, and a growing sense of not being believed. Part of the difficulty is structural — the pelvis is where several specialties meet, and pain that crosses their boundaries can belong to nobody. A pain medicine assessment is designed for exactly this situation: it starts from the pain, not from one organ system.

Why pelvic pain is complicated. Organs, joints, muscles and a dense network of nerves share a small space, and pain from any of them refers into overlapping territory. Two patterns deserve particular attention because they are common and treatable. First, pelvic floor muscle overactivity: muscles that tighten in response to pain from any source can become a pain source themselves, sustaining the problem after the original trigger has resolved. Second, nerve involvement — the pudendal nerve and its neighbours can be irritated by childbirth, surgery, cycling or prolonged sitting, producing burning or aching pain in the perineal region, typically worse with sitting.

Conditions seen here include pain after pelvic or abdominal surgery, pain following childbirth, pudendal neuralgia, coccyx pain, bladder and bowel-associated pain syndromes, endometriosis-associated pain persisting despite gynaecological treatment, and pain with no identified cause despite thorough investigation — which is a recognised outcome, not a failed one, and still treatable.

How assessment works. A careful history maps the pain's territory, triggers and associations; examination assesses the joints, muscles and nerve territories involved. Where a specific nerve is suspected, an image-guided diagnostic block tests it directly. Assessment is conducted with attention to privacy and dignity; a chaperone is available and can be requested at any point.

Treatment is assembled from what the assessment finds: targeted nerve blocks and radiofrequency treatment where a nerve source is confirmed; injection for pelvic floor overactivity used to enable pelvic floor physiotherapy, which does the lasting work; medication matched to the mechanism; and coordination with gynaecologists, urologists, colorectal surgeons and psychologists where their expertise is needed. Dr Martin will say plainly when another specialty should be involved.

Realistic goals. Where pain has persisted for years with several mechanisms involved, progress is usually stepwise — meaningful reduction, restored sitting tolerance, return to work and intimacy — rather than instant resolution. Stepwise progress, sustained, changes lives.

Sources: International Association for the Study of Pain; Healthdirect Australia.