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Pelvic pain procedures

Persistent pelvic pain can arise from nerves, muscles, joints or organs, and often from more than one at once. Targeted nerve blocks help identify which structures are involved and can provide relief, alongside pelvic floor treatment where muscle overactivity is contributing.

Persistent pelvic pain is common, frequently misattributed, and often poorly served. People are commonly referred between specialties for years without a coherent assessment. It affects people of all genders and can follow surgery, childbirth, infection, trauma, or no identifiable event at all.

Why it is complicated. The pelvis contains organs, joints, muscles and a dense network of nerves in a small space, and pain from any of them refers into similar territory. Overactivity of pelvic floor muscles frequently develops as a response to pain from any source and then becomes a pain source itself. Changes in central pain processing are common by the time people are referred. All of these can be present together.

Nerve blocks. The pudendal nerve is a common target where pain is felt in the perineal region, is often worse with sitting, and follows the nerve's distribution. Blocks of sacral and other pelvic nerves are used depending on the pattern. Under image guidance, local anaesthetic is placed at the target; substantial relief while it is active identifies the nerve as involved. Radiofrequency treatment may also be considered.

Pelvic floor muscle injection. Where examination identifies overactive, tender pelvic floor muscles contributing to the pain, targeted intramuscular injection can reduce that overactivity. It is used selectively and works best combined with pelvic floor physiotherapy — the injection creates the conditions for that work, and the work is what produces lasting change.

Working with others. Pelvic pain rarely sits within one specialty. Dr Martin works alongside pelvic floor physiotherapists, gynaecologists, urologists, colorectal surgeons and psychologists as required, and will say clearly when another opinion is needed.

On the day. Procedures are image-guided and take 20–40 minutes. Sedation is available, and privacy and dignity are managed carefully. A chaperone is available and can be requested at any point.

Risks. Whilst pain procedures are generally safe and well tolerated, all procedures carry risks. The specific risks relevant to you and your procedure will be discussed with you, and written information provided, before you decide to proceed.

Realistic expectations. Where pain has been present for years and several mechanisms are involved, the goal is usually meaningful reduction and improved function rather than complete resolution. Progress is generally stepwise.