Pelvic pain

This includes bladder pain syndrome, Interstitial cystitis and urethritis, pain that appears to be coming from the lower urinary tract structures.

Urethral pain syndromes is when pain can be experienced when you pee, when there is no evidence of urinary tract infection.

Proctalgia

Proctalgia Fugax is an intermittent attack of severe rectal pain, which can last from a few seconds to 2 hours, then disappears completely.

Levator ani syndrome is usually described as a vague or dull ache or pressure sensation high in the rectum, often worse with sitting.

Dyshezia is when it is painful or difficult to pass a poo / bowel motion.

It is estimated that 85% of chronic pain syndromes may be muscular in origin.  Tension through muscles or mal alignment of the skeletal system can cause aggravation of structures that cause pain.  Sacral and coccyx pain can be very difficult to treat without the full picture of what is happening to the pelvic floor muscles.

Visceral pain comes from internal organs.  Most viscera has no mapping in the brain, that that makes the visceral pain feel vague.  This is not like somatic pain that can be mapped and clearly defined.

Just because there may be pain in the muscles, that does not mean they are the problem, pain can sometimes be referred pain and be felt in quite distant points on the body.  It is often described as generalised or aching.

Pelvic pain can be driven by endometriosis.  Many patients with endometriosis also have irritable bowel syndrome and bladder pain syndrome due to a process called viscero-visceral convergence.  Visceral pathology such as with endometriosis can make the pelvic floor muscles really tight, like a cage over the top of the uterus to protect it.  This can cause pain by a process called viscero-somatic convergence.

Neuropathic pain disorders include pudendal neuralgia, genitofemoral neuralgia and posterior cutaneous neuralgia. Neuralgia’s are caused by damage to the nerve itself by nerve irritation or certain nerve disorders.  Pudendal neuralgia can cause pain along the distribution of the pudendal nerve, and is often worse with sitting.

Meralgia Paraesthetica can be caused from pregnancy where a compression of the nerve causes numbness to the front of the thigh.

Scarring for surgery or from injuries sustained during childbirth can be painful and sensitive.

Dyspareunia means pain with sex.  That might be superficial pain around the entrance of the vagina, or pain that is felt deep inside with deep penetration.  You may have a combination of both.  Don’t put up with it.  It is one of the most common conditions we see, and treatment can be very successful.

Vaginismus is a vaginal tightness that causes discomfort, burning, pain with intercourse or tampon use, penetration problems and sometimes almost complete closure of the vaginal opening, making intercourse impossible, despite the desire to do so.

We work with finding the underlying driver to why this is happening.  We can advise on how to use vaginal dilators, and also work closely with the specialist doctors before and after procedures such as vaginal botox, to optimise the outcome.  We use technology such as biofeedback and stims machines to help train the muscles on how to relax, desensitise the tissues to allow penetration.

Painful bladder syndromes can cause the feeling of pain above pubic bone, and pain related to bladder filling, which can sometimes be associated with increased day and night time frequency.  There is no urinary infection or other obvious pathology.  There can be a sudden, intense, desire to pass urine for fear of pain (not fear of leaking).

Interstitial cystitis can be a tenderness, irritation or burning sensation in the bladder, the feeling of fullness even when there is little urine in the bladder and pain is often relieved by urination.  Some patients develop a stabbing or burning vaginal pain.

Vulval discomfort, often described as burning pain, in the absence of any other pathology.