What is persistent pelvic pain (PPP)?

Persistent pelvic pain is also known as chronic pelvic pain. It is pain in the pelvic area (the area below your belly button), which lasts for 6 months or more. Your pelvis includes many muscles, joints, and your bowel and bladder, and may also include your ovaries, uterus and fallopian tubes.

Chronic pelvic pain affects up to 1 in 4 Australian females and around 1 in 10 Australian males.

What are the symptoms of PPP?

Everyone experiences PPP differently, especially because PPP can have many different causes. The area you have the pain and the type of pain you feel may not always be the same.

The pain you feel may be:

• dull or aching
• sharp or stabbing
• burning
• cramping
• pressure or heaviness
• tingling or pins and needles

You may feel the pain at any time, and it may be triggered at specific times such as:

• during your period
• when you sit on the toilet
• when you sit or stand for a long time
• with certain movements or activities
• during sex
• when you insert a tampon

Your pain may radiate (travel upwards) from your pelvis to your abdomen or down towards your legs.

What causes PPP?

Chronic pain can take several years to develop. PPP is usually due to multiple factors, including:

• physical factors such as physical health conditions, inflammation and hormones
• psychological factors such as how pain affects your mood and sleep and how you think about your pain
• social factors such as relationships, your workplace and social connections

Often the pain will start with a physical cause. However, even when the cause is no longer present, your body may still experience pain. Gynaecological conditions, digestive system problems, urinary system issues or pelvic muscle or nerve irritation can all contribute to PPP.

Other physical causes that can contribute to PPP include:

• period pain
• endometriosis
• adenomyosis
• urinary tract infections
• irritable bowel syndrome (IBS)
• pelvic floor muscle dysfunction
• vulvodynia (pain in the vulva)

When should I see my doctor?

If you have pelvic pain, see your doctor. It's best to see a doctor early if you experience pelvic pain, to help avoid developing PPP.

How is PPP diagnosed?

PPP is complicated and you can experience pain without having a physical cause that can be found or treated. Your doctor will check if there is physical cause they can treat before diagnosing you with PPP.

Your doctor will ask you about your symptoms and do a physical examination. They may recommend having an ultrasound or other imaging scan to look at your pelvic area.

Sometimes, your doctor may recommend an operation to check possible causes. A laparoscopy (keyhole surgery) uses a camera to look inside your pelvis, while a cystoscopy uses a small camera to look inside your bladder.

You may see a gynaecologist, pain specialist, physiotherapist or a psychologist as part of investigating and treating your pain.

How is PPP treated?

There is no cure for persistent pelvic pain, but there are many things your doctor may recommend to help you manage it:

• psychological/behavioural techniques
  • psychotherapy — this is considered the best management for PPP since you can learn to reduce the way your brain feels the pain

• physical methods
  • physiotherapy
  • osteopathy
  • pacing — avoiding too much physical activity in one day

• lifestyle changes
  • diet — because IBS is often associated with PPP
  • mindfulness and yoga

• medicines
  • paracetamol
  • non-steroidal anti-inflammatory drugs (NSAIDS)
  • anti-neuropathic medicines — these affect how your pain nerves work
  • hormonal treatments — such as the pill, if your pain has a hormonal trigger
  • opioids — rarely recommended as they can worsen chronic pain

Can PPP be prevented?

You can reduce the risk of developing PPP by seeing your doctor for early treatment of any short-term or intermittent pelvic pain you experience. For example, see your doctor to investigate painful periods in teenagers.

Complications of PPP

PPP impacts your mental health and can lead to anxiety and depression. If left untreated, it can affect your daily life and stop you from socialising or doing certain activities. It can also impact your sleep, appetite, energy levels and motivation. You may experience PPP along with other chronic pain conditions.

Resources and support

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) has a helpful information sheet about chronic pelvic pain.

Do you prefer languages other than English? Health Translations Victoria offers translated information.

The Pelvic Pain Foundation of Australia can connect you with support groups in your area.

The Australian Government funds pelvic pain clinics to reduce the time it takes for diagnosis and treatment. Find your nearest clinic.

The Agency for Clinical Innovation has multilingual resources on understanding and managing chronic pain.