What is persistent pelvic pain (PPP)?

Persistent pelvic pain (PPP) 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 area includes:

• muscles
• joints
• your bowel
• your bladder

Your pelvis may also include your ovaries, uterus and fallopian tubes.

PPP affects up to 1 in 4 Australian females and around 1 in 12 Australian males.

What are the symptoms of PPP?

Everyone experiences PPP differently because it can have many different causes. The location of 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 PPP symptoms at any time. Pain may be triggered at certain 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

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 your relationships, workplace and social connections

Often, chronic pain starts with a physical cause. However, even when the original cause has gone, 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 any pelvic pain, see your doctor.

It's best to see a doctor early if you experience pelvic pain. Early treatment can help you to avoid developing PPP.

How is PPP diagnosed?

Your doctor will check if there is a 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.

As part of investigating and treating your pain, you may be referred to see a:

• gynaecologist
• pain specialist
• physiotherapist
• psychologist

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 or behavioural treatment

With psychotherapy you can learn to reduce the way your brain feels the pain. This is often the best way to treat PPP.

Physical treatment

Physical treatment may include

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

Lifestyle changes

Making changes to your lifestyle can help.

Your doctor may suggest some changes to your diet. This is because irritable bowel syndrome (IBS) is often associated with PPP.

Some people with PPP get relief through mindfulness and yoga.

Medicines for PPP

Your doctor may suggest:

• 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 — but these are rarely recommended as they can make chronic pain worse over time

What are the complications of PPP?

PPP impacts your mental health and can lead to anxiety and depression.

If left untreated, PPP can affect your daily life and stop you from socialising or doing certain activities. It can also impact your:

• sleep
• appetite
• energy levels
• motivation

You may experience PPP along with other chronic pain conditions.

Can PPP be prevented?

You can lower your chance of getting PPP by seeing your doctor for early treatment of any short-term or intermittent (comes and goes) pelvic pain you experience.

For example, if you are a teenager and have painful periods, it is a good idea to see your doctor.

Resources and support

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

The Pelvic Pain Foundation of Australia provides support for people living with pelvic pain.

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

Languages other than English

Health Translations Victoria has translated fact sheets about pelvic pain.

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