Chronic Pelvic Pain Physiotherapy in Clapham

Chronic pelvic pain is pain in the lower tummy or pelvis that has lasted six months or longer. It can be constant or come and go, and isn’t only linked to your period or sex.

The Royal College of Obstetricians and Gynaecologists (RCOG) notes that it’s seen in GP surgeries as often as migraine or low back pain. It’s often caused by several factors at once, rather than one single problem.

• Aching, burning or sharp pain in the lower tummy, pelvis, vulva or bottom
• Pain that’s worse with sitting, standing for long periods or exercise
• Pain during or after sex
• Pain when you pee or poo, or a frequent urge to go
• Pain in your lower back, hips or groin
• Tiredness, poor sleep and low mood from living with long-term pain

Chronic pelvic pain often has more than one cause. Common contributors include:

• Endometriosis and adenomyosis
• Bladder conditions, such as interstitial cystitis
• Bowel conditions, including irritable bowel syndrome (IBS) and constipation
• Nerve pain, such as pudendal neuralgia
• Vulval pain, such as vulvodynia
• Joint and muscle problems in the pelvis, hips and lower back, including pelvic and sacroiliac joint pain
• Pain after surgery, including hysterectomy

When pain lasts a long time, the pelvic floor and surrounding muscles often tighten to protect the area. Over time, this muscle guarding can become a source of pain in itself, adding to discomfort with sitting, sex, peeing or opening your bowels.

The nervous system can also become more sensitive, so pain is felt more easily and more intensely. Pelvic floor physiotherapy can help with both, whatever started the pain in the first place.

RCOG guidance recognises that muscle and joint problems can be a main or added cause of chronic pelvic pain, and that referral to physiotherapy may be useful. Depending on your assessment, treatment may include:

• Manual therapy and myofascial release to the pelvic floor, tummy, hips and lower back
• Pelvic floor relaxation and breathing techniques
• Graded exercise and movement to rebuild strength and confidence
• Pain education, to help you understand and calm a sensitised nervous system
• Pacing and flare-up strategies for work, exercise and daily life

Flare-ups are common with long-term pain, and having a plan can make them easier to manage. These may help:

• A hot water bottle or heat pad (not too hot) on your tummy or lower back
• Pelvic floor relaxation and slow breathing to ease muscle guarding
• Gentle movement, such as walking or stretching, rather than staying still
• Pacing, balancing activity and rest rather than pushing through and then crashing
• Prioritising sleep where you can

Olivia can help you put together a personal flare-up plan.

Your first appointment lasts 60 minutes and takes place in a private, judgement-free room at our Clapham clinic. Olivia will:

• Talk through your symptoms, cycle, bladder and bowel habits, any diagnosis or treatment so far, and your goals
• Assess your posture, breathing, movement and tummy
• With your consent, carry out an internal examination to check for pelvic floor tension and tenderness. It’s always optional and fully explained beforehand
• Explain what she has found and agree a treatment plan with you

See your GP if you have pelvic pain that keeps coming back or doesn’t go away, so they can look for causes that need medical treatment.

The NHS advises getting urgent help if pelvic pain comes with a high temperature, blood in your pee or poo, unusual vaginal discharge or difficulty peeing or pooing, or if you could be pregnant. Call 999 or go to A&E if the pain is severe and getting worse, you feel faint or dizzy, or you have heavy vaginal bleeding.