Pelvic Pain Toolkit
Living with pelvic pain can be exhausting, frustrating, and isolating. Whether your pain is constant or arrives in waves, it can deeply affect your work, relationships, and overall quality of life.
Your pain is real, you are not alone, and you don’t have to manage it by yourself.
In New Zealand, over one million people live with persistent pain, making pelvic pain more common than many realise.
Understanding Your Pelvic Pain
Pelvic pain is complex and often involves multiple overlapping causes. It’s common to experience different types of pain at the same time, which can make identifying the source difficult.
A key step is working with a healthcare professional to understand the different factors contributing to your pain.
Common Pelvic Pain Sources
Endometriosis
Tissue similar to the lining of the uterus grows outside it, causing inflammation, scarring, and pain. Even if you have endometriosis, other pain sources may contribute and sometimes be the main issue.
Pelvic Floor Muscle Pain
Pelvic muscles can become tight, tense, or sensitive, causing aching or sharp spasms. Conditions like pelvic floor myalgia or spasm may require physiotherapy and specific relaxation exercises.
Bladder Sensitivity
Also called Painful Bladder Syndrome (PBS) or Interstitial Cystitis (IC). This involves bladder irritation without infection and can cause pelvic pain, urgency, and frequent urination.
Bowel Sensitivity
Irritable or sensitive bowel can cause lower abdominal pain, bloating, diarrhoea, or constipation. Pain may worsen with certain foods or stress.
Nerve Sensitisation
Chronic pain can make the nervous system over-responsive, leading to neuropathic pain or central sensitisation. Even light touch can feel painful, and fatigue, nausea, and low mood are common.
Other Contributing Factors
Hormonal changes, previous surgeries, musculoskeletal issues, and psychological stress can all influence pain perception. Pain often has physical and emotional components — addressing both improves outcomes.
Building Your Toolkit: Strategies for Management
A structured approach can help you feel more in control of your pain. Think of your toolkit as a mix of self-care strategies, professional therapies, and practical adjustments.
1. Mindset & Planning
- Acceptance & Action: Acceptance doesn’t mean giving up. It means acknowledging your pain and taking proactive steps to manage it.
- Pain Flare Plan: Identify what helps when your pain spikes. This could be heat, gentle movement, medication, or relaxation techniques.
- Support Network: Build a team — include your healthcare providers, physiotherapists, mental health professionals, friends, and family. Having people who understand your condition reduces isolation.
- Track Your Pain: Use a diary or app to record pain patterns, triggers, and relief strategies. This helps your healthcare team tailor your treatment.
2. Immediate Relief Options
Heat Therapy
Warmth relaxes muscles, eases tension, and can reduce pain. Options include:
- Heat packs or hot water bottles (wrap in a towel to avoid burns).
- Warm baths or showers.
- Heated clothing or pads for long-lasting comfort.
Medication Management
- NSAIDs: Ibuprofen, mefenamic acid, naproxen, diclofenac, or celecoxib. Most effective if taken early. Always take with food and avoid combining NSAIDs.
- Paracetamol: Often complements NSAIDs, reducing reliance on stronger painkillers.
- Opioids: Reserved for short-term flares. Long-term use is discouraged due to tolerance and risk of increased pain.
- Nerve Pain Medications: Amitriptyline, nortriptyline, gabapentin, or pregabalin can calm nerve sensitisation. Usually prescribed after specialist review.
TENS (Transcutaneous Electrical Nerve Stimulation)
Gentle electrical pulses can reduce pain signals. Often used alongside physiotherapy for chronic pelvic pain.
3. Movement & Lifestyle
- Gentle Exercise: Walking, swimming, yoga, or Pilates can release endorphins, improve circulation, and prevent stiffness.
- Pelvic Floor Physiotherapy: A pelvic floor physiotherapist can teach relaxation, stretching, and strengthening techniques tailored to your pain.
- Pacing Activities: Avoid “boom and bust” cycles. Break tasks into manageable chunks and rest before pain increases.
- Posture & Ergonomics: Supportive chairs, cushions, and work setups can reduce strain on pelvic and lower back muscles.
4. Diet & Gut Health
- Identify Triggers: Keep a food diary to detect patterns. Common triggers include FODMAP-rich foods, caffeine, alcohol, and bladder irritants.
- Anti-Inflammatory Diet: Emphasise vegetables, fruit, lean protein, and omega-3-rich foods.
- Hydration: Adequate water supports bladder and bowel health.
5. Sleep & Relaxation
- Prioritise Sleep: Quality sleep restores body function and helps calm the nervous system.
- Sleep Hygiene: Keep a regular schedule, limit screens before bed, and create a comfortable sleeping environment.
- Relaxation Techniques: Mindfulness, guided meditation, diaphragmatic breathing, or gentle stretching can reduce tension and improve pain coping.
6. Mental & Emotional Wellbeing
- Cognitive Behavioural Therapy (CBT): Can help manage the emotional impact of chronic pain.
- Support Groups: Connecting with others experiencing pelvic pain provides validation and practical tips.
- Mind-Body Approaches: Yoga, tai chi, or meditation may improve coping and reduce perceived pain intensity.
7. When to Seek Professional Help
- Persistent or worsening pain despite home management.
- Pain affecting sleep, work, or relationships.
- New symptoms like heavy bleeding, fever, or urinary/bowel changes.
- Difficulty managing emotional distress.
A healthcare professional can help identify pain sources, recommend investigations, and tailor treatment plans that may include medications, physiotherapy, procedures, or surgery if needed.
This toolkit is designed to be flexible — what works for one person may not work for another. The key is to experiment safely, track your results, and adjust strategies with guidance.
Dr Sam Holford
Your Next Step: A Personalised Management Plan
This toolkit is a helpful starting point — but it can’t replace a formal diagnosis or individualised treatment plan. Let's develop a comprehensive plan tailored to your unique situation.
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