Managing persistent pelvic pain

Learn about pain

You can learn about pain, for example, where it comes from, what makes it better or worse and how it affects you physically and emotionally. This will help you to take control and try different things to reduce your pain. Read more on our Learn about pain page.

Stay active

Physical activity is an important part of staying healthy. But many people who have persistent pelvic pain avoid moving, as they fear it will make their pain worse. Even low-impact activity, such as swimming or walking, can help to reduce your pain sensitivity. Discuss a tailored physical activity plan with your healthcare team.

Stretching and yoga

Mind-body practices, like yoga and stretching, can help you manage your pelvic pain.

If you have pelvic pain, your muscles may become tense – particularly your pelvic floor, abdominal and hip muscles. When your muscles stay tight, it can lead to painful muscle cramps.

A pelvic floor physiotherapist can recommend different exercises to help you relax and coordinate your pelvic floor muscles, and gentle stretches for your stomach and muscles on the outside of your pelvis. These exercises can also reduce pain and may improve bladder, bowel and sexual function. Read the Pelvic Pain Foundation of Australia fact sheet about easy stretches to relax the pelvis.

Yoga or guided relaxation exercises can reduce tension in other areas of your body, which may also reduce stress and pelvic pain.

Pace yourself

Pacing means doing enough physical activity to improve your pain without causing a pain flare. It’s a fine balance – and it may take time to learn your limits. It can be helpful to keep track of your activities and responses to see if you can find where your limits are. This approach will help you manage your energy and pain levels in the long term.

When you have learnt to pace yourself, you will be able to gradually increase your activity. It’s important to note how increases in activity affect your pain. Keep in mind there may be some discomfort if you work muscles you haven’t used for a while. This is normal and shouldn’t stop you from doing these activities. The soreness will reduce as your muscles get stronger.

You can pace yourself by:

• doing activity for shorter periods and resting regularly
• setting a timer for a few minutes before you expect to feel pain, and resting when it goes off before starting again
• limiting your efforts to about 80% and gradually increasing this by 10% each week, continuing to take regular breaks
• focusing only on activities that are important to you, so you don’t use up too much energy.

If you are having a good day, don’t be tempted to overdo it.

You shouldn’t experience pain flares during this process. An increase in discomfort that goes away after 30 minutes is normal. You may have muscle soreness for a day or so – this is not a pain flare.

It can be helpful to work with a physiotherapist or exercise physiologist while you are learning how to pace yourself. If you fear that movement will make your pain worse, talk to your physiotherapist or a psychologist or counsellor.

Eat well

The food you eat may influence your persistent pelvic pain. A dietitian can help you develop a plan, especially if you have a condition like irritable bowel syndrome (IBS) or painful bladder syndrome that may be affected by the food you eat. Research suggests an anti-inflammatory diet can help reduce persistent pain levels.

Try to eat more: fish; lean meat; eggs; vegetables; fruit; potatoes; raw nuts and seeds; coffee and tea; extra virgin olive oil.

Try to eat less: refined sugars; red meat; processed meats; processed foods like biscuits and cakes; food preservatives; fatty acids (found in some oils).

You will also benefit from limiting alcohol intake and drinking more water.

Read more about the anti-inflammatory diet.

The following links provide more information about different diets and healthy eating for certain conditions:

• Endometriosis and natural therapies
• Living with endometriosis
• Dietitans Australia: Irritable bowel syndrome (IBS)
• Monash University: FODMAP diet to help manage IBS

Good bowel habits

Good bowel habits are important if you have persistent pelvic pain, especially if you have irritable bowel syndrome (IBS).

You can try:

• eating foods high in fibre such as fruits, vegetables and whole grains
• eating breakfast
• drinking 6 to 8 glasses of water (1.5 to 2 litres) each day
• doing regular physical activity
• not straining or rushing when doing a poo.

It’s also important to have the right posture when doing a poo. Try:

• leaning forward with a straight back
• placing your forearms on your thighs
• raising your feet slightly if possible (a footstool can help)
• letting your stomach muscles relax and flop forward
• relaxing and ‘letting go’ of your pelvic floor muscles
• breathing normally.

These habits can help you to do soft poo so you don’t need to strain. This will reduce pressure on your pelvic floor muscles and supportive structures.

Look after your emotional wellbeing

Persistent pelvic pain can affect your emotional wellbeing. It can cause stress, anxiety, depression, problems with your sleep, sexual dysfunction and strained relationships. You can talk to a counsellor or psychologist about ways to look after your emotional health and manage pain. And you can try different strategies to care for your body and mind.

Stress management

When you are stressed, your body releases chemicals that are similar to the ones released when you feel pain. These chemicals can ‘turn up the volume’ on your pain and make it worse. Learning how to reduce and manage stress is an important part of managing persistent pain.

Sleep

It can be hard to get a good night’s sleep when you have persistent pelvic pain, but there are practical things you can do to improve your sleep and quality of life. For example:

• Cognitive behavioural therapy for insomnia (CBT-I) – Learn to focus on how you think, feel and act when it comes to sleep. Stimulus control is an important part of CBT-I. Stimulus-control strategies help you associate being in bed with feeling sleepy and ready for bed (e.g. no electronic devices in bed before going to sleep). Your doctor, psychologist or sleep specialist can give you more information about CBT-I.
• Relaxation strategies – Try deep breathing, progressive muscle relaxation, mindfulness and meditation.
• Good sleep habits – Change your environment and routine to improve your sleep (e.g. make sure your room is dark, and limit fluids before bed).
• Melatonin – Research shows that melatonin supplements may help reduce the time it takes to get to sleep, and improve sleep quality and duration. Before taking melatonin (or any other supplements) it’s important to tell your doctor, as this may affect other medicines.

You can also try different apps and digital programs. For example:

• guided meditation and mindfulness apps, such as Smiling Mind.
• digital CBT-I programs, such as This Way Up and A Mindful way.

For more information, read the Jean Hailes Persistent pelvic pain and sleep fact sheet and visit the Sleep Health Foundation website.

Relationships

Persistent pelvic pain can make you feel emotionally drained and withdrawn. It’s important to seek support from people close to you. It can be helpful to talk to your friends or family about your pain. Find ways to connect that work for you (e.g. a phone call).

If you have a partner, they might not understand what you’re going through. You can tell them about your pain, what causes it and what makes it better. If your pain is affecting your sex life, try to communicate openly with one another. A psychologist, sex therapist or relationship counsellor can help.

Practical ways to manage your pain

There are many practical things you can do to help manage your pain.

Heat packs

Warm baths and heat packs can provide relief from cramping and muscle spasms.

Massage therapy

Massage therapy can relieve tightness and pain in soft tissues, whether it be targeted treatment or massage for relaxation. Massage therapy has also been found to relieve pelvic pain for people with endometriosis. Research suggests that massage can increase your awareness of your body and where you hold tension. This can help you make changes that will result in less muscle tightness, less stress and reduced pain.

Breathing exercises

Deep breathing (belly breathing) brings more oxygen into your body and slows your heart rate. It can help you relax your pelvic floor muscles and other muscles in your body. When you focus on your breath, it can distract you from unhelpful thoughts and sensations such as pain.

How to deep breathe

1. Find a quiet, comfortable place to sit or lie.
2. Breathe in slowly through your nose.
3. Allow your chest and lower belly to rise while you breathe in.
4. Let your belly fully expand as it fills with air.
5. Slowly breathe out through your mouth.

You can also focus on calming images or a word that helps you relax while you practise your deep breathing.

Transcutaneous electrical nerve stimulation (TENS)

A TENS machine is a small, battery-operated device with sticky pads called electrodes. These electrodes are attached directly to your skin. When the machine is turned on, it sends small electrical impulses to the pads. This causes a tingling feeling. TENS changes the signals that go to the spinal cord and brain. It also helps the body release endorphins, which are the body’s natural pain relievers.

Related resources

Download our fact sheets or visit resources for more information.

Useful websites, online programs and apps

These websites may help you learn more about pain and different coping strategies:

• Pelvic Pain Foundation of Australia: information for women and People Assigned Female at Birth
• Pelvic Pain Foundation of Australia: Introduction to Pelvic Pain by Dr Susan Evans
• Pain Australia: What is pain?
• Tame the Beast: It’s time to rethink persistent pain
• Pain revolution
• MindSpot - Chronic Pain Course

You can also try these online programs and apps for pain:

• Curable App
• This Way Up Chronic Pain Program

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at May 2023.