Another factor to consider is whether other pelvic pain conditions could be contributing to your pain.
Read more about other conditions causing pelvic pain
If you have tried all these options, have received good manual therapy, and paced your activity well and made good progress but have stopped improving and still have some PGP symptoms, you may need to accept that this is your ‘new normal’.
It may take a few years for you to reach this stage – don’t accept that “nothing more can be done” if you are only weeks or months into PGP. Adjusting to a ‘new normal’ can be helpful for you to accept your current situation and feel more liberated to plan for the future and move on.
It can be helpful to appreciate and focus on what you are now able to do rather than dwelling on the things you were once able to do that you now find difficult. However, this is a grieving process that can take time. This is something that a pain clinic or counsellor may be able to help you to explore. The Pelvic Pain Support Network holds a list of pain clinics in the UK.
Chronic or persistent pain is any injury or condition that causes pain for more than three months, and impacts on your quality of life.
To get a better idea of chronic pain, we need to understand how we feel pain.
Our brain and nervous system are responsible for how we feel pain, regardless of the cause. The longer we experience pain in one or more areas of our body, the more our nervous system can become over-sensitised. Part of recovery involves re-educating the nervous system to reduce and manage our pain. This is the similar to when we need to re-educate our muscles following injury or for conditions such as PGP. This re-education process often involves addressing the elements of the pain cycle that affect you.
Many women find that their pain improves when they start to have effective manual therapy. Others find that their symptoms continue and so they may need to actively treat their pain first with painkillers to get it under control before continuing with hands-on treatment.
In some cases, women continue to feel pain even though their pelvic joints and their muscles are working normally. This is most likely to be due to the nervous system being over-sensitised because the pain has been going on for some time. It is important to access the right care to work on all elements of the pain cycle for the best outcome (see the information below).
If you are finding it hard to cope with treatment, you can try painkillers or complementary therapies such as acupuncture to help you cope with this hands-on treatment.
When you have a chronic pain problem you can lose strength and feel tired more quickly than usual during your normal day-to-day activities. You may experience more pain because your muscles are working incorrectly, becoming shorter and tighter, or going into spasm. Many people with chronic pain start avoiding activities and exercise that make their pain worse.
This cycle continues until your pain and the underlying cause of your pain are treated. Then you can re-start day-to-day activities and exercise that you may have been avoiding. Firstly, get manual therapy for your pelvis, make sure it is functioning normally and your pain is being managed well. Then you can gradually introduce exercise to regain strength in the muscles supporting your pelvis.
The rate at which you will be able to increase this exercise may depend on how long you have had your pain and how de-conditioned your muscles have become. You will probably need to pace your daily activities to make the most of this rehabilitation process as you may tire quite quickly.
People experiencing chronic pain may also experience associated mental health problems, including:
anxiety (fear of pain and the future with pain)
depression (low mood and lack of motivation).
Mental health problems can have a huge impact on the rate at which you recover from or learn to manage your pain. It is important to talk about how you are feeling and seek the right support.
In particular, anxiety can also cause you to hold your muscles more tensely, stopping them from functioning correctly. Recognising this relationship between anxiety and stress and your muscles can help you to break this pattern.
Accessing mental health support can help you to engage in and cope with addressing other elements of the pain cycle that are affecting you and make the most of the ‘hands-on’ treatment for PGP.
Chronic pain can not only have an impact on how you cope with day-to-day activities at home or at work but also on personal relationships with your partner, family members or friends. Many women have reported that they feel a loss of independence, isolated and alone due to their physical and emotional symptoms of PGP. It can be difficult to ask for help and express how you feel but it is important to do this to help yourself and your relationships. Often partners, family members and friends feel relieved when you share how you are feeling and can understand better how they can help you.
Being overweight can put extra stress on your joints and muscles, which in the case of PGP are already stressed from working incorrectly. It can be very hard to lose weight when you have PGP as you are often unable to exercise easily, but it can help to think about what you are eating. Small changes can often make a big difference. You may be feeling less hungry due to pain.
At the same time, being underweight or skipping meals can make you more tired so maintaining a healthy balanced diet is important.
The treatment of chronic pain can be complex and need considerable input and support from many health professionals. These may include doctors, psychologists, counsellors, physiotherapists and occupational therapists. Treatment may include:
medication
physiotherapy
acupuncture
counselling
cognitive behavioural therapy (CBT)
relaxation techniques and more.
Your GP can refer you to specialist pain clinics and pain management programmes.
The Pelvic Pain Network holds a list of pain clinics in the UK.
The Pelvic Partnership was formed to help women with pregnancy-related PGP. We are strong in our conviction that PGP caused by pelvic joint dysfunction can be resolved with hands-on treatment, including manual therapy.
There are many other possible causes of pelvic pain. The healthcare professionals caring for you should consider these alternatives when diagnosing PGP.
If you have not responded to treatment for your PGP, try to keep an open mind about your symptoms and discuss possible causes of your pain with your GP.
Read more about what to do if treatment isn’t helping
Read more about other causes of pelvic pain from the Pelvic Pain Support Network
We believe that surgery should only ever be done as a very last resort once all other treatment options have proved unsuccessful. We remain unconvinced that surgery is a good option for women with PGP, even those with very severe and long-term symptoms.
We have had mixed feedback from women about surgery to treat their chronic pain:
some women had been told the only option was surgery, but then they made a full recovery with effective manual therapy
some women have had surgery for their chronic pain and were disappointed with the outcome. They said their pain had not improved, although the pelvis had been stabilised and several have said they wished they hadn’t had it done. They shared with us that either they were not aware of manual therapy or how effective it was or they had only had exercises and advice.
We encourage anyone considering this route to try absolutely everything else first. Once you have had surgery there is no going back – everything else we suggest is reversible if it is not effective, surgery is not.
We are happy to talk through your alternatives if you are considering surgery. Please call and leave a message on our helpline: 01235 820921.
The NHS Choices website also has a list of questions to consider to help you make an informed choice about surgery.
Prolotherapy is a stabilising injection treatment which may be helpful for women with the chronic pain and instability associated with PGP. In particular, it may be recommended for women who have had ongoing problems with PGP despite having courses of manual therapy from experienced and skilful practitioners, and where the joints do not seem to stay in alignment for long after treatment.
It involves the injection of an ‘irritant’ dextrose solution along with a local anaesthetic into a ligament around a joint, including the symphysis pubis, sacroiliac joints or lumbar spine. However, the average person requires around three sessions of treatment. The treatment usually entails three sets of injections with between a week and a month’s break between each set.
The effectiveness of prolotherapy treatment may vary because of the women’s different needs. The best results seem to be in women who have had their pelvic alignment checked just before and after the injections. This ensures the pelvis is in the best possible position for the ligaments to hold it in.
The procedure is supported by many hospitals in this country and abroad. A Cochrane Review in 2007 found there was conflicting scientific evidence about the effectiveness of prolotherapy. There are research reviews published online which can help you to understand the pros and cons of this procedure.
If you are considering prolotherapy, you are welcome to discuss this with our volunteers on our helpline: 01235 820921.
In some cases, people with chronic pain can have an injection to temporarily block the nerve carrying the pain messages. This can help diagnose the source of their chronic pain.
This is generally not applicable for PGP because it won’t treat the underlying cause of the problem, only the symptoms. Before considering more invasive options, it is worth checking that:
Your manual therapist may recommend a nerve block if your symptoms are very irritable.
