Pelvic pain & endometriosis

Persistent pelvic & abdominal pain

Pelvic pain is a common but overlooked and misunderstood condition. Chronic pelvic pain syndrome is defined as “the occurrence of chronic pelvic pain where there is no proven infection or other obvious local pathology that may account for the pain. It is often associated with negative cognitive, behavioural, sexual and emotional consequences as well as with symptoms suggestive of lower urinary tract, sexual, bowel or gynaecological dysfunction”(1, p2). Here we use the term Persistent rather than Chronic Pelvic Pain.

There are as many causes of pelvic pain as there are individuals suffering from it. Myofascial pain can be a cause of pelvic and abdominal pain (2-4), as can visceral issues, and the challenge is that there is an array of different factors that can trigger the development and persistence of this pain. The treatment of pelvic pain thus must address the underlying causes, if there is to be lasting effect.

Endometriosis & pelvic pain

Endometriosis affects about 6-10% of women (5). These women often suffer from pelvic pain and sensitization (6), and this can be very challenging and difficult to treat. Endometriosis involves cells from the lining of the uterus (endometrium) which end up outside the uterus, for example in the abdomen. These cells can then call local bleeding, inflammation and irritation. A challenge is that there is poor correlation between extent of endometriosis and pain. Despite this, common treatment still involves targeting the lesions through hormonal therapy or surgery. There is still much we don’t know about this condition, much we still have to learn.

Another approach to treating pelvic pain in women with endometriosis is to look at all the various factors that could impact it. There is no cure for endometriosis at present, but there are tools for treating the symptoms, and there is much you can do to manage these. A key is to understand exacerbating factors, to explore the different pieces of the puzzle that make up your specific pain situation.


1. Chaitow L, Lovegrove Jones R. Chronic pelvic pain and dysfunction. Practical physical medicine. London: Elsevier; 2012.

2. Jarrell J. Myofascial dysfunction in the pelvis. Current pain and headache reports. 2004;8(6):452-6.

3. Jones R. The contribution of pelvic floor muscles to pelvic pain. In: Fernandèz-de-las-Penas C, Cleland J, Dommerholt J, editors. Manual therapy for musculoskeletal pain syndromes. UK: Elsevier; 2016. p. 226-35.

4. Srinivasan AK, Kaye JD, Moldwin R. Myofascial dysfunction associated with chronic pelvic floor pain: management strategies. Current pain and headache reports. 2007;11(5):359-64.

5. Giudice LC, Kao LC. Endometriosis. Lancet. 2004;364(9447): 1789-99.

6. Stratton P, Khachikyan I, Sinaii N, Ortiz R, Shah J. Association of chronic pelvic pain and endometriosis with signs of sensitization and myofascial pain. Obstetrics and gynecology. 2015;125(3):719.

Jenny Wickford