Maybe this sounds familiar. You have sat in more waiting rooms than you can count. The scans are clear, the tests for infection are negative, and still there is the ache, the burning, the feeling that you cannot sit through a long meeting or the drive to the coast. It is not something you can easily explain to a colleague, so mostly you say nothing at all.
A hidden and very real kind of pain
Chronic pelvic pain is pain in the lower abdomen, pelvis or genital area that lasts for months. It affects both women and men. It can be linked to a known condition, such as endometriosis, a bladder condition or an irritated nerve. In many people, though, it carries on even when no ongoing infection or tissue damage can be found.
That does not make it imaginary. It may mean that the pain is being maintained by the way muscles and nerves are behaving, which standard tests are not designed to show. Because the area is so private, people often wait a long time before asking for help, and they often feel ashamed. There is no need for shame. This is a health problem like any other.
See your doctor first
A proper medical assessment always comes first. Pelvic pain has many possible causes, and some of them need specific treatment from a GP, gynaecologist, urologist or other specialist. Neurofeedback should never be used in place of that assessment.
Seek urgent medical attention if you have:
- Sudden, severe pelvic or abdominal pain
- Pain with fever, vomiting or feeling very unwell
- Heavy or unexpected bleeding, or pain during pregnancy
- Blood in your urine or stool
- Sudden, severe pain in a testicle
- Numbness between the legs, or new loss of control of your bladder or bowel
Once serious causes have been dealt with or ruled out, treatment often involves a team. Pelvic floor physiotherapy is often an important part, along with medical treatment, pain education and psychological support.
How the body learns to hold on
The pelvic floor is a sling of muscles at the base of the pelvis that supports the bladder, bowel and reproductive organs. Like the jaw and the shoulders, it can tighten when you are frightened, anxious or in pain. This is automatic. It is part of the body's protective response, linked to the sympathetic nervous system, which is the fight-or-flight side of your automatic wiring.
Trouble starts when the muscles stay tight for months. Tight muscles become sore and tired. Sore muscles send more pain signals. Pain makes you guard even more. The loop can keep running long after whatever first set it off, whether that was an infection, an injury, surgery, childbirth or a long period of stress.
There is a second layer. When pain signals keep arriving for a long time, the spinal cord and brain can become more sensitive to them. The name for this is central sensitisation. It is often described as a volume control that has been turned up and left there. Signals that would normally be mild may be felt as strong.
This may be part of why chronic pelvic pain so often travels with poor sleep, anxiety, low mood and exhaustion. Our article on fibromyalgia and central sensitisation explains this volume control in more detail.
Pain that outlasts its original cause is not weakness. It may be a protective system that has not yet learnt it is safe to stand down.
Where neurofeedback may help
Neurofeedback is a non-invasive form of brain training. Small sensors are placed on the scalp, and only on the scalp, to read the brain's electrical activity. Nothing is sent into the brain. When your brain shifts towards a calmer, steadier pattern, you receive feedback through sound or a picture on a screen, and the aim is that, with repetition, the brain learns that pattern. Our guide to what neurofeedback is covers the basics.
Neurofeedback does not treat the pelvic organs or release the muscles directly. That is the work of your doctor and your pelvic floor physiotherapist. What it aims to do is help the nervous system as a whole come down from high alert, which may support sleep, soften reactions to stress and ease guarding.
There is little research on neurofeedback for pelvic pain specifically. We cannot promise that your pain will go away. Results vary from person to person.
What training looks like
Every client at our Krugersdorp practice starts with a 19-channel brain map, which takes about an hour and a half. It is a recording of how your brain is functioning at rest. Sessions last 45 to 60 minutes and begin with a short check-in on how you are feeling. You can read more on our what to expect page.
If difficult past experiences are part of your story, our article on trauma and the nervous system may be a gentle place to read further.
Common questions
Can neurofeedback cure chronic pelvic pain?
No, we cannot promise a cure. Neurofeedback does not treat the pelvic organs or muscles directly. It is a complementary form of brain training that may help an over-alert nervous system settle. The aim is for pain to feel less dominant, but the evidence is limited, results vary and medical care must continue.
Does this mean the pain is all in my head?
Not at all. The pain is real and it is felt in the body. Research into long-term pain suggests that the nervous system can become over-sensitive and keep pain going. Working with the brain is simply one way of trying to calm that system. It says nothing about your character or your honesty.
Can I do neurofeedback alongside pelvic floor physiotherapy and medication?
Yes. Neurofeedback works alongside medical treatment and physiotherapy, not instead of them. Keep taking any medication exactly as prescribed, and only change it with the doctor who prescribed it. Tell everyone involved in your care what other treatment you are having, so that everything works in the same direction.
You have probably carried this quietly for a long time. If you have been medically assessed and would like to explore whether calming the nervous system could be part of your care, you are welcome to contact Irine and ask your questions.
- chronic pelvic pain
- somatic pain
- pudendal nerve
- vagus nerve
- pelvic floor
