Pelvic Pain: Causes, Symptoms & When Physical Therapy Can Help
Pelvic pain can be debilitating and often feels like a silent struggle. Many people arrive at our clinic after seeing multiple providers, often dismissed and without answers or relief for an average of five years. Pelvic pain is complex, and many providers lack a full understanding of its underlying causes, frequently offering medications or birth control without addressing musculoskeletal or neurological factors. Effective care often requires a multidisciplinary approach, including physicians, mental health providers, and physical therapists. Although 1 in 10 people experience pelvic pain, it is not normal and affects all genders. At Summus, we take a whole-body approach to identify root causes, provide individualized care, and connect you with a trusted referral network to help you find lasting relief and better manage your symptoms.
What Is Pelvic Pain?
Pelvic pain can be classified as pain in any of the muscles attaching onto the pelvis including the groin muscles, the lower abdominal wall, and the pelvic floor. The experience of pelvic pain varies, and is not identical in any two people. Pelvic pain can feel sharp, dull, stinging, burning, or aching, and can refer to the low back, hips, or the abdomen. It can be acute lasting for a couple of weeks or more persistent or chronic lasting more than 3 months. Because the pelvis has several muscle attachments, it can feel confusing where the pain is coming from, especially because pain from one muscle can refer to the area of another muscle. Pelvic pain is often a symptom rather than a diagnosis. It gives us information about strength of the surrounding muscles, how pressure is being managed, and the nervous system’s response to stress and pain processing. Pelvic pain often presents alongside other types of diagnoses such as endometriosis, polycystic ovarian syndrome, constipation, and urinary incontinence (just to name a few).
Common Causes of Pelvic Pain
Pelvic pain can come from many different sources, including muscles, organs like the bladder or uterus, and even the nervous system. The pelvic floor muscles work closely with your hips, core, and surrounding muscles, so problems in one area can affect another. Pain may be caused by muscle weakness or tightness, conditions like endometriosis or fibroids, or even stress and trauma affecting the body. Because there are so many possible causes, it’s important to look at the whole picture. A pelvic floor physical therapist at Summus Rehabilitation can help identify what’s contributing to your pain and guide you through a personalized plan to feel better.
Pelvic Pain in Women
Endometriosis
Endometriosis is a condition where uterine tissue grows outside of the uterus and can be a significant cause of pelvic pain. It can contribute to significant overactivity, trigger points, scarring and inflammation in the pelvic floor and pelvis. Pelvic floor physical therapy can help manage the pain of endometriosis by addressing musculoskeletal and neurological effects of the condition.
Pelvic floor overactivity
Pelvic floor overactivity is when the pelvic floor muscles are shortened or “tight.” This can be caused by various factors including upregulation of the nervous system from stress or trauma (physical and emotional), weakness of the surrounding muscles, posture, breathing mechanics, pregnancy, and conditions like endometriosis. A pelvic floor evaluation can help understand and address these causes and develop a plan of care that meets your needs.
Low back pain
Low back pain is an incredibly common condition with one of the highest disease burdens in the United States. Low back pain can have several causes including pelvic floor overactivity, weakness in pelvic muscles including glutes and hips, and difficulty with pressure management mechanics and breathing. A pelvic floor evaluation can help get to the bottom of what might be causing your pain and create a plan to address it.
Constipation
Constipation is a frequent but often overlooked cause of pelvic pain. Straining while emptying, incomplete bowel emptying, and chronic gastrointestinal dysfunction and pain can increase demand on the pelvic floor muscles, leading to discomfort, tension, and pain throughout the pelvis. A pelvic floor physical therapist can help address causes of constipation, discuss bowel emptying techniques, improve abdominal discomfort, and decrease pelvic pain.
Pelvic Pain in Men
Pelvic pain in men is more common than many realize, yet it is often overlooked or misunderstood. Prostate cancer affects 1 in 8 men, and many undergo a prostatectomy (removal of the prostate) as part of treatment. After surgery, individuals may experience urinary incontinence and/or pelvic pain related to scar tissue and the healing process. Prostatitis, or inflammation of the prostate, is another common condition that can contribute to pelvic pain.
Both prostatectomy and prostatitis can significantly impact the pelvic floor muscles, often leading to tightness, overactivity, and trigger points. Symptoms may include urinary or fecal leakage, erectile dysfunction, pelvic pain, or low back pain.
Despite strong evidence supporting pelvic floor physical therapy, men are less likely to be referred for this care. At Summus, we provide comprehensive pelvic floor evaluations and individualized treatment to support recovery and improve quality of life.
Musculoskeletal and Pelvic Floor Pain Causes
Many cases of pelvic pain involve the muscles, joints, nerves, and connective tissues of the pelvis. Pelvic floor dysfunction can occur when the pelvic floor muscles are weak, poorly coordinated, overly tense or guarded, and/or from a traumatic experience. Pelvic floor muscles work in a system with muscles of the pelvis including glute muscles, hip muscles, and abdominal muscles, and thigh muscles. When these muscles are not working together to meet the demands of your everyday life, this can contribute to pelvic floor dysfunction and pain.
Pelvic floor spasms and chronic muscle tension may cause sensations of aching, cramping, burning, or sharp pain in the pelvis or may refer pain into the buttocks and the lower abdomen. Pudendal neuralgia is a common pelvic pain condition that occurs when the pudendal nerve, the nerve that innervates the pelvic floor muscles, becomes compressed, causing pain, burning, sensitivity, or even numbness in the pelvic region. Other times pelvic floor spasms and tension can cause abdominal pain, urinary or fecal leakage, pain or lack of sensation with intimacy, or pelvic organ prolapse. At Summus, we will complete a comprehensive pelvic floor evaluation to identify contributing factors to your pain and develop a thorough plan of care to address your individualized needs.
Digestive and Urinary Causes
Digestive and urinary conditions like irritable bowel syndrome (IBS), constipation, painful bladder syndrome/ interstitial cystitis, urinary urgency, and frequent urinary tract infections can contribute to and coexist with pelvic pain. Symptoms may include bloating, cramping, burning, sharp pain, aching pain, and difficulty with bowel and/or bladder emptying. When these organs are experiencing dysfunction, the surrounding muscles of the pelvis, including the pelvic floor, will contract and guard to help protect against the pain. Oftentimes this muscle guarding can create increased tension and trigger points in the muscles that contribute to pelvic pain. At Summus, we specialize in pelvic floor physical therapy that can successfully address the musculoskeletal and neurological components of pain, improve bowel and bladder habits, discuss nutrition, and improve overall function and quality of life.
What Does Pelvic Pain Feel Like? Recognising the Symptoms
Pelvic pain can present differently from person to person. Symptoms may develop suddenly or gradually, remain constant, or come and go depending on activity, stress levels, bladder and bowel function, or hormonal changes.
Common pelvic pain symptoms include:
Sharp or stabbing: Intense pain that may occur with movement, exercise, bowel movements, urination, or intimacy.
Aching or dull pain: A persistent soreness or heaviness felt in the lower abdomen, pelvis, low back, hips, or vulva, or perineum.
Pelvic pressure: A sensation of fullness, heaviness, crowding, or downward pressure within the pelvis that can worsen with prolonged activity or after a long day.
Burning pain: Often associated with nerve entrapment or compression, fascial restriction, or overactive pelvic floor muscles.
Cramping or spasms: Involuntary muscle tightening that can create intermittent pain or discomfort. This can happen at any time of your cycle, not just during menstruation, but is frequently exacerbated by menstruation or other abdominal or bladder conditions.
Tailbone pain: This can happen after a fall or an injury to the pelvis. Pain may worsen with sitting for long periods or with laying on the back. Most muscles of the pelvic floor attach onto the tailbone, and trauma to this region can cause muscles to guard and become overactive.
Recognizing these symptoms is an important first step toward identifying potential causes and seeking appropriate evaluation and treatment.
Pelvic Pain During and After Sex
Pain during or after intimacy or sex is one of the most common yet least discussed symptoms of pelvic floor dysfunction. Many people delay seeking help because they feel embarrassed, assume the pain is “normal”, or worry their pain will be dismissed or not taken seriously. Pain may occur with deep penetration, insertion, external stimulation, orgasm, or several hours after intimacy. It can feel sharp, burning, cramping, aching, or like pressure deep in the pelvis. Furthermore, this can affect all genders and not just women.
Common contributors include pelvic floor muscle guarding or overactivity, endometriosis, scar tissue, nerve compression, vaginal dryness, or hormonal changes either postpartum or with perimenopause and menopause. Our physical therapists will perform an evaluation and help determine whether the muscles are contributing to your pain. Many people are surprised to learn that treatment may involve far more than exercises, it may often include muscle relaxation work, manual therapy, breathing and movement retraining, postural exercises, and strategies for gradually returning to comfortable intimacy.
Pelvic Pain After Birth and Postpartum
Pelvic pain in the postpartum period is common, but it is not normal. During pregnancy and birth, the pelvic floor muscles and surrounding tissues undergo significant stress. Some individuals develop muscle guarding or overactivity during pregnancy, while others experience tearing during delivery. After birth, the pelvic floor must heal and rebalance with the surrounding muscles to restore support, posture, and pressure management.
Hormonal changes also play a key role. Relaxin increases ligament laxity, requiring muscles to work harder to stabilize the pelvis, often leading to imbalance and pain. Postpartum, especially during breastfeeding, lower estrogen levels can impact tissue elasticity and healing.
Additionally, all individuals who carry to full term develop some degree of abdominal separation (diastasis recti), which may persist without proper rehabilitation.
At Summus, we take a whole-body, individualized approach to identify the specific drivers of your pain. You do not have to “push through” or simply “bounce back”—we help you return to movement and daily life feeling strong, supported, and pain-free.
Pelvic Pain When Sitting, Walking, or Moving
Many people notice that pelvic pain gets worse in specific positions or with certain activities. Pain with sitting is often associated with pelvic floor muscle tension, tailbone or coccyx dysfunction, pudendal nerve irritation, or low back pain. Pelvic pain with walking, stairs, running, or rolling in bed may point toward involvement of the hips, sacroiliac (SI) joints, pubic symphysis, or abdominal wall, and/or the body’s inability to properly coordinate muscles during the activity resulting in pain.
When movement changes pain, it is a sign that the musculoskeletal system is a contributing factor to pain. Rather than focusing only on the location of symptoms, a pelvic floor physical therapy assessment looks at posture, breathing mechanics, pelvic floor muscle function, lower body strength, gait, mobility, and movement patterns to identify the true driver of symptoms.
Targeted treatment may include manual therapy, movement retraining, progressive strength training, breathwork, and activity modifications that help you return to sitting, walking, exercise, and daily activity with less pain.
When Should You Be Worried About Pelvic Pain?
Most pelvic pain is not a medical emergency, however, there are some symptoms that may call for urgent or emergent care. Some “red flags” that warrant urgent medical care include:
Severe and sudden-onset pain that is significantly different from your usual symptoms
Heavy vaginal bleeding, especially during pregnancy
Fever with pelvic pain
Inability to urinate
Severe abdominal swelling or pain
Persistent vomiting
Inability to feel yourself wipe when using the bathroom
Many people worry that pelvic pain may be caused by cancer. While this is possible, it is not the most common cause. Cancers affecting the pelvic region are often accompanied by additional symptoms such as abnormal bleeding, unexplained weight loss, persistent bloating, or changes in bowel or bladder habits. Pain related to cancer also tends to remain constant and not change with movement or position.
For most individuals, pelvic pain lasting more than 2–4 weeks or interfering with daily life deserves evaluation. At Summus, we take a whole-body approach to identify musculoskeletal contributors and guide you toward lasting relief.
How Is Pelvic Pain Diagnosed?
Diagnosing pelvic pain usually involves combining history, physical examination, and targeted testing. Medical doctors will rule out other medical conditions with ultrasound, MRI, urodynamic testing, and urinalysis. If these tests show up dysfunctional or normal, your physician will refer you to a physical therapist to address the musculoskeletal and neurological component of your symptoms. Your PT will ask about the pain’s location, quality (sharp, burning, pressure, cramping), timing, triggers, menstrual or pregnancy history, bowel and bladder habits, sexual function, history of surgeries, injuries, and previous treatment.
During at PT initial evaluation, a pelvic assessment may take place involving one finger inserted into the vaginal or rectal canal. This can help to assess the quality and resting activity of the pelvic floor muscles, strength, pressure management, assessment of prolapse, and reproduction of pain. Next, a back, hip, and pelvic assessment will take place to understand where your pain may be coming from, whether it is your hips, low back, or pelvis that may be driving pain. This assessment will involve strength testing and looking at functional movement patterns as well.
Once information has been collected from various exams, your physical therapist will determine what may be driving your pain and what your treatment plan will include. At Summus, we will communicate with other members of your medical team to ensure everyone is in the loop with your care.
How Physical Therapy Can Help Pelvic Pain
Pelvic floor physical therapy is one of the most effective, and often underutilized, treatments for pelvic pain when the source is musculoskeletal or when pelvic floor dysfunction is contributing to symptoms. The goal is not simply to “strengthen the pelvic floor”. In many people with pelvic pain, the first priority is improving muscle relaxation, coordination, pressure management, breath coordination, movement tolerance, and nervous system sensitivity.
A typical evaluation includes a detailed history plus external assessment and, if you consent, internal assessment of pelvic floor muscles. An internal exam is never required, however, it is one of the best ways to evaluate and treat the pelvic floor. Treatment may include manual therapy to address muscle tension, trigger points, scar tissue, and connective tissue restrictions. It can also include neuromuscular re-education to restore healthy pelvic floor coordination, breathing and pressure-management, and rehabilitation to address the muscle attachments of the pelvis including the glutes, hips, and abdominal wall. It will consist of practical and individualized exercises and strategies to take home to be able to address pain in a guided manner.
Persistent pelvic pain is not something you have to simply live with. A thorough assessment with a pelvic floor physical therapist at Summus can identify modifiable contributors, and many people improve significantly with targeted rehabilitation that helps them return to the activities, relationships, and goals that matter most.
Pelvic Pain Exercises
People often search for “pelvic pain exercises,” but the right exercises depend on what is causing the pain. In some cases, a combination of mobility, breathing, nervous system downtraining or relaxation, and hip or glute strengthening can be helpful. In those with a hypertonic or overactive pelvic floor, aggressive strengthening or repeated kegels, or pelvic floor contractions, may actually worsen symptoms.
For that reason, we recommend exercises guided by a pelvic floor physical therapist rather than a one-size-fits-all routine that may not be addressing the source of the pain. A therapist at Summus can determine whether you need relaxation, coordination training, graded loading, scar mobilization, pressure management exercises, or progressive strengthening, and then build a program around your symptoms and goals.
Frequently Asked Questions About Pelvic Pain
What is the most common cause of chronic pelvic pain?
There is no single most common cause for every population, but pelvic floor dysfunction is one of the most frequent and under-recognized contributors to chronic pelvic pain. Gynecologic, urologic, gastrointestinal, musculoskeletal, and nerve-related conditions can also play a role, and many people have more than one contributing factor. Other factors may be a traumatic event such as a fall, broken bone (pelvis or hip), post surgery pain, and significant emotional and mental stress contributing to pelvic floor muscle dysfunction and tightness.
How long is too long to have pelvic pain?
Once pelvic pain lasts more than a few weeks, recurring repeatedly, or interferes with daily life, it is likely time for a professional evaluation from a pelvic floor physical therapist. Please do not wait months for symptoms to become “severe enough” before seeking assessment! If other providers dismiss your symptoms of pelvic pain, please reach out a physical therapist specializing in pelvic pain because they can help you address the pain and refer you to their trusted network of providers so that you can feel better as quickly as possible.
What are the red flags for pelvic pain?
Red flags include sudden severe pelvic or abdominal pain, heavy bleeding during pregnancy, fever with severe pelvic pain, inability to urinate, persistent vomiting, unexplained weight loss, or a new pelvic mass. These symptoms warrant an emergent evaluation by a medical doctor because they may indicate a more serious condition.
Can physical therapy help pelvic pain?
Yes absolutely, especially when the pain has a musculoskeletal or pelvic floor component. Pelvic floor physical therapy can address muscle overactivity or weakness, scar tissue restrictions, movement dysfunction, pressure-management problems, strength training, and is supported by significant evidence for many pelvic pain conditions. Pelvic floor physical therapy is very effective in treating pelvic pain!
What makes pelvic pain go away?
The most effective treatment depends on the cause. A combination of pelvic floor physical therapy, movement and exercise rehabilitation, medical treatment for underlying conditions, medication, and stress management can all help eliminate and manage pelvic pain. Identifying the specific contributors is usually more important than trying generic pelvic pain exercises or treatments on your own.
Ready to find answers? Book a pelvic pain evaluation at Summus Rehabilitation.