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Pelvic Pain: Causes, Prevention, Treatment, and Best Exercises

What’s making your pelvic area hurt? Learn about causes of female pelvic pain, prevention, treatment, and exercises from pelvic floor physical therapists.

Published Date: Feb 9, 2023
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Pelvic pain, or pain in the lower abdomen, is common in women and can have many causes. It’s important to find out what’s causing your pain so you can treat it and start feeling better.

Your pelvic area houses some of the most important organs in your body, like the ones that help you digest your food and eliminate waste. It’s also where the organs of the female reproductive system are found — your ovaries, uterus, and fallopian tubes. With everything that’s going on in your pelvic area, it’s understandable to be concerned when you have pelvic pain, especially when it interferes with your daily activities and takes a toll on your quality of life. 

While there are many common conditions that can cause pelvic pain (like appendicitis and kidney stones), there are some that are unique to women and people born with vaginal anatomy. 

Here, learn more about what causes pelvic pain in women, and how to prevent and treat it — especially with exercises from our Hinge Health pelvic floor physical therapists.

Our Hinge Health Experts

Jeni Sepe, PT, DPT
Pelvic Health Physical Therapist
Dr. Sepe is a Hinge Health physical therapist with a focus on women's health (specifically pregnancy and postpartum care).
Tamara Grisales, MD
Expert Physician in Urogynecology and Medical Reviewer
Dr. Grisales is a board-certified urogynecologist and surgeon and oversees the Women's Pelvic Health program at Hinge Health.
Kandis Daroski, PT, DPT
Pelvic Health Physical Therapist and Clinical Reviewer
Dr. Daroski is a pelvic health physical therapist who provides clinical expertise for the Hinge Health Women's Pelvic Health Program.

What Is Pelvic Pain?

Pelvic pain is any pain in your lower abdomen between your belly button and your groin, or pelvic area. Acute pelvic pain can be sudden and usually lasts for a short period of time. It can also come and go with your menstrual cycle, sex, or other activities. Chronic pelvic pain is when symptoms last six months or more. 

Pelvic Pain Symptoms

Your pelvic area includes many organs, muscles, and other structures, which can make it hard to pinpoint the exact location of (or cause) your pain. Pelvic pain can vary in intensity and includes many different types of pain. Symptoms can include:

  • Sudden onset of sharp, localized abdominal pain

  • Pain in your lower abdomen that spreads out across a wide area

  • Pain that builds slowly and doesn’t go away

  • Dull ache or pressure

  • Cramping or throbbing that’s constant or comes and goes with your menstrual cycle

  • Pain with movement or activities like urination, sex, or inserting a tampon

  • Twisted or knotted sensation

Severe pelvic pain in women can be a sign of a serious medical condition. If your pain is severe or occurs with other warning signs (see the When to See a Doctor section below), you should see your provider to rule out serious conditions.

Pelvic Pain: A Hinge Health Perspective 

Whether you know what’s causing your pelvic symptoms or not, pelvic pain can be scary and overwhelming. If you’re feeling overwhelmed by all the symptoms and causes (which we’ll discuss below), here’s the good news: Pelvic pain is very treatable. Many people significantly improve their symptoms with lifestyle changes and exercises that target the muscles of the pelvic floor and other connected structures. Just know this: Whatever your symptoms are, you're in the right place to get the support you need.

Causes of Pelvic Pain

Many conditions can cause pelvic pain and other bothersome symptoms in women and people born with vaginal anatomy. Some — like appendicitis, kidney stones, and gastrointestinal issues like constipation — can affect both men and women. Pelvic pain in women can have more than one cause, but it is often related to problems with your reproductive organs. Here are some of the most common causes of pelvic pain that are unique to women:

Your Menstrual Cycle

Menstrual cramping is the most common type of pelvic pain in women. It can feel like a muscle spasm or a dull ache and is often accompanied by backache. Menstrual cramps occur when your uterus contracts and sheds its lining. Cramps are usually most severe at the beginning of your period. Over-the-counter medications and home remedies like heating pads are often effective for this type of pain. Hormonal birth control can also make your periods lighter and less painful. 

Ovarian cysts are fluid-filled sacs on the surface of an ovary. The most common type occurs when your ovary fails to release an egg at ovulation and a cyst forms around it. Cysts can cause pain, pressure, and sometimes bloating. Most ovarian cysts go away on their own. But some can bleed or burst, which can lead to sharp, severe pain that requires medical attention.

Painful ovulation or mittelschmerz (the German word for pain in the middle of your cycle) can occur when an egg is released from your ovary. It usually occurs on just one side of your body. It can feel sharp or dull and the pain typically goes away within a few hours.

Infections

Pelvic adhesions, or scar tissue in the pelvic cavity, can occur after an infection or surgery. Pain and other symptoms can occur when scar tissue joins tissues that are normally separate. Surgery is sometimes needed to address adhesions. 

Pelvic inflammatory disease (PID) is an infection of the female reproductive system that can involve your uterus, ovaries, fallopian tubes, and other reproductive organs. It can cause aching pain in your lower abdomen. PID can also occur with symptoms like vaginal bleeding or discharge, fever, painful sex, and urinary symptoms. PID is often caused by a sexually transmitted infection (STI) and, if untreated, can lead to infertility. 

Sexually transmitted infections (STIs) are caused by viruses and bacteria that are transmitted through sex. The type of pain depends on the type of infection. STIs can cause painful urination, breakthrough vaginal bleeding, vaginal discharge, and other symptoms.

Urinary tract infections (UTIs) are infections of the urinary system, including your kidneys, ureters, bladder, and urethra. UTIs produce symptoms like:

  • Pelvic pain, especially around your pubic bone

  • Burning and stinging with urination

  • Frequent urination

  • A strong urge that doesn’t go away after urination

  • Urine that is cloudy, strong-smelling, or contains blood

  • Fever, nausea, vomiting, chills, and back pain if the infection spreads to your kidneys

Sex and Pregnancy

Ectopic pregnancy is when a pregnancy occurs in your fallopian tube instead of inside your uterus. The fallopian tubes can’t expand with the growing pregnancy, leading to severe pain as the tube stretches. If the fallopian tube ruptures, it can lead to life-threatening bleeding. Seek medical care immediately for any severe pain during pregnancy.

Miscarriage or stillbirth is the loss of a pregnancy. Pregnancy loss is very common. As many as 26 percent of all pregnancies end in miscarriage (before 20 weeks). Stillbirth, or loss of a pregnancy after 20 weeks, is far less common. Severe cramps are a common symptom of both types of pregnancy loss, along with vaginal bleeding, discharge, and back pain. Seek medical care immediately if you have severe pain or any of these symptoms during pregnancy.

Pain with sex, or dyspareunia, can have a variety of causes. It can be related to a vaginal infection or a UTI. Some STIs can cause inflammation of your cervix, the lower part of your uterus, that can lead to pain with deep penetration. Many women have pain when resuming sex after having a baby. Painful sex can be due to thinning of vaginal tissues with menopause and a lack of vaginal lubrication. It can also be related to overly tight or inflamed pelvic floor muscles or pain related to sexual trauma.

Pelvic pain in pregnancy is common and usually not a cause for concern. Your bones, joints, and ligaments have to stretch and adjust to accommodate the growing pregnancy. Round ligament pain is a common and normal pregnancy symptom that can lead to sharp pain or pressure in the hip and pelvic area with sudden movements. Later in pregnancy, you might experience pelvic pain with Braxton-Hicks contractions. These practice contractions help your uterus prepare for the contractions of labor. See your doctor if you are concerned about any pain during pregnancy.  

Your Uterus

Endometriosis occurs when tissue that normally lines the inside of your uterus grows outside of the uterus. During your cycle, it responds to hormones like uterine tissue, so it can cramp and bleed during your period, leading to pain and inflammation. It can also cause scarring that can lead to infertility. 

Uterine fibroids are an overgrowth of muscle cells in the wall of your uterus. Fibroids can grow into the uterine cavity. They can also extend into and outside the wall of your uterus. Fibroids are usually painless and noncancerous. But they can sometimes cause pelvic pain, pressure, or backache. 

Cancer

 

Cancers of the reproductive system can occur in the cervix, uterus, ovaries, or other structures. Cancer can cause pelvic and lower back pain, painful sex, and other symptoms: 

  • A lump or swelling

  • Bloating

  • Weight loss

  • Fatigue

  • Constipation

  • Unusually heavy vaginal bleeding

  • Bleeding after menopause

  • Urinary changes

  • Changes in vaginal discharge

  • Blood in your urine

Other Pelvic Pain Causes

Irritation of nerves in your pelvis can occur after an injury or as a result of pressure or inflammation. Nerve irritation can produce many different types of pain, but often feels like burning, stabbing, or shooting pain.

Ovarian torsion, or a twisted ovary, can occur when your ovary becomes twisted around a ligament or other connecting tissues. The twisting can cut off the blood supply to your ovary and cause severe pain. Ovarian torsion requires immediate treatment to prevent the loss of your ovary.

Pain related to stress or psychological trauma. There is a strong correlation between pelvic pain, stress, and sexual trauma. And pelvic pain from other causes can be complicated by stress and trauma. If you have experienced sexual trauma, talk to your healthcare provider about seeking mental health or counseling care.

Pelvic organ prolapse can occur when your pelvic floor muscles and other tissues in your pelvis weaken. This can allow organs in your pelvis to move from their original position and put pressure on other structures. While prolapse isn't typically painful, it can cause pelvic pressure and heaviness. As many as 50% of women have some degree of prolapse. It's more common among older women who have given birth and people with a family history. 

Issues with muscles and ligaments in your pelvic floor. Your pelvic floor is made up of layers of muscles, ligaments, and fascia (connective tissue). These tissues stretch from your pubic bone in front of your body back to your tailbone in the back. Your pelvic floor muscles can become tight, inflamed, weak, or stop working as they should. This can lead to pelvic pain, painful sex, and urinary issues like incontinence, or leaking urine. 

Vulvodynia is pain, burning, or irritation of the area around your vagina, or vulva, without a clear cause. It can be constant or can occur only with touch or pressure. 

When to See a Doctor

Many causes of pelvic pain in women are not serious, but some conditions require immediate care. See your doctor if your pain is severe or doesn’t go away after several days. See a doctor if you notice pain with any of the following:

  • Foul-smelling or bloody urine

  • Foul-smelling vaginal discharge

  • Heavy or irregular vaginal bleeding

  • Difficulty or pain with urination

  • Difficulties with bowel movements, including constipation, diarrhea, gas, and bloating, or rectal bleeding

  • Hip pain

  • Signs of an infection, including fever, chills, nausea, and vomiting

“It can be hard to know if pelvic pain is serious. In most cases of mild pain, it’s probably not,” says urogynecologist Tamara Grisales, MD, an expert physician at Hinge Health. “If you have severe pain, irregular bleeding, or other red flag symptoms and your pain doesn’t respond to simple measures, it’s important to see your doctor for an exam. They can help you decide if more testing or any treatment is needed.”

Diagnosing Pelvic Pain

Pelvic pain can be difficult to diagnose. Your provider will start with your symptoms, medical history, and a physical exam. They may ask:

  • When did your pain start?

  • Where is your pain located?

  • What’s the severity or nature of your pain (sharp, aching, dull, etc.)?

  • When does your pain occur (menstrual cycle, urination, sex)?

  • For how long have you had pain?

Diagnostic tests can help your provider identify the cause of your pelvic pain. Your doctor may order tests including:

Laboratory Tests

  • Blood tests to identify an infection

  • Pregnancy tests

  • Urinalysis to screen for urinary tract infection (UTI)

  • Vaginal or cervical cultures to identify infection or signs of cancer

  • Stool samples to look for blood in your stool

Imaging

  • X-rays of the abdomen and pelvis use radiation to produce images of your bones and organs

  • Ultrasound imaging uses sound waves to create images of your internal organs

  • CT scans use X-rays to create computerized views of your bones and soft tissues

  • MRI uses a powerful magnetic field to create detailed images of your internal organs

Other Tests 

  • Laparoscopy uses a laparoscope (a thin tube with a light and a camera) inserted through your abdominal wall. The laparoscope lets your doctor see pelvic structures and look for signs of infection. 

  • Colonoscopy uses a long, flexible tube inserted through your rectum to examine your colon.

  • Hysteroscopy uses a thin, lighted scope inserted through your vagina to view the inside of your uterus.

Pelvic Pain Prevention Tips

Pelvic pain can have many causes and not all pain can be prevented. Some lifestyle habits can help reduce your chances of experiencing pelvic pain. 

  • Schedule routine examinations with your primary care provider ob-gyn to identify problems before they lead to pain.

  • Eat a nutritious, high-fiber diet. The fiber in fresh fruits and vegetables can help prevent constipation, which can worsen some pelvic pain conditions.

  • Exercise regularly to keep your joints and muscles strong and flexible. Regular exercise can also help reduce menstrual cramp intensity.

  • Practice safe sex to avoid contracting STIs that can lead to pelvic pain.

  • Urinate after sex to flush bacteria out of your urinary tract and prevent UTIs.

  • Practice stress management with breathing and relaxation exercises to keep your stress at manageable levels. 

  • Establish healthy sleep routines to make sure your body has time to rest, replenish, and heal. 

Treatment for Pelvic Pain

Treatment for pelvic pain will depend on the cause and the nature of your symptoms. The following tips from our Hinge Health physical therapists and medical doctors can provide relief for pelvic pain.

  • Medications, such as over-the-counter pain relievers and prescription medications (such as hormonal birth control) to treat menstrual cramps and endometriosis pain

  • Home remedies like heating pads, ice packs, baths, or massage

  • Lifestyle strategies like relaxation techniques and improved sleep habits

  • Behavioral modifications, including diet changes and smoking cessation

  • Mental health support, including cognitive behavioral therapy

  • Physical therapy and exercise therapy

  • Steroid and anesthetic injections

  • Surgery

Physical Therapy and Exercise for Pelvic Pain

Regular exercise and physical therapy can help prevent and treat some types of pelvic pain and other pelvic symptoms. 

Some pelvic pain conditions are caused by problems with your pelvic floor. Your pelvic floor is made up of layers of muscles, ligaments, and fascia (connective tissue) that stretch from your pubic bone in front of your body to your tailbone in the back. They can become tight, inflamed, weak, or stop working as they should. 

Pelvic floor physical therapy for pelvic pain and other symptoms is a comprehensive treatment that includes education, behavioral and lifestyle strategies, movement and exercise, and manual therapy. You can see a physical therapist in person or use a program like Hinge Health to access a PT who specializes in pelvic health via telehealth/video visit.

Depending on your symptoms, a pelvic floor physical therapist may recommend:

  • Stretching exercises to relax tense muscles and increase flexibility

  • Pelvic floor exercises

  • Whole-body exercises to strengthen areas that support your pelvic floor 

  • Bladder retraining

  • Stress management techniques

  • Nutritional changes

  • Sleep strategies

  • Other treatments, including internal massage and vaginal training devices

Many women with pelvic floor-related pain see improvement after a few weeks of pelvic floor physical therapy. Ask your doctor if pelvic floor physical therapy could be right for you. “Once your provider rules out serious conditions, consider pelvic floor physical therapy for symptoms like pelvic pain, pressure, incontinence, urinary urgency, and frequency, or painful sex,” says Jennifer Sepe, PT, DPT, a physical therapist at Hinge Health. “These symptoms can often be related to problems with your pelvic floor. The good news is that they are also very treatable — with approaches like movement, exercise, and lifestyle modifications.”

Exercises for Pelvic Pain

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Movement and exercise can be one of the most effective parts of pelvic pain treatment. Low-impact exercises stretch, strengthen, and stabilize the structures that support your pelvic floor. Exercise can increase your mobility while decreasing pelvic pain and other symptoms.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment. 

Surgery for Pelvic Pain

Surgery usually isn’t needed to address pelvic pain. Most people can get pelvic pain relief from targeted exercise, stretching, medications, lifestyle and behavioral modifications, and other conservative treatments. There are, however, some instances when surgery is advised. If pelvic pain causes you to change your daily activities or it takes a toll on your quality of life, your doctor may suggest surgery. Pelvic pain surgeries can include procedures to remove endometrial tissue, uterine fibroids, or pelvic organs and many other procedures. 

Talk to your doctor about whether you’re a good candidate for surgery. 

PT Tip: Breathing Is Key

“I can’t say enough about the power of diaphragmatic breathing to help manage pelvic pain and symptoms,” says Dr. Sepe. “It’s not a flashy or complicated exercise. It just takes time and intentional focus to target the areas of tightness and pain.” Diaphragmatic breathing can help you gradually improve the brain-body connection to those areas to address nearly all types of pelvic pain. And it can help reduce the inflammation and muscle tension that’s at the root of your symptoms. 

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

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References

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  4. Chronic Pelvic Pain. (n.d.). Retrieved from: https://www.acog.org/womens-health/faqs/chronic-pelvic-pain 

  5. Dugas, C., & Slane, V. H. (2022). Miscarriage. In StatPearls. StatPearls Publishing. 

  6. Garza-Leal, J. G., Sosa-Bravo, F. J., Garza-Marichalar, J. G., Soto-Quintero, G., Castillo-Saenz, L., & Fernández-Zambrano, S. (2021). Sexual abuse and chronic pelvic pain in a gynecology outpatient clinic. A pilot study. International urogynecology journal, 32(5), 1285–1291. doi:10.1007/s00192-021-04772-4 

  7. Armour, M., Ee, C. C., Naidoo, D., Ayati, Z., Chalmers, K. J., Steel, K. A., … Delshad, E. (2019). Exercise for dysmenorrhoea. Cochrane Database of Systematic Reviews, (9). doi:10.1002/14651858.cd004142.pub4 

  8. Bradley, M. H., Rawlins, A., & Brinker, C. A. (2017). Physical Therapy Treatment of Pelvic Pain. Physical medicine and rehabilitation clinics of North America, 28(3), 589–601. doi:10.1016/j.pmr.2017.03.009 

  9. van Reijn-Baggen, D. A., Han-Geurts, I., Voorham-van der Zalm, P. J., Pelger, R., Hagenaars-van Miert, C., & Laan, E. (2022). Pelvic Floor Physical Therapy for Pelvic Floor Hypertonicity: A Systematic Review of Treatment Efficacy. Sexual medicine reviews, 10(2), 209–230. doi:10.1016/j.sxmr.2021.03.002 

  10. Leonardi, M., Armour, M., Gibbons, T., Cave, A., As-Sanie, S., Condous, G., & Cheong, Y. C. (2021). Surgical interventions for the management of chronic pelvic pain in women. The Cochrane database of systematic reviews, 12(12), CD008212. doi:10.1002/14651858.CD008212.pub2