You go running for the first time in months. The next day, your legs are stiff and crazy sore. You volunteer to help your friend move and wake up the next morning with your back a little achy. When it comes to pelvic pain, however, the who-dun-it may not be so obvious. It hurts when you pee — but it’s not the tell-tale sting of a urinary tract infection. Your pelvis feels heavy and achy, but you’re not on your period. Get this: These symptoms could be a muscle thing, too. Just like your thighs and calves, the muscles in your pelvic floor can get tight or inflamed and lead to symptoms that may interfere with everyday life. And just like for other muscles, there are steps you can take to find relief. 

Read on to learn about pelvic floor pain, its symptoms and causes, and the best treatment options, including exercises and lifestyle strategies.

What Is Pelvic Floor Pain?

Your pelvic floor is a group of muscles and connective tissues that stretch like a hammock from the pubic bone in the front to your tailbone in the back. It helps hold abdominal and pelvic organs in place, such as your bladder and rectum, and plays a role in bladder and bowel control and sexual response. 

Pelvic floor pain can stem from problems with your pelvic floor muscles. If pelvic floor muscles are too tight (or hypertonic), for example, you may feel an ache with urination or bowel movements. Sustained tightness can compress or irritate nerves in the area, leading to sensations of burning or shooting pain. Pelvic floor muscles and tissues can also become inflamed, weak, or stop working as they should. Pelvic floor problems can lead to pelvic pain, painful sex, and pelvic floor disorders, such as incomplete bladder and bowel emptying, urinary and fecal incontinence (leaking pee or stool) or gastrointestinal issues, like constipation.

Symptoms of Pelvic Floor Pain 

Your pelvic area is a busy place. It includes many internal organs, pelvic muscles, and other structures, which can make it hard to pinpoint the exact location or cause of your pain. Pelvic floor pain can vary in intensity and duration. It might be a sharp pain, a dull ache, or feel like cramping. It may be constant, flare at certain times of the day or during your cycle, or come and go. Chronic pelvic pain is any steady or off-and-on pelvic pain that lasts six months or more.

“Pelvic floor pain can also radiate,” adds Lori Walter, PT, DPT, a physical therapist at Hinge Health. “It may travel up to the belly button or into the lower back. That’s one reason it’s missed — people may think they just have lower back pain.”

Signs that your pain stems from your pelvic floor include:

• Pain during urination or bowel movements

• Pain during gynecological exams

• Pain inserting or wearing tampons

• Pain during intercourse

• Pain while sitting, riding a bike, or wearing tight-fitting clothing

• Pain or heaviness deep inside your pelvis

Possible Causes of Pelvic Floor Pain

Pelvic floor pain is often related to a combination of factors, such as:

Stress. You might clench your pelvic floor when you’re anxious and increase tension in the muscles without even realizing you’re doing it, says Dr. Walter. Tight or tense pelvic floor muscles can lead to pain. 

Overuse or injury to pelvic floor muscles. Muscles taxed by constant use can produce sensations of pain. This can occur during pregnancy and childbirth, for example, when pelvic muscles have additional pressure. A trauma or injury to the pelvis can also irritate nerves in the area, which can lead to pain. 

Issues with surrounding muscles and joints. Imbalances in the strength and flexibility of muscles around the pelvis and orthopedic issues in your hips and back can contribute to pelvic floor pain.

Certain conditions. Some medical problems related to pelvic floor pain include:

• Interstitial cystitis (inflammation of the bladder wall) 

• Vulvodynia (pain, burning, or irritation of the area around your vagina, or vulva)

• Endometriosis (when uterine tissue grows outside the uterus)

• Infections, such as pelvic inflammatory disease (infection of the reproductive organs) or urinary tract infections

• Digestive system problems, such as irritable bowel syndrome (IBS)

Emotional trauma. Research shows 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 a history of abuse or sexual shaming, talk to your healthcare provider to seek counseling.

Pelvic organ prolapse. This occurs when your pelvic floor muscles and other tissues in your pelvis weaken, allowing pelvic organs 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.

Physical Therapy for Pelvic Floor Pain Relief: Exercises and Lifestyle Tips

When pelvic pain is caused by problems with your pelvic floor muscles, a pelvic floor physical therapist (PT) can help. A PT will evaluate which activities or positions trigger or relieve your pain. They can help determine which pelvic floor muscles are involved and whether connecting areas, such as the hips and back, have imbalances that contribute to your pain, explains Dr. Walters. “Understanding where the pain is coming from brings relief in itself and helps people be their own advocate,” she says.

Depending on your symptoms, a pelvic floor physical therapist may recommend treatment options, such as exercises and lifestyle strategies for overall well-being, including:

• Diaphragmatic breathing. The goal is to practice slow, deep breathing to help lengthen your pelvic floor muscles so they remain strong and flexible.

• “Reverse” Kegel exercises. These do the opposite of standard Kegel exercises — by focusing on relaxing pelvic floor muscles instead of tightening them.

• Pelvic floor stretches. They can help reduce tension in your pelvic floor muscles. 

• Whole-body exercises. Your pelvic floor is connected to many other muscles and structures. An effective treatment approach also offers whole-body exercises to strengthen areas that support your pelvic floor.

• Supportive pillows. Sitting on a cushion or a donut pillow, or placing one behind your back, can help relieve pressure on the pelvis and ease pelvic pain.

• Self-massage of the pelvic floor. Ask your PT if this is right for you.

• Relaxation techniques. Experiment with mindfulness meditation, tai chi, or journaling, for example. These can help reduce stress that contributes to pelvic floor pain.

• Sleep strategies. Practice good sleep hygiene habits, such as limiting screen time in the evening and avoiding caffeine before bed.

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 sometimes 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. 

PT Tip: Breathing Is Key

“Diaphragmatic breathing is not a flashy or complicated exercise, but it’s so powerful in helping manage pelvic pain and symptoms,” says Jennifer Sepe, PT, DPT, a physical therapist at Hinge Health. “With time and intentional focus, you can gradually improve the brain-body connection and target the areas of tightness and pain.” Plus, deep breathing can help reduce the inflammation and muscle tension that’s at the root of symptoms. 

How Hinge Health Can Help You

If you have pelvic pain or symptoms that are affecting your quality of life, 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.

References

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2. Dydyk, A. M., & Gupta, N. (2020). Chronic Pelvic Pain. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK554585/

3. Grimes, W. R., & Stratton, M. (2021). Pelvic Floor Dysfunction. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559246/

4. Seehusen, D. A., Baird, D. C., & Bode, D. V. (2014). Dyspareunia in Women. American Family Physician, 90(7), 465–470. https://www.aafp.org/afp/2014/1001/p465.html

5. van Reijn-Baggen, D. A., Han-Geurts, I. J. M., Voorham-van der Zalm, P. J., Pelger, R. C. M., Hagenaars-van Miert, C. H. A. C., & Laan, E. T. M. (2021). Pelvic Floor Physical Therapy for Pelvic Floor Hypertonicity: A Systematic Review of Treatment Efficacy. Sexual Medicine Reviews, 10(2). doi.org/10.1016/j.sxmr.2021.03.002

6. What causes pelvic pain? | NICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development. (2017, January 31). Www.nichd.nih.gov. https://www.nichd.nih.gov/health/topics/pelvicpain/conditioninfo/causes