Pelvic Pain: Causes, Symptoms & Treatments

Pelvic pain affects many people, both women and men, and can have a significant impact on quality of life. With pelvic floor rehabilitation, it is possible to regain greater comfort in everyday life. Whether the pain is related to pregnancy, surgery, or a chronic condition, our professionals are here to support you on your path to better well-being.

How does pelvic pain present?

Pelvic pain includes all discomfort felt in the pelvic region, lower abdomen, and pelvic floor. It can present as:

Pain during sexual intercourse
A feeling of heaviness or vaginal pressure
Severe menstrual cramps
Muscle tension in the pelvic region
Pain during the bladder filling phase
Difficulty and pain during bowel movements

These symptoms may be temporary or chronic and can affect different age groups.

What are the possible causes of pelvic floor pain?

In general, pelvic pain and pelvic issues are caused by dysfunction (for example, weakness or excessive tension) of the pelvic floor muscles, a group of muscles located at the base of the pelvis between the pubic bone and the coccyx. Other factors may also be involved, such as ligament injury, a difficult delivery, certain lifestyle habits, or associated medical conditions.

Pelvic organ prolapse

Pelvic organ prolapse often creates a feeling of pressure or heaviness in the vaginal area. It may be accompanied by urinary issues, including incontinence. Depending on the severity, a bulge, sometimes appearing like a small ball, may be seen at the vaginal opening. However, these symptoms can take several years to develop and, in some cases, may never appear. The main cause of pelvic organ prolapse is damage to the structures that support the pelvic organs (ligaments and the myofascial system), along with weakening of the pelvic floor muscles.

Overactive bladder

Overactive bladder is characterized by urgent, hard-to-control urges to urinate, even when the bladder is not full. These strong urges can also lead to urinary leakage. Possible causes include lifestyle habits that irritate the bladder (such as consuming caffeine, carbonated drinks, energy drinks, alcohol, and tobacco), urinary tract infection, and hypertonicity (excessive tension) of the pelvic floor muscles. Drinking too little water can also contribute to overactive bladder. Other medical conditions, such as bladder pain syndrome or interstitial cystitis, can also cause pelvic pain.

Pregnancy and childbirth

Pregnancy and childbirth can lead to discomfort or pain in the pelvic region. Natural postural and hormonal changes during pregnancy can cause lower back pain, pain in the lower abdomen, at the pubic symphysis (the joint between the left and right sides of the pubic bone), or at the sacroiliac joint (at the back of the pelvis). Changes in position, such as standing up, sitting down, or turning over in bed, can be difficult and painful. After childbirth, vulvar or vaginal pain may make sitting uncomfortable. This pain is often increased with bowel movements and sexual intercourse. It occurs more frequently after a delivery with tearing or an episiotomy, when the pushing phase is longer, or due to the baby’s size. A scar following a pelvic floor tear, an episiotomy, or a cesarean section can also be painful if it is stiff and does not move well because tissues have adhered.

Pain during sexual intercourse

Several causes may explain pain related to sexual intercourse: hypersensitivity of nerve cells, hypertonicity of the pelvic floor muscles (too tense), scar tissue adhesions, an associated medical condition such as fibromyalgia, etc. The pain often feels like burning or a “razor-blade” sensation and may occur at penetration, during, and after intercourse. Several diagnoses are associated with this type of pain:

Dyspareunia: the medical term for pain during sexual intercourse
Vestibulodynia: pain at the entrance of the vagina (the vestibule)
Vulvodynia: pain in the vulvar region
Vaginismus: involuntary contraction of the pelvic floor muscles, making penetration difficult or impossible
Pudendal neuralgia: pain along the path of the pudendal nerve, possibly accompanied by numbness or tingling

Severe menstrual cramps

Certain medical conditions, including endometriosis, can cause pelvic pain, pain during sexual intercourse, pain during urination, and pain during bowel movements. Endometriosis affects about 10% of women and is characterized by significant, sometimes debilitating, menstrual pain. Medical management is necessary, but pelvic floor rehabilitation can also help reduce these symptoms.

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Pelvic floor rehabilitation to relieve pain

Pelvic floor rehabilitation in physiotherapy is the recommended approach to treat this type of pain. This approach aims to:

Strengthen or relax the pelvic floor muscles
Correct posture and movement habits
Improve breathing patterns
Improve pelvic mobility
Improve body awareness
Adapt daily activities to reduce tension

A personalized treatment plan is developed by your professional based on your symptoms and goals.

Frequently asked questions (FAQ)

What are the causes of urinary incontinence?

The most common cause of urinary incontinence is weak pelvic floor muscles. It most often occurs in connection with aging or childbirth, but can also affect women and men of all ages.

Learn more about urinary incontinence

How do you know if Kegel exercises are right for you?

Kegel exercises are known to strengthen the pelvic floor muscles. These are good exercises, but are targeted at women with actual muscle weakness that requires strengthening. Some women instead have hypertonic (too tight) muscles that need to be relaxed and stretched. To be effective, Kegel exercises must also be performed correctly, which is more difficult than you might think. Ideally, you should consult a physiotherapist in perineal and pelvic rehabilitation who will advise you on the exercises suitable for you and teach you how to perform them properly.

You should know that in the presence of pain, we tend to contract our muscles and block our breathing. To relieve the pain, it is therefore recommended to begin by doing diaphragmatic breathing exercises which consist of breathing slowly and deeply by inflating the belly with each inspiration. You can place a hand on your belly to better feel the movement. Keep all the other muscles in your body relaxed. Do this exercise for about 5 minutes every day.

If you have an overactive bladder, avoid reducing the amount of water you drink each day. To promote bladder control, try to hold back your urges a little longer and consult a physiotherapist in perineal and pelvic rehabilitation.

When should you consult for pelvic pain?

As soon as the pain persists or begins to affect your daily activities. Early intervention helps support better recovery.

Is pelvic physiotherapy painful?

No. Treatments are performed gently and respectfully, based on your comfort level and progress.

Can men benefit from this approach?

Yes. Pelvic conditions also affect men, particularly in cases of urinary issues or following surgery.

What is the impact of running on the pelvic floor?

Because of its anatomy, the sacrum is supported by the pelvis, and the lumbar spine rests on the sacrum. If pelvic stabilization is not adequately maintained while running, the entire spine can become unbalanced. In addition, a stable pelvis helps maintain proper leg alignment during running.

Of course, the pelvic floor is not the only structure involved in running. The transverse abdominal muscle and the gluteal muscles also play an important role and should not be overlooked.

Learn more about running and its impact on the pelvic floor