What is Pelvic Pain?

Pelvic pain is pain felt in the lower abdomen, pelvis, or perineum. It has many possible causes and affects up to 20% of the population in the United States, including women and men. Pelvic pain is considered “chronic” when it lasts for more than 6 months. Physical therapists help people experiencing pelvic pain restore strength and flexibility to the muscles and joints in the pelvic region, and get them back to their functional activities.

What Is Pelvic Pain?

Pelvic pain can be caused by:

• Pregnancy and childbirth, which affect pelvic muscles and cause changes to pelvic joints
• Pelvic joint problems from causes other than pregnancy and childbirth
• Muscle weakness or imbalance within the muscles of the pelvic floor, trunk, or pelvis
• Changes in the muscles that control the bowel and bladder
• Tender areas in the muscles around the pelvis, abdomen, low back, or groin areas
• Pressure on one or more nerves in the pelvis
• Weakness of the muscles surrounding the pelvis including the pelvic floor
• Scar tissue after abdominal or pelvic surgery
• Disease

• A shift in the position of the pelvic organs, known as prolapse

How Does it Feel?

The pain in your lower abdomen and pelvis may vary; some people say it feels like an aching pain; others describe it as a burning, sharp, or stabbing pain, or even pins and needles. In addition, you may have:

• Pain in the hip or buttock.
• Pain in the tailbone or pubic bone.
• Pain in the joints of the pelvis.
• Tenderness in the muscles of the abdomen, low back, or buttock region.
• A sensation of heaviness in the pelvic region or even a sensation as if you are sitting on something hard, like a golf ball.

Signs and Symptoms

• Inability to sit for extended periods of time.
• Reduced ability to move your hips or low back.
• Difficulty walking, sleeping, or performing daily activities.
• Pain or numbness in the pelvic region with exercise or recreational activities, such as riding a bike or running.
• Pain during sexual activity.
• Urinary frequency, urgency, or incontinence, or pain during urination.
• Constipation, straining or pain with bowel movements
• Difficulty with penetration including tampons or sexual penetration

How Is It Diagnosed?

Your physical therapist will complete a thorough review of your medical history, and perform a physical examination to identify the causes of your pelvic pain and any joint issues, muscle tightness or weakness, or nerve involvement. The exam may include:

• Pelvic girdle screening.
• Soft tissue assessment.
• Visual inspection of the tissues.
• Sensation testing.
• Internal assessment of pelvic floor muscles.

Your physical therapist also will determine whether you should be referred to a physician to assist in your interdisciplinary plan of care.

How Can a Physical Therapist Help?

Based on the examination results, your physical therapist will design an individualized treatment program to meet your specific needs and goals. Your physical therapist may:

• Show you how to identify the appropriate muscles, such as the pelvic floor, deep abdominals, and diaphragm.
• Educate you on how to use these muscles correctly for activities like exercise, posture correction, getting up from a chair, or squatting to pick up a child or something else from the floor.
• Work with you on exercises to stretch and strengthen the affected muscles to stretch and strengthen them so they work together optimally
• Demonstrate appropriate pelvic floor muscle exercises.
• Get you back to doing all of the activities you were able to perform before you experienced this pain

Can this Injury or Condition be Prevented?

Some risk factors, such as aging, smoking and associated coughing, inactivity, obesity, or childbirth, affect general health and may affect core trunk and pelvic strength. Exercises, such as core stabilization, pelvic floor, and deep abdominal wall exercises, muscle flexibility training, and body awareness may help improve muscle function and lower the risk of pelvic injury or pain. See other resources to help you maintain health, such as Fitness Across the Lifespan, Fit After Fifty, Five Ways to Prepare Your Body for Pregnancy, and Nine Physical Therapist Tips to Help You Age Well.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat a variety of conditions or injuries. You may want to consider:

• A physical therapist who is experienced in treating people with pelvic health issues.
• A physical therapist who completed a residency or fellowship in women’s health physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.
• A physical therapist who is a board-certified specialist in women’s health physical therapy
• Someone who has gone through the CAPP-Pelvic certificate program through the Academy of Pelvic Health Physical Therapy

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you’re looking for a physical therapist (or any other health care provider):

• Get recommendations from family and friends or from other health care providers.
• When you contact a physical therapy clinic for an appointment, ask about the physical therapists’ experience in helping people with pelvic pain.
• During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

Authors:

• Carina Siracusa PT, DPT, board-certified clinical specialist in women’s health physical therapy and board-certified specialist in oncology physical therapy
• Jennifer Davia, PT, DPT, board-certified clinical specialist in women’s health physical therapy.

Further Reading

The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for a visit with their health care provider.

The following articles provide some of the best scientific evidence related to physical therapy treatment of pelvic pain. The articles and resources report recent research and give an overview of the standards of practice for treatment both in the United States and internationally. The article titles are linked either to a PubMed abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.

Singh MK, Rivlin ME. Chronic pelvic pain in women. Medscape.  Updated

American College of Obstetricians and Gynecologists. Chronic pelvic pain. Published August 2011. Accessed January 6, 2016.

Ortiz D. Chronic pelvic pain in women. Am Fam Physician. 2008;77(11):1535–1542. Free Article. Accessed January 6, 2016.

Fisher KA. Management of dyspareunia and associated levator ani muscle overactivity. Phys Ther. 2007;87:935–941. Free Article.

Borello-France DF, Handa VL, Brown MB, et al. Pelvic-floor muscle function in women with pelvic organ prolapse. Phys Ther. 2007;87:399–407. Free Article.

Stuge B, Holm I, Vollestad N. To treat or not to treat postpartum pelvic girdle pain with stabilizing exercises? Man Ther. 2006;11:337–343. Article Summary on PubMed.

Depledge J, McNair PJ, Keal-Smith C, Williams M. Management of symphysis pubis dysfunction during pregnancy using exercise and pelvic support belts. Phys Ther. 2005;85:1290–1300. Free Article.

Clinton, S. C., Newell, A., Downey, P. A., & Ferreira, K. (2017). Pelvic girdle pain in the antepartum population: physical therapy clinical practice guidelines linked to the international classification of functioning, disability, and health from the section on women’s health and the orthopaedic section of the American Physical Therapy Association. JWHPT, 41(2), 102-125. Free Article.

Trahan, J., Leger, E., Allen, M., Koebele, R., Yoffe, M.B., Simon, C., Alappattu, M. and Figuers, C. (2019). The Efficacy of Manual Therapy for Treatment of Dyspareunia in Females: A Systematic Review. JWHPT, 43(1), 28-35. Free Article

Alappattu, M., Hilton, S., & Bishop, M. (2019). An international survey of commonly used interventions for management of pelvic pain. JWHPT, 43(2), 82. Free Article

Hilton, S., & Vandyken, C. (2011). The puzzle of pelvic pain—a rehabilitation framework for balancing tissue dysfunction and central sensitization, I: pain physiology and evaluation for the physical therapist. JWHPT, 35(3), 103-113. Free Article

* PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.

Authored by APTA’s Academy of Pelvic Health Physical Therapy; Kendra Harrington, PT, DPT, board-certified clinical specialist in women’s health physical therapy (original author). Revisions by Stephanie Fournier, PT, DPT, PhD(c), board-certified clinical specialist in women’s health physical therapy; Lorien Hathaway PT, DPT, board-certified clinical specialist in women’s health physical therapy; and Venita Lovelace-Chandler, PT, PhD, board-certified clinical specialist in pediatric physical therapy, Carina Siracusa PT, DPT, board-certified clinical specialist in women’s health physical therapy and board-certified specialist in oncology physical therapy and Jennifer Davia, PT, DPT, board-certified clinical specialist in women’s health physical therapy. Reviewed by the editorial board.

Additional resources can be found at ChoosePT.com