Pelvic Pain: Understanding the Causes and How Physiotherapy Can Help

Pelvic pain can affect women at any stage of life. It may appear suddenly or develop gradually, and the symptoms can range from a mild ache to persistent or more complex discomfort.

Pain may be felt around the lower abdomen, pelvis, hips, lower back or pelvic floor. For some women, it may interfere with exercise and movement, while others may notice discomfort when sitting, using the toilet or during sexual activity.

Physiotherapy can help identify physical factors that may be contributing to symptoms and provide practical strategies to improve movement, comfort and confidence.

What Can Cause Pelvic Pain?

Pelvic pain can have many possible causes, and sometimes several factors may be involved.

These can include:

• Pelvic floor muscle tension or weakness
• Pregnancy and childbirth
• Musculoskeletal problems
• Previous surgery or injury
• Changes associated with menopause
• Bladder or bowel symptoms
• Changes in movement or physical activity

Persistent pelvic pain should not automatically be assumed to be a muscle problem. Depending on the symptoms, medical assessment may also be appropriate.

What Does Pelvic Pain Feel Like?

Symptoms can vary considerably between individuals.

You may experience:

• Aching or pressure around the pelvis
• Sharp or stabbing sensations
• Muscle tightness or tension
• Discomfort around the hips or lower back
• Pain when sitting, walking or exercising
• Pain during sexual activity
• Symptoms that come and go

Noticing when the pain occurs and what makes it better or worse can provide useful information during an assessment.

How Can Physiotherapy Help?

A physiotherapy assessment looks at how your symptoms relate to movement and the way different parts of the body are functioning together.

Treatment is not always about strengthening. If muscles are tight or overactive, relaxation and coordination may be more appropriate.

The Role of the Pelvic Floor

The pelvic floor supports the pelvic organs and contributes to bladder and bowel control. These muscles also need to contract and relax at the right times.

For some women with pelvic pain, the muscles may become tense or have difficulty relaxing. This can contribute to discomfort and may affect movement or sexual activity.

Pelvic floor physiotherapy may form part of treatment where this is relevant.

Depending on the individual, treatment may include:

• Relaxation techniques
• Breathing exercises
• Movement retraining
• Pelvic floor coordination
• Gentle strengthening where appropriate
• Education about managing symptoms

The aim is to address the factors contributing to your symptoms rather than simply treating the area that hurts.

Pelvic Pain During Pregnancy

Pregnancy changes the way the body moves and places additional demands on the pelvis, hips and lower back.

Some women may experience:

• Pelvic or lower back discomfort
• Difficulty walking or changing position
• Pelvic pressure
• Discomfort during exercise
• Reduced confidence with movement

Pregnancy physiotherapy can provide guidance on suitable movement and exercise while taking the stage of pregnancy and individual symptoms into account.

Pelvic Pain After Childbirth

Pregnancy and childbirth can affect the pelvic floor, abdominal muscles and wider musculoskeletal system. Recovery is different for every woman.

Some women may continue to experience pelvic or lower back discomfort after childbirth, particularly when returning to exercise or more demanding activities.

Postnatal physiotherapy can help assess movement and muscle function and support a gradual return to everyday activities.

Pelvic Pain During Menopause

Hormonal changes during menopause can be accompanied by changes in pelvic health, bladder symptoms and musculoskeletal comfort.

Some women may notice:

• Pelvic discomfort
• Changes in bladder control
• Muscle or joint aches
• Changes in exercise tolerance
• Increased pelvic floor tension

Menopause physiotherapy can provide guidance on strength, mobility, pelvic floor function and maintaining physical activity.

Chronic Pelvic Pain

Physiotherapy for chronic pelvic pain takes a broader view of how symptoms behave and how physical factors may influence them.

Treatment may involve movement rehabilitation, breathing and relaxation strategies, education, appropriate hands-on techniques and individually selected exercises.

Are Pelvic Floor Exercises Always Appropriate?

Pelvic floor exercises are commonly associated with women's pelvic health, particularly bladder leakage. However, strengthening is not necessarily appropriate for every problem.

For example:

• Weak muscles may benefit from strengthening.
• Tight muscles may need relaxation.
• Poor coordination may require movement retraining.
• Breathing patterns can influence pressure through the pelvis.
• Several factors may contribute to pain at the same time.

This is why an individual assessment can be useful before starting a specific exercise programme.

What Happens During an Assessment?

An assessment usually begins with a confidential discussion about your symptoms, medical history, activities and goals.

Depending on your concerns, your physiotherapist may assess:

• Movement and posture
• Breathing
• Abdominal and core function
• Pelvic floor function
• Hip and lower back movement
• Activities that affect your symptoms

An internal assessment may sometimes be appropriate. This will always be explained beforehand and only undertaken with your informed consent.

The findings can then be used to develop an approach suited to your symptoms and needs.

When Should Pelvic Pain Be Assessed?

Consider seeking professional advice if your pain:

• Persists or repeatedly returns
• Interferes with daily activities
• Limits exercise or movement
• Affects sleep
• Causes discomfort during sexual activity
• Occurs alongside bladder or bowel changes
• Develops during pregnancy or after childbirth

Unexplained or persistent symptoms may require medical assessment to identify the underlying cause.

Conclusion

Pelvic pain can have different causes and may affect movement, exercise and everyday life. Physiotherapy can help identify contributing factors and provide individualised strategies to manage symptoms.

At Xcel Health, we provide physiotherapy for pelvic pain and wider women's pelvic health concerns, with treatment tailored to each woman's needs and goals.