Move Forward Guide
Physical Therapist's Guide to
Pelvic pain has many possible causes and a variety of symptoms that can make you feel uncomfortable and embarrassed. You're not alone—and your physical therapist can help.
What Is Pelvic Pain?
Pelvic pain is felt in the lower abdomen, pelvis, or perineum and is considered to be "chronic" when it lasts for more than 6 months.
Pelvic pain can be caused by:
- Pregnancy and childbirth, when changing hormone levels can affect the muscles and cause the joints to become more "loose"
- Pelvic joint problems
- Muscle weakness or imbalance within the muscles of the pelvic floor, trunk, or pelvis
- Lack of coordination in the muscles that control the bowel and bladder
- Tender points in the muscles of the pelvic floor
- Pressure on one or more nerves in the pelvis
- Weakness in the muscles of the pelvis and pelvic floor
- Scar tissue after abdominal or pelvic surgery, such as a C-section or episiotomy (incision), or as a result of a tear in the vaginal area
- Pelvic organ prolapse, a shift in the position of the pelvic organs
How Does it Feel?
The pain in your lower abdomen and pelvis may vary; some people say that it feels like an aching pain; others say that it feels like 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
- Inability to sit for normal periods of time
- Pain in the joints of the pelvis
- Pain with sexual intercourse
- Tender points in the muscles of the abdomen
- Reduced ability to move your hips or low back
- Difficulty walking, sleeping, and doing physical activities
- Urinary frequency, urgency, or incontinence
- Painful bowel movements
- Constipation or straining with bowel movements
With pelvic organ prolapse, there also might be a sensation of pelvic heaviness or a feeling like you're sitting on a ball, due to the pelvic organs bulging at the opening of the vagina.
How Is It Diagnosed?
Your physical therapist will perform an examination to identify the causes of your pelvic pain and any joint problems, muscle tightness or weakness, or pinched nerves. Your therapist also will determine whether you should be referred to a physician for additional tests.
How Can a Physical Therapist Help?
Based on the examination results, your therapist will select from treatments designed to reduce muscle tightness, improve your muscle strength, and improve how you use your muscles—which in turns helps reduce your pain and increase your ability to perform your roles in the home, in the community, and at work.
Strengthen Your Muscles and Make Them Work Better for You
Your physical therapist will:
- Teach you how to do relaxation exercises.
- Show you how to "find" the right muscles and use them correctly.
- Use pelvic-floor exercises to help you strengthen your muscles so that they can properly support the pelvic organs. Pelvic-floor exercises include "kegels," in which you gently squeeze the sphincter muscles and squeeze the buttocks, thighs, and stomach muscles.
- Instruct you in exercises to stretch and strengthen other important muscles and retrain them so that they work together normally.
Depending on your symptoms and level of discomfort, your physical therapist may decide to use biofeedback to make you aware of how your pelvic-floor muscles work and how you can control them better. Electrodes attached vaginally or rectally will provide measurements of muscle activity and display them on a monitor, and the therapist will work with you to help you understand and change those readings. The therapist also may use electrical stimulation to improve your awareness of your muscles and increase muscle strength.
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 pain or women's health problems.
- 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.
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.
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 their 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 report recent research and give an overview of the standards of practice for treatment of TMD 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.
Fisher KA. Management of dyspareunia and associated levator ani muscle overactivity. Phys Ther. 2007;87:935-941. 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
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
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
Weiss JM. Pelvic floor myofascial trigger points: manual therapy for interstitial cystitis and the urgency-frequency syndrome. J Urol. 2001;166:2226-2231. Article Summary on PubMed
Acknowledgments: APTA's Secion on Women's Health; Kendra Harrington, PT, DPT, WCS