Chronic Pelvic Pain: What’s Causing It and How Physical Therapy Helps
- Katherine Koch, PT, DPT
- 7 days ago
- 7 min read
Updated: 6 days ago
If you’re living with chronic pelvic pain, you know how much it can affect every part of life—your comfort, your movement, your relationships, even your sense of self. For many people, the pain isn’t just physical. It can bring uncertainty, frustration, and isolation when the cause isn’t clear and solutions feel out of reach.
The good news is that our specialists in pelvic floor dysfunction physical therapy can play a powerful role in understanding and treating chronic pelvic pain. Whether your pain is related to muscle tension, nerve irritation, organ dysfunction, or past trauma, there are effective, research-backed approaches that can help you find relief and regain confidence in your body.
In this post, we’ll explore:
What “chronic pelvic pain” really means
Common causes and contributing factors
How the pelvic floor and surrounding systems are involved
What pelvic floor physical therapy looks like
How treatment helps reduce pain and restore function
What Is Chronic Pelvic Pain?
Chronic pelvic pain (CPP) is typically defined as pain in the pelvis that lasts for six months or longer. The pain can be constant or intermittent, sharp or dull, localized or widespread. It may affect the lower abdomen, vagina, rectum, hips, or low back, and can occur during specific activities—like sitting, exercise, urination, or sexual intercourse—or seemingly without a clear trigger.
CPP is incredibly common—studies estimate that about 1 in 5 women and 1 in 10 men will experience it at some point. In fact, men do have pelvic floors and here at Sage Physical Therapy we treat male pelvic floor dysfunction as well as female pelvic floor dysfunction. But because the pelvis houses multiple systems (muscular, reproductive, urinary, gastrointestinal, and nervous), pinpointing the exact cause can be challenging. For many people, it’s not just one issue—it’s a combination.
What Causes Pelvic Floor Dysfunction and Chronic Pelvic Pain?
Pelvic pain often develops when multiple systems overlap and influence one another. Here are some of the most common sources of chronic pelvic pain:
1. Pelvic Floor Muscle Dysfunction
The pelvic floor muscles support the pelvic organs, control bowel and bladder function, and play a role in sexual activity. When these muscles become overactive, tight, or in spasm, they can create pain themselves and refer discomfort to nearby areas like the hips, tailbone, or lower abdomen.
Some people develop muscle tension in response to trauma, injury, childbirth, chronic stress, or prolonged sitting. Over time, this tension can lead to poor blood flow, trigger points, and nerve irritation—all of which contribute to persistent pain.
2. Nerve Sensitization or Entrapment
Nerves that travel through the pelvis, such as the pudendal nerve, can become compressed or hypersensitive. This may lead to burning, tingling, or shooting pain that radiates into the perineum, genitals, or rectal area. Even if the original irritation (like surgery or an infection) has resolved, the nervous system can remain “on high alert,” amplifying pain signals.
3. Gynecological or Urological Conditions
Several medical conditions can either cause or coexist with pelvic floor dysfunction, including:
Endometriosis
Interstitial cystitis/painful bladder syndrome
Pelvic inflammatory disease
Ovarian cysts or uterine fibroids
Vulvodynia or vestibulodynia
When pain persists beyond the healing of these conditions—or when the pelvic muscles tighten in response to them—it becomes a musculoskeletal issue that physical therapy can address.
4. Gastrointestinal Issues
Chronic constipation, irritable bowel syndrome (IBS), or straining with bowel movements can all place repeated stress on the pelvic floor. Over time, these patterns can cause muscles to tighten or weaken, perpetuating discomfort even when the original GI issue is managed.
5. Postpartum or Post-Surgical Changes
After childbirth or pelvic surgery, scar tissue, muscle imbalance, or nerve sensitivity can develop. These changes may limit mobility and contribute to ongoing pain, especially if the muscles have been compensating for a long time.
6. Emotional and Stress-Related Factors
It’s important to acknowledge the mind-body connection in chronic pain. Stress, anxiety, or past trauma can increase muscle tension and alter how the nervous system perceives pain. This doesn’t mean the pain is “in your head”—rather, the emotional and physical systems influence one another, and both need care for true healing.
How the Pelvic Floor Contributes to Pain
The pelvic floor is made up of a complex network of muscles, ligaments, and connective tissue that form a supportive sling at the base of your pelvis. Ideally, these muscles should contract, relax, and lengthen easily—supporting your organs and allowing pain-free movement, bladder and bowel control, and sexual function.
When this system becomes dysregulated, pain can occur due to:
Muscle tension or spasm (overactivity)
Weakness or lack of coordination
Trigger points (knots of hyperirritable muscle tissue)
Nerve compression or hypersensitivity
Altered posture or core mechanics
Pelvic floor dysfunction often doesn’t stay contained to the pelvis—it can affect and be affected by the hips, abdomen, spine, and diaphragm. This is why a whole-body approach is key in physical therapy.
How Pelvic Floor Physical Therapy Helps
Pelvic floor physical therapy is a comprehensive, evidence-based approach to diagnosing and treating chronic pelvic pain. It focuses on identifying the specific muscular, skeletal, and nervous system factors contributing to your symptoms, and addressing them through tailored interventions.
Here’s what you can expect:
1. Thorough Evaluation
Your first visit involves an in-depth discussion about your pain history, daily habits, medical background, and goals. Here at Sage Physical Therapy, your experienced and specialized pelvic floor PT will assess your posture, breathing patterns, movement mechanics, and how your core and hips work together.
With your consent, an internal pelvic floor muscle assessment may also be performed. This allows your therapist to feel for muscle tone, trigger points, scar tissue, and coordination issues. Every step is explained clearly, and you’re always in control of the process.
2. Manual Therapy
In pelvic floor dysfunction physical therapy, hands-on techniques are used to reduce muscle tension, improve circulation, and calm the nervous system. This may include:
Myofascial release of tight pelvic, hip, or abdominal muscles
Gentle internal release techniques to reduce muscle guarding
Soft tissue mobilization or scar tissue work
Joint mobilization of the hips or sacroiliac joints
Manual therapy helps restore mobility, blood flow, and tissue resilience, which can decrease pain and promote healing.
3. Neuromuscular Re-education
Pain can disrupt how muscles coordinate. Here at Sage Physical therapy, your specialized pelvic floor physical therapist will guide you through exercises that retrain the pelvic floor, core, and diaphragm to work in harmony again. This may include:
Relaxation and breathing exercises
Gentle mobility and stretching
Progressive strengthening and posture retraining
Awareness training to reconnect with your pelvic floor
The goal is to restore normal movement patterns so your body no longer defaults to protective tension.
4. Education and Empowerment
Understanding your pain is one of the most powerful steps toward recovery. Your experienced pelvic floor PT will teach you:
How to recognize and release pelvic tension
Bladder and bowel habits that reduce strain
Ergonomic and lifestyle adjustments
Strategies to manage pain flare-ups
Knowledge turns fear into confidence. Many patients say that simply learning why they hurt and how to help their body relax changes everything.
5. Integrative Support
Because chronic pelvic pain often involves multiple systems, your physical therapist may collaborate with other providers—such as gynecologists, urologists, gastroenterologists, or mental health professionals—to ensure you have comprehensive, whole-person care.
The Research Behind Pelvic Floor PT for Pelvic Pain
Multiple studies support pelvic floor physical therapy as a highly effective intervention for chronic pelvic pain. For example:
Research in the Journal of Sexual Medicine found that pelvic floor physical therapy significantly reduced pain intensity and improved quality of life in patients with pelvic floor myalgia.
Another study in Pain Medicine showed that manual therapy and neuromuscular re-education led to meaningful improvements in pain, function, and psychological well-being for people with pelvic pain syndromes.
For conditions like endometriosis and interstitial cystitis, pelvic floor PT has been shown to help break the cycle of muscle guarding and pain amplification.
In other words, it’s not just about managing symptoms—it’s about restoring normal function and retraining your body to move, breathe, and respond differently.
What Healing Really Looks Like
Recovery from chronic pelvic pain is rarely linear, and that’s okay. It often unfolds in layers: physical, emotional, and neurological. As the body learns safety again—through movement, breath, and skilled manual therapy—the nervous system can finally start to turn down the volume on pain signals.
Most people begin noticing improvement after several sessions, though complete resolution may take time depending on how long the pain has been present. Your therapist will help you track progress, celebrate small wins, and adjust your plan as your body changes.
It’s worth emphasizing: relief is possible. Many patients who thought they’d “tried everything” finally find answers and meaningful improvement through pelvic floor physical therapy.
When to See a Pelvic Floor Physical Therapist
You don’t have to live with chronic pelvic pain—or wait for it to get worse—before seeking help. Consider scheduling an evaluation if you experience:
Ongoing pelvic, vaginal, rectal, or testicular pain
Pain with sitting, exercise, or intercourse
Painful urination or bowel movements
Feelings of tightness, heaviness, or pressure in the pelvis
History of pelvic surgery, childbirth, or trauma
Even if you’re unsure whether your symptoms are “muscular,” one of our specialist pelvic health PTs can assess and guide you toward the right next step.
Final Thoughts: There’s Hope for Healing
Chronic pelvic pain can be complex, but it’s not hopeless. Every story is unique, and every body can heal when given the right tools, time, and support. Pelvic floor physical therapy offers a compassionate, evidence-based path to understanding your pain, calming your nervous system, and restoring confidence in your body.
If you’re struggling with chronic pelvic pain, you don’t have to go through it alone. Our team at Sage Physical Therapy specializes in pelvic floor rehabilitation and is here to help you move beyond pain toward strength, comfort, and freedom again.
Ready to take the next step? Scroll down to reach out to schedule your pelvic floor evaluation today and start your journey toward lasting relief with one of our expert pelvic floor PTs here in Denver.