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Pelvic pain

Learn more about the causes, symptoms and treatment options for pelvic pain.

Pelvic pain is a common symptom that can affect people of all ages. It may develop suddenly, for example following an injury, infection or surgery, or gradually over time.

Pelvic pain can have many different causes, and there is not always one clear explanation. It may be associated with gynaecological, urological, gastrointestinal, musculoskeletal, neurological or other medical conditions. In persistent pelvic pain, several contributing factors may exist at the same time, including physical, psychological and social factors (1-3).

Importantly, pelvic pain is a symptom rather than a diagnosis. Understanding the possible contributors is an important part of deciding what assessment and treatment may be appropriate (1,2).

In this article, you can learn more about the symptoms and possible causes of pelvic pain, associated conditions and available treatment options.

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Darya Zaiceva

Senior Osteopath (GOsC Registered) | Master Degree of Osteopathy M.Ost | Postgraduate Diploma in Women's Health

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What can pelvic pain feel like?

Pelvic pain can feel very different from person to person.

Symptoms may include:

Pain around the lower abdomen, pubic bone or groin
Hip or buttock pain
Lower back pain
Tailbone (coccyx) pain
Pain around the sacroiliac region
Pain that radiates into the legs
Pain when walking, climbing stairs or changing position
Pain when sitting for prolonged periods
Pain during exercise
Pain during or after sexual intercourse
Bladder or bowel discomfort
A feeling of pressure or heaviness in the pelvis

Symptoms may be intermittent or persistent and can affect sleep, work, exercise, relationships and everyday activities (1,2).

Why does pelvic pain happen?

There is often more than one contributing factor.

Possible causes include:

Gynaecological conditions such as endometriosis, adenomyosis or pelvic inflammatory disease
Urinary or bladder conditions
Gastrointestinal conditions, including some forms of bowel dysfunction
Pelvic floor muscle dysfunction
Musculoskeletal problems involving the lower back, hips, pelvis or pelvic floor
Nerve-related pain
Previous injury or surgery
Pregnancy and childbirth
Psychological or social factors that can influence the experience and persistence of pain

Current guidance emphasises that persistent pelvic pain is often multifactorial rather than being explained by a single structure or condition (1-3).

This does not mean that the pain is “all in your head”. Pain is a genuine sensory and emotional experience, and physical, psychological and social factors can all influence how pain is experienced and maintained (1,3).

Understanding Pelvic Pain

Watch the video below, where Darya explains pelvic pain and some of the factors that may contribute to it.

Conditions commonly associated with pelvic pain

Endometriosis

Endometriosis is a condition in which tissue similar to the lining of the uterus is found outside the uterus. It can be associated with pelvic pain, painful periods, pain during or after sex, bowel or urinary symptoms and difficulties with fertility (4).

Endometriosis should be considered when symptoms are suggestive, particularly when pain is cyclical or associated with menstruation, bowel movements, urination or sexual activity (4).

Osteopathy may form part of a broader management plan for some people, particularly when musculoskeletal or pelvic-floor symptoms are also present, but it does not treat the underlying endometriosis itself (1,4).

Bladder pain and urinary symptoms

Pelvic pain can occur alongside urinary symptoms such as urgency, frequency, discomfort when passing urine or bladder-related pain.

Repeated urinary tract infections or bladder irritation can sometimes contribute to persistent pelvic pain and pelvic floor muscle tension. However, these symptoms may also have other causes and may require further medical assessment and appropriate treatment (1,5).

Pelvic floor dysfunction

The pelvic floor is a group of muscles that helps support the pelvic organs and contributes to bladder, bowel and sexual function.

Pelvic floor dysfunction does not simply mean that the muscles are “weak”. Some people have difficulty contracting the muscles effectively, while others may have difficulty relaxing or coordinating them. Symptoms can include urinary or faecal incontinence, difficulty emptying the bladder or bowel, pelvic organ prolapse symptoms, sexual dysfunction and pelvic pain (6).

Assessment and treatment should therefore be individualised rather than assuming that everyone with pelvic symptoms needs strengthening exercises. Where appropriate, pelvic-health osteopathic appointment may include education, exercises, relaxation, coordination training and other strategies based on the individual’s findings (1,6).

Tailbone pain (coccydynia)

Pain around the coccyx can occur following a fall or other injury, pregnancy and childbirth, prolonged sitting or repeated strain. Sometimes no clear cause is identified (7).

Symptoms commonly include pain when sitting, standing up from sitting or leaning backwards.

Depending on the presentation, management may include activity modification, pain relief and appropriate manual therapy. In persistent cases, other treatments may be considered following clinical assessment (7).

Read more about tailbone pain (coccydynia) in this article.

Previous surgery and scars

Pelvic or abdominal surgery can sometimes be associated with persistent pelvic pain. However, the presence of a scar does not necessarily mean that the scar itself is causing pain.

Persistent pain after surgery can involve several factors, including the surgical site, nerves, surrounding tissues and the nervous system’s processing of pain. Chronic postsurgical pain following caesarean birth, for example, has been reported in a proportion of women (8).

Manual scar therapy may help improve scar mobility and reduce discomfort in some individuals. However, research into its effectiveness is still limited, and further studies are needed to establish which techniques are most beneficial and for whom (10).

Pregnancy and postpartum pelvic pain

Pregnancy and childbirth can place significant physical demands on the pelvis and pelvic floor.

Some people experience pelvic girdle pain, pubic symphysis pain, lower back pain, coccyx pain or pelvic floor symptoms during pregnancy or after birth.

Read more about pelvic pain after cesarean section in this article.

Osteopathic management is tailored to the individual’s symptoms and may include education, exercise and rehabilitation, pelvic-floor assessment and other appropriate healthcare interventions (6).

How can osteopathy help?

Manual therapy may help reduce pelvic pain in some individuals, although its effectiveness varies depending on the underlying condition and treatment approach (3). At OsteoNordic, we take the time to understand not only where your pain is, but what may be contributing to it.

During your assessment, we look at how your whole body moves, including your spine, pelvis, hips, breathing, posture and movement patterns. We also discuss lifestyle factors such as stress, sleep, exercise and previous injuries, as these can all influence how pain is experienced.

Many people are surprised to learn that persistent pelvic pain is not always caused by damage to the tissues themselves. The nervous system can become increasingly sensitive over time, which may contribute to muscle tension, guarded movement and persistent pain.

Understanding this can be an important part of recovery.

Treatment is always tailored to you and may include:

Gentle hands-on treatment
Joint mobilisation
Soft tissue techniques
Breathing exercises
Rehabilitation exercises
Movement advice
Lifestyle guidance
Education about pain and recovery

Our aim is to help you manage your symptoms, understand possible contributing factors and develop strategies to support your recovery and reduce the risk of recurring problems.

However, evidence for manual therapy varies between different pelvic pain conditions and techniques. It may therefore be a useful complementary approach for some patients, rather than a replacement for appropriate medical assessment and other healthcare interventions (1,3).

For some individuals, a multidisciplinary approach involving healthcare professionals from different areas may be appropriate.

Gentle Tips for Pelvic Pain

Watch the video below, where Darya shares some gentle tips you can explore to help manage pelvic pain and discomfort.

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Frequently Asked Questions About Pelvic Pain

What is the most common cause of pelvic pain?

There is no single most common cause that applies to everyone. Pelvic pain can have gynaecological, urological, gastrointestinal, musculoskeletal, neurological and other contributors, and several factors may coexist (1,2).

Can pelvic pain be caused by tight pelvic floor muscles?

Yes. Overactivity or difficulty relaxing the pelvic floor muscles can contribute to pelvic pain in some people. Assessment is important because pelvic floor symptoms can also involve weakness, poor coordination or other problems (1,6).

Can endometriosis cause pelvic pain?

Yes. Pelvic pain is one of the symptoms associated with endometriosis, particularly when pain is related to menstruation, sex, bowel movements or urination (4).

Can pelvic pain come from the lower back or hips?

Musculoskeletal problems involving the lower back, hips, pelvis and surrounding muscles can contribute to pelvic symptoms in some people. However, pelvic pain should not automatically be assumed to be musculoskeletal without considering other possible causes (1,2).

Can stress make pelvic pain worse?

Stress and emotional factors can influence how pain is experienced and can contribute to the persistence of chronic pain. This does not mean the pain is psychological or imaginary (1,2)

Can pelvic pain go away on its own?

Sometimes. The outlook depends on the underlying cause. New, mild symptoms may settle, but persistent or recurrent pelvic pain should be assessed rather than simply ignored (2,9).

Can osteopathy help with pelvic pain?

Osteopathy may form part of a wider treatment plan for some individuals, particularly where musculoskeletal factors are contributing. It should complement appropriate medical assessment and other healthcare interventions rather than replace them (1,3).

Do I need an internal pelvic floor examination?

Not necessarily. An internal examination is only one possible component of pelvic health assessment and should only be undertaken when clinically appropriate, by a suitably trained healthcare professional and with informed consent. Other aspects of assessment can often be performed without an internal examination (6).

9. When should pelvic pain be investigated?

Persistent, recurrent or unexplained pelvic pain should be discussed with a healthcare professional. Investigation may be particularly important when symptoms include abnormal bleeding or discharge, urinary or bowel changes, painful periods, pain during sex, fever, unexplained weight loss or possible pregnancy (4,9).

What should I do if my pelvic pain is severe?

Severe or rapidly worsening pelvic pain requires urgent medical assessment, especially when accompanied by fainting, significant dizziness, heavy bleeding, difficulty breathing or other severe symptoms. Call 999 or attend A&E if symptoms are severe or you feel seriously unwell (9).

References

M. F, Baranowski, A.P, Fowler, C.J, V. L, Malone-Lee, J.G, Messelink, E.J, et al. EAU Guidelines on Chronic Pelvic Pain. European Urology. 2004 Dec 1
Royal College of Obstetricians and Gynaecologists. The Initial Management of Chronic Pelvic Pain. Green-top Guideline No. 41. London: RCOG.
Starzec-Proserpio M, Frawley H, Bø K, Morin M. Effectiveness of nonpharmacological conservative therapies for chronic pelvic pain in women: a systematic review and meta-analysis. American Journal of Obstetrics and Gynecology. 2025 Jan
National Guideline Alliance (UK). Endometriosis: diagnosis and management. PubMed. London: National Institute for Health and Care Excellence (NICE); 2017
Girard BM, Tooke K, Vizzard MA. PACAP/Receptor System in Urinary Bladder Dysfunction and Pelvic Pain Following Urinary Bladder Inflammation or Stress. Frontiers in Systems Neuroscience. 2017 Dec 4
Pelvic floor dysfunction: prevention and non-surgical management [Internet]. ncbibooks. National Institute for Health and Care Excellence (NICE); 2021
NHS – Tailbone (coccyx) pain. nhs.uk. 2017. Available from: https://www.nhs.uk/conditions/tailbone-coccyx-pain/
Ciechanowicz S, Joy RR, Kasmirski J, Blake L, Carvalho B, Sultan P. Incidence, Severity, and Interference of Chronic Postsurgical Pain After Cesarean Delivery: A Systematic Review and Meta-analysis. Journal of Clinical Anesthesia. 2025 June;104:111832
NHS website. Pelvic pain. nhs.uk. 2017. Available from: https://www.nhs.uk/symptoms/pelvic-pain/
Lubczyńska A, Garncarczyk A, Wcisło‐Dziadecka D. Effectiveness of various methods of manual scar therapy. Skin Research and Technology. 2023 Feb 28;29(3).