The causes of pelvic pain can include:

• 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 (stomach area), low back, or groin areas.
• Pressure on one or more nerves in the pelvis.
• Weakness of the muscles around 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.

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 like "pins and needles." You also 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.
• A feeling that you are sitting on something hard, like a golf ball.

With pelvic pain, you may experience:

• Inability to sit for a long period.
• Reduced ability to move your hips or low back.
• Trouble walking, sleeping, or doing daily activities.
• Pain or numbness in the pelvic region with exercise or other 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.
• Problems inserting tampons or with sexual penetration.

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

• Pelvic-girdle (the basin-shaped bony structure that connects the spine to the legs) screening.
• Soft-tissue assessment.
• Visual exam of the tissues.
• Sensation testing.
• Internal assessment of pelvic-floor muscles.
  
  

Your physical therapist also may refer you to a doctor to help in your plan of care.

Based on their findings, your physical therapist will design a 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.
• Teach you how to use these muscles correctly. Your physical therapist can instruct you on the proper ways to do activities like:
• Exercise.
• Correcting your posture.
• Getting up from a chair.
• Squatting to pick up a child or an object from the floor.
• Work with you on exercises to stretch and strengthen the affected muscles. The goal is to help your muscles work together in the best way possible.
• Teach you the right pelvic-floor muscle exercises.
• Get you back to doing all of the activities you were able to do before your pelvic pain started.

Some risk factors affect general health and your core and pelvic muscle and joint strength. These include:

• Aging.
• Smoking and related coughing.
• Inactivity.
• Obesity.
• Childbirth.

Exercises may help improve muscle function and lower the risk of pelvic injury or pain. These can include:

• Core stability, pelvic-floor, and deep abdominal-wall exercises.
• Muscle flexibility training.
• Body-awareness exercises.

Your physical therapist will design the right treatment program for your specific condition. The main goal of physical therapy is to restore muscle strength and movement and help to relieve your pain.

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 physical 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.
• A physical therapist who has earned a certificate from the CAPP-Pelvic program through the Academy of Pelvic Health Physical Therapy.

You can find physical therapists in your area with these credentials and clinical expertise on Find a PT, a tool built by the American Physical Therapy Association.

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

• Get recommendations from family, friends, or 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.
• Be prepared to describe your symptoms in as much detail as possible during your first visit. Make a note of what makes your symptoms better or worse.