The pelvic floor is the group of muscles around the vagina, urethra, and anus.
They're located between your pubic bone and your tailbone. Like a trampoline stretching across the base of our torso, they also support the organs around that area: your uterus, bladder, and bowel [1].
Essentially, the pelvic floor exists to keep everything in our pelvis contained and supported.
When we hear about the pelvic floor, it's usually about how weak or strong it is. Things like childbirth, constipation, some medical conditions, and even just the process of ageing can weaken the pelvic floor, making it more difficult for it to do its job.
But one thing we don't often discuss is pelvic floor pain.
Most of us have probably experienced it at least once or twice in our lives — but what exactly is it? What causes it? And more importantly, how can you stop it? Let's dive into it.
What causes pelvic floor pain?
There are many possible causes of pelvic pain but in women, 3 are particularly common:
1. Menstrual cramps
Period pain is maybe the most common way to experience pelvic floor pain.
During our periods, the pelvic floor can cramp and contract along with the uterus, causing pain that can spread out across our abdomen, back, and vulva.
Although it's never pleasant, the good news is that in many cases, this kind of pain only lasts for a day or two, and can be relieved with painkillers [2].
2. Endometriosis
Chronic pelvic pain can also be caused by endometriosis, a condition where the tissue that would normally line the uterus grows outside the uterus, like on your ovaries, bowels, or bladder.
Endometriosis can be agonising and can cause further pain in the tissues of the pelvic floor if they become inflamed.
3. Irritable bowel syndrome
For those with irritable bowel syndrome, or IBS, pelvic floor pain can happen alongside things like bloating, diarrhoea, and constipation.
While it's not known exactly what causes IBS, it can be treated and managed, just like pelvic floor pain can.
Additionally, pelvic pain can be triggered by:
- Pelvic inflammatory disease
- Uterine fibroids
- Constipation
- Urinary tract infections
- Pelvic floor muscle spasms
- Kidney stones
- Pregnancy complications, like a miscarriage, ectopic pregnancy, preterm labour or placental abruption
It's worth noting that pelvic floor pain isn't just something that occurs in women. Everyone can experience it because everyone has a pelvic floor.
“It can occur in men, but it's not as common,” says CEO of Pain Australia, Carol Bennett. “[Pelvic floor pain] affects about 20% of women or 1 in 5 — and about 1 in 12 men.”
What does pelvic floor pain feel like?
Pelvic pain occurs in the lower part of the stomach, although it can also affect the lower back, buttocks, and thighs.
The pain itself is difficult to describe because not everyone experiences it in the same way. For some, it feels like a sharp pain, while for others it is dull. Plus, it can happen in different levels of severity and be constant or intermittent.
How long it lasts can also vary from a few days to months. When it is sudden and severe, it's considered acute pelvic pain. On the other hand, when it comes and goes for longer than 6 months and doesn't improve with treatment, it's considered chronic pelvic pain [3].
The thing about this type of pain is that it rarely comes alone.
“Pelvic floor pain can be associated with any number of symptoms,” says Bennett. Those who experience pelvic floor pain can also feel fatigue, mental health issues, muscle pain and spasms, bloating, and difficulty going to the toilet.
Signs your pelvic pain is serious
Pelvic pain isn't always a symptom of something serious.
However, if you experience severe pelvic pain with any of the symptoms below, speak to your doctor or head to the hospital as soon as you can:
- Fever
- Blood in your urine or poo
- Inability to stand up straight
Additionally, if you are currently pregnant or have been in the last 6 months, seek medical attention as soon as possible.
How is pelvic pain diagnosed?
The term “pelvic floor pain” can sound pretty broad.
The number of things that can cause it, and the ways in which we can experience it, can also make it tricky to decide if what we're feeling is just a random, once-off pain or something that needs to be investigated further.
Bennett says that pelvic floor pain can be difficult to diagnose, even for medical professionals — but we shouldn't let that put us off speaking to a doctor if we're concerned.
“One of the issues around why these conditions are not always quickly diagnosed is because they tend to be things that are difficult to diagnose,” she says.
“It can be difficult to diagnose, and it can be difficult to treat. It's a bit of a journey in terms of identifying the source of the pain and getting a proper diagnosis, and [finding] good management as well which is a very individual thing. It's not simple, but if people can get effective treatment it can be huge in terms of the impact on their quality of life.”
When it comes to seeking medical advice, Bennett says it's always worth seeing a doctor, just in case the pain is caused by an underlying condition.
“The more these things develop,” she says, “The harder it is to manage once it takes hold.”
How is pelvic pain treated?
“With most forms of pain, whether it's pelvic or other forms, the most effective form of management is multidisciplinary care. That basically means, individual treatment tailored to the person's needs,” Bennett says.
Your doctor may recommend:
- Physical therapy. Physiotherapy can be incredibly effective for chronic pain, as can counselling and therapy to help people understand the cause of their pain and manage it accordingly. Your physical therapist may help you pinpoint stiff or tight muscles that may be contributing to the pain and teach you stretches to help loosen them up. Some therapists also use transcutaneous electrical nerve stimulation (TENS) for treating pelvic pain [4].
- Medication. “Some people do use medication and that can be useful as a short-term treatment for pain, but it's generally not recommended in the long term. Medications are generally used in combinations with other treatments.” Medications for pelvic pain include OTC pain relievers, hormonal contraceptives, antibiotics, and muscle relaxers.
- Surgery. In certain cases, surgery may be appropriate, particularly if it's a problem with your pelvic organs that is causing the pain.
For those suffering from period pain, endometriosis or IBS, treatment would involve treating and managing not only pelvic floor pain but the underlying condition as well.
As for at-home pain relief, stretching and heat packs can be useful. Massaging your pelvis can also help (especially for pain related to endometriosis).
“And, obviously, with all of these conditions, one of the other recommendations is that people have a good diet, exercise, and good sleep, as those things will impact your overall health," Bennett adds.
Looking at diet specifically, keeping a food diary can help you identify any foods that may trigger your pain. However, as a rule of thumb, you want to minimise your consumption of red meats, trans fats, dairy, gluten, sugar, and heavily processed foods.
As for what to eat, be sure to have plenty of anti-inflammatory foods — things like dark leafy greens, turmeric, walnuts, salmon, sardines, berries, almonds, and more.
Focus as well on foods that are high in omega-3 fatty acids, as this nutrient can, once again, help reduce inflammation [5] and consider taking a supplement.
You don't have to live with pelvic pain
Pelvic floor pain is a common thing.
For most of us, it might be a once-in-a-blue-moon ache that we can dismiss pretty easily, but anyone experiencing it regularly would be doing themselves a favour by mentioning it to their doctor, especially if there's no obvious cause behind the pain.
Pelvic floor pain can be annoying, frustrating, and, well, painful — but it's important to know that it can be diagnosed, it can be treated, and it's not something we have to put up with forever.
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