Understanding Pelvic Floor Pain: A Hidden Source of Chronic Discomfort

By Dr. Bindu Lewis, MD – Interventional Pain & Spine Specialist

Pelvic floor pain is one of the most under-recognized—and often misunderstood—sources of chronic discomfort I see in practice. Patients frequently arrive after months or even years of searching for answers, having been told their symptoms are “unclear,” “stress-related,” or simply something they must learn to live with. The truth is, pelvic floor pain is real, diagnosable, and very treatable when approached with the right expertise and a multidisciplinary mindset.

What Is the Pelvic Floor?

The pelvic floor is a complex network of muscles, ligaments, and connective tissue that spans the bottom of the pelvis. It supports critical organs including the bladder, bowel, and—in women—the uterus. These muscles also play a vital role in urinary and bowel control, sexual function, and core stability.

When the pelvic floor muscles become tight, weak, or uncoordinated, pain can develop. Unlike more familiar musculoskeletal injuries, pelvic floor dysfunction often manifests in subtle, diffuse, and sometimes deeply personal ways that patients may hesitate to discuss.

Common Symptoms of Pelvic Floor Pain

Pelvic floor pain does not always present as localized discomfort. Instead, it can show up in a variety of ways, including:

• Chronic pelvic pain or pressure
• Pain with sitting, especially over long periods
• Pain during or after sexual activity
• Urinary urgency, frequency, or incomplete emptying
• Painful bowel movements or constipation
• Lower back, hip, or groin pain without a clear orthopedic cause

Because these symptoms overlap with multiple specialties—gynecology, urology, gastroenterology, orthopedics—patients are often referred from one provider to another before landing on the correct diagnosis.

Why Pelvic Floor Pain Is Often Missed

Pelvic floor dysfunction is frequently overlooked for several reasons:

• Lack of awareness – Many patients (and even some clinicians) are unfamiliar with the pelvic floor as a source of pain.
• Non-specific symptoms – The pain may not follow typical nerve or joint patterns.
• Stigma and discomfort – Patients may feel embarrassed discussing pelvic symptoms.
• Overlap with other conditions – Disorders such as endometriosis, irritable bowel syndrome (IBS), and interstitial cystitis can coexist.

In my practice, I emphasize that pelvic floor pain is not “in your head”—it is a neuromuscular condition that deserves thoughtful evaluation and targeted treatment.

What Causes Pelvic Floor Dysfunction?

Pelvic floor pain can develop from a variety of underlying factors, including:

• Muscle overactivity or spasm (often from chronic stress or guarding)
• Childbirth-related injury or trauma
• Prior surgeries in the pelvic or abdominal region
• Chronic constipation or straining
• Repetitive physical stress (athletics, heavy lifting)
• Nerve sensitization or chronic pain syndromes

Importantly, many patients do not recall a single triggering event. Instead, pelvic floor dysfunction often develops gradually over time.

A Modern Approach to Diagnosis

Accurate diagnosis begins with listening. A detailed history combined with a focused physical exam—often including specialized pelvic floor assessment—is essential.

In some cases, we may incorporate:

• Diagnostic imaging (to rule out structural issues)
• Ultrasound-guided evaluations
• Collaboration with pelvic floor physical therapists

The goal is not just to identify pain, but to understand why those muscles are behaving abnormally.

Treatment: A Multidisciplinary Path Forward

Pelvic floor pain is highly treatable, but rarely with a one-size-fits-all approach. In my experience, the most successful outcomes come from combining therapies tailored to the individual.

1. Pelvic Floor Physical Therapy

This is the cornerstone of treatment. Specialized therapists help patients:

• Learn to relax overactive muscles
• Improve coordination and control
• Reduce trigger points and muscle tension

2. Targeted Interventional Treatments

For patients who do not improve with conservative care alone, interventional options may include:

• Trigger point injections
• Nerve blocks
• Image-guided pelvic muscle injections

These treatments can “reset” pain pathways and allow physical therapy to be more effective.

3. Medication Management

Certain medications may help reduce nerve hypersensitivity or muscle spasm, particularly in chronic cases.

4. Behavioral and Lifestyle Modifications

Stress plays a significant role in pelvic floor tension. Addressing posture, breathing patterns, and stress response can meaningfully impact symptoms.

When to Seek Help

If you have been experiencing pelvic pain, urinary or bowel changes, or discomfort that has not been explained by imaging or standard tests, it may be time to consider the pelvic floor as a potential source.

Early intervention can significantly improve outcomes and prevent symptoms from becoming chronic.

Final Thoughts

Pelvic floor pain sits at the intersection of multiple body systems, which is why it demands a comprehensive and compassionate approach. As a pain specialist, my role is not only to treat symptoms, but to help patients understand their bodies and regain control over their quality of life.

If there is one message I hope patients take away, it is this:

You are not alone, and your pain is both valid and treatable.

Dr. Bindu Lewis is an interventional pain physician specializing in spine, nerve, and musculoskeletal conditions, with a focused interest in complex pelvic pain syndromes. She practices a patient-centered, multidisciplinary approach to restoring function and improving quality of life.