Pelvic pain affects roughly one in six women at some point. The experience ranges from a dull ache that comes and goes to sharp, persistent discomfort that disrupts sleep and daily activities. Most importantly, the majority of cases are not caused by anything sinister and respond well to targeted treatment.
The challenge is that pelvic pain sits at the intersection of several body systems. Your muscles, joints, reproductive organs, bladder, and bowel all share the same anatomical space. Pain can stem from any of these structures, which is why finding the root cause matters.
In clinic, we often see women whose scans are normal yet who still experience genuine, limiting pain. That disconnect happens because many causes of pelvic pain do not show up on imaging. Muscle tension, nerve sensitivity, and pelvic floor dysfunction are invisible to ultrasound but very real.
What Causes Pelvic Pain in Women?
Pelvic pain in women typically arises from musculoskeletal issues, gynaecological conditions, or digestive system problems. In many cases, multiple factors contribute simultaneously, which is why a thorough assessment is essential to identify the primary drivers.
Musculoskeletal causes are more common than most people realise. Your pelvic floor muscles can become overactive or weak, creating pain during sitting, intercourse, or bowel movements. The joints at the front and back of your pelvis can become stiff or irritated, particularly after pregnancy.
Abdominal wall tension and trigger points often refer pain into the pelvis. We see this frequently in women who have had caesarean sections or other abdominal surgery. Scar tissue can change how muscles recruit, creating pain months or years later.
Gynaecological causes include endometriosis, ovarian cysts, fibroids, and pelvic inflammatory disease. These conditions often produce cyclical pain that worsens around menstruation, though not always. Chronic pelvic pain can persist even after gynaecological treatment if musculoskeletal factors are not addressed.
Digestive issues such as irritable bowel syndrome and constipation contribute to pelvic pain more often than you might expect. Chronic straining or bloating increases intra-abdominal pressure, which loads the pelvic floor muscles and can trigger pain cycles.
Pelvic pain after childbirth deserves specific mention. Healing takes time, but pain persisting beyond three months or worsening over time warrants assessment. Postnatal pain can arise from pelvic floor trauma, pelvic girdle instability, or caesarean complications.
When Should You Be Worried About Pelvic Pain?
Most pelvic pain is not an emergency, but certain symptoms require urgent medical attention. Red flags include sudden severe pain, fever, unexplained bleeding, fainting, or pain during early pregnancy. These symptoms need same-day medical review to rule out serious conditions.
Cancer anxiety is understandable when you experience persistent pain. Gynaecological cancers typically present with specific patterns rather than isolated pelvic pain. Ovarian cancer, for instance, usually involves bloating, early satiety, urinary frequency, and abdominal swelling alongside pain. Persistent symptoms deserve investigation, particularly if worsening or accompanied by other concerning changes.
Seek urgent medical care if you experience:
- Fever above 38°C with pelvic pain
- Sudden, severe pain that comes on rapidly
- Unexplained vaginal bleeding, particularly after menopause
- Fainting or feeling faint alongside pain
- Pain in early pregnancy or suspected pregnancy
- Blood in your urine
- Rapidly worsening symptoms over hours or days
These symptoms may indicate conditions like ectopic pregnancy, ovarian torsion, appendicitis, or pelvic infection. They require prompt assessment, not physiotherapy.
Can Physiotherapy Help Pelvic Pain?
Physiotherapy addresses the mechanical and neuromuscular aspects of pelvic pain. Research shows that pelvic floor physiotherapy reduces pain and improves function in women with chronic pelvic pain, even when other treatments have been tried.
We work with the muscles, fascia, nerves, and movement patterns that contribute to pain. Sometimes the pelvic floor is too tight and needs to learn to relax. Other times it is weak in specific areas or poorly coordinated. Both scenarios can produce pain.
Consider someone who develops pain six months after a difficult birth. Her pelvic floor might be gripping protectively around scar tissue, creating tension and pain during activities like walking or lifting. Physiotherapy helps retrain that muscle to release, improves tissue mobility, and gradually rebuilds strength without flaring symptoms.
Beyond the pelvic floor itself, we look at your whole movement system. Hip stiffness, core muscle imbalance, and breathing patterns all influence pelvic pain. Addressing these factors alongside local tissue work produces better outcomes than focusing on one area alone.
Physiotherapy is particularly effective for musculoskeletal pelvic pain, postpartum pain, pelvic floor dysfunction, and chronic pelvic pain where no structural cause has been found. It often works well alongside medical management for conditions like endometriosis.
What Happens During a Pelvic Pain Assessment?
Your first appointment involves detailed discussion about your pain history, menstrual cycle, bowel and bladder function, sexual health, and any previous births or surgeries. These conversations provide crucial context that scans cannot offer.
We assess your posture, movement, breathing pattern, and abdominal wall. Many people are surprised that we examine hips, lower back, and feet. Pain in the pelvis rarely exists in isolation.
An internal examination is often valuable but always optional. This involves gently assessing the pelvic floor muscles to check for tension, tenderness, strength, and coordination. We proceed only with your informed consent and can pause or stop at any point. Internal assessment is not always necessary on the first visit, particularly if you are anxious or experiencing severe pain.
Following assessment, we develop a treatment plan tailored to your findings. This might include manual therapy to release tight tissues, exercises to improve coordination, strategies to reduce pain flares, and education about your body.
When Should You See a Physiotherapist in London?
If your pelvic pain has persisted for more than three months, it qualifies as chronic pelvic pain and warrants specialist assessment. Waiting longer rarely leads to spontaneous resolution.
Book an appointment if your pain is stopping you from exercising, working comfortably, or enjoying time with family. Pain that disrupts your sex life or makes you avoid social situations deserves attention.
Postnatal women should seek help if pain persists beyond the initial healing period or worsens over time. The common advice to “wait and see” works for minor discomfort but not for significant pain.
Our clinic in Bloomsbury provides specialist women’s health physiotherapy in London with same-day and weekend appointments. Being located near Tottenham Court Road makes us accessible for women working in Central London.
You do not need a GP referral to book. Some women prefer to see us first to understand what is happening before pursuing medical investigations. Others come after scans have been normal but symptoms persist.
The NHS provides guidance on pelvic pain that can help you understand when to seek medical versus physiotherapy input. For many women, both are important parts of comprehensive care.
Moving Forward
Pelvic pain is common, but it is not something you simply have to live with. Most causes respond well to treatment once properly identified.
Learn more about our pelvic pain physiotherapy service or book your appointment at our Central London clinic. We offer thorough assessment and evidence-based treatment for all types of pelvic pain in women.
Book your appointment or contact our team today and take the first step towards understanding and resolving your pelvic pain.