Chronic pelvic pain is a condition that affects both men and women, yet it is one of the most misunderstood and under-treated pain problems. Many patients spend months or even years visiting gynecologists, urologists, and general physicians, undergoing scans, blood tests, and medications — yet their pain continues. What is often missed is that chronic pelvic pain is frequently driven by musculoskeletal and myofascial dysfunction, not just internal organ problems. At CB Physiotherapy, a comprehensive musculoskeletal approach can play a crucial role in identifying and treating the real source of pain.
This blog explores how chronic pelvic pain can originate from muscles, joints, and nerves — and how physiotherapy offers a safe, evidence-based solution.
What Is Chronic Pelvic Pain?
Chronic pelvic pain is defined as pain in the lower abdomen or pelvic region lasting more than 3 to 6 months, and severe enough to affect daily activities, work, or quality of life. Common descriptions from patients include:
1. Deep aching or heaviness in the pelvis
2. Burning or sharp pain in the lower abdomen
3. Pain during sitting for long periods
4. Pain during or after intercourse
6. Groin or inner thigh discomfort
7. Unexplained bladder or bowel discomfort
In many cases, imaging such as ultrasound, CT scan, or MRI may appear normal — leading patients to feel frustrated or dismissed.
The Hidden Musculoskeletal Link
The pelvis is a complex region where muscles, joints, ligaments, fascia, and nerves work closely with internal organs. When musculoskeletal structures become dysfunctional, they can mimic or contribute to pelvic pain. Some commonly overlooked causes include:
1. Pelvic Floor Muscle Dysfunction
Pelvic floor muscles can become:
1. Overactive (tight and unable to relax)
2. Weak and poorly coordinated
3. Painful with trigger points
4. Tight pelvic floor muscles can cause:
5. Pain with sitting
6. Pain during intimacy
7. Urinary urgency
8. A feeling of pressure or heaviness
2. Sacroiliac Joint (SI Joint) Dysfunction
The SI joints connect the spine to the pelvis. Even subtle dysfunction can refer pain to:
1. Lower abdomen
2. Groin
3. Buttocks
4. Hip region
5. Pelvic area
6. This is often mistaken for gynecological or urological pain.
3. Myofascial Trigger Points
Trigger points in muscles such as:
1. Obturator internus
2. Iliopsoas
3. Piriformis
4. Adductors
5. Lower abdominal muscles
6. can refer pain directly into the pelvis, bladder region, or perineum, creating symptoms that feel “internal.”
4. Nerve Sensitization
Chronic pain can cause nerves such as:
1. Pudendal nerve
2. Ilioinguinal nerve
3. Genitofemoral nerve
4. to become hypersensitive, leading to burning, electric, or stabbing pain sensations.
Why Medications and Scans Often Don’t Solve It?
Painkillers, antibiotics, or hormonal treatments may temporarily reduce symptoms but do not address muscle tension, joint restriction, or nerve irritation.
Similarly, scans focus mainly on organs and bones — but:
1. Muscle tension
2. Fascial tightness
3. Movement dysfunction
4. Poor pelvic control
5. do not always appear on imaging.
6. This is why many patients are told “everything is normal” despite real, ongoing pain.
How Physiotherapy at CB Can Help?
At CB Physiotherapy, a specialized musculoskeletal and movement-based approach allows therapists to identify the real drivers of chronic pelvic pain.
1. Detailed Musculoskeletal Assessment
This includes:
1. Pelvic alignment
2. Hip and lumbar spine mobility
3. Muscle length and strength testing
4. Trigger point evaluation
5. Functional movement analysis
6. This helps differentiate between organ-based and movement-based pain sources.
2. Pelvic Floor Physiotherapy (When Indicated)
For appropriate patients, physiotherapy may focus on:
1.Pelvic floor relaxation techniques
2. Breathing retraining
3. Down-training overactive muscles
4. Coordination and control exercises
5. This is especially helpful for patients with pain related to tight or guarded pelvic muscles.
3. Manual Therapy and Myofascial Release
Targeted hands-on techniques can:
1. Release tight pelvic and hip muscles
2. Improve tissue mobility
3. Reduce trigger point sensitivity
4. Improve blood flow and healing
4. Core and Pelvic Stability Training
Poor control of deep core and pelvic muscles can overload sensitive tissues. Physiotherapy helps:
1. Restore balanced muscle activation
2. Improve load distribution
3. Reduce strain on pain-sensitive structures
5. Nervous System Desensitization
Chronic pain often involves central sensitization. Education, graded movement, and pacing strategies help:
1. Calm the nervous system
2. Reduce pain amplification
3. Improve confidence with movement
Who Should Consider Physiotherapy for Pelvic Pain?
Physiotherapy is especially helpful if you:
1. Have ongoing pelvic pain with normal scans
2. Experience pain while sitting
3. Have tailbone, groin, or hip pain with pelvic symptoms
4. Have bladder or bowel discomfort without a clear medical cause
5. Have pain after childbirth or abdominal surgery
6. Have pain that worsens with stress or prolonged postures
A Different Way to Understand Pelvic Pain
At CB Physiotherapy, chronic pelvic pain is not viewed as “just in your head” or purely an internal problem. It is understood as a complex interaction between muscles, joints, nerves, and the nervous system.
By addressing these physical contributors, many patients finally experience:
1. Reduced pain
2. Improved sitting tolerance
3. Better movement confidence
4. Improved quality of life
5. Reduced dependence on medication
Chronic pelvic pain does not have to be a lifelong struggle. When musculoskeletal factors are properly assessed and treated, physiotherapy can be a powerful and often missing part of recovery.
If you or someone you know has persistent pelvic pain with no clear answers, a physiotherapy assessment at CB may uncover causes that have been overlooked — and open the door to meaningful, lasting relief.
