Pain Down There Isn’t “Normal”—Let’s Talk Solutions

Pelvic pain is one of those things many women silently endure, hoping it will go away or assuming it’s just “part of being a woman.” Maybe you feel sharp twinges during intimacy, a dull ache that lingers for days, or monthly cramps that keep you in bed. Whatever form it takes, here’s the truth: pelvic pain is common, but it’s not normal—and it is treatable.

Since September is Pain Awareness Month, let’s dig into what pelvic pain really is, why it happens, and what you can do to start finding relief.

What is Pelvic Pain?

Pelvic pain is any discomfort felt in the area between your belly button and thighs. It may be sharp, dull, achy, burning, or even feel like pressure. It can interfere with movement, intimacy, exercise, and your day-to-day life.

Why Does Pelvic Pain Happen?

Pelvic pain rarely comes from just one cause—it’s usually the result of muscles, nerves, and tissues working together in ways that aren’t balanced. Here are three of the most common reasons women experience pelvic pain and how pelvic floor physical therapy can help:

1. Pelvic Floor Muscle Tension or Spasms

The pelvic floor muscles should be able to contract and relax just like any other muscle in the body. But sometimes, they get “stuck” in a tightened state. This can happen due to:

• Holding tension in response to stress

• After childbirth, when muscles overcompensate for weakness

• Protective guarding from a past painful experience (like pain with sex or recurrent UTIs)

Why it causes pain: Tight muscles compress nerves, restrict blood flow, and create trigger points—leading to sharp, burning, or aching pain in the pelvis, hips, or low back.

How pelvic floor therapy helps: A pelvic floor PT can teach you how to relax these muscles through manual therapy, breathing techniques, and specific stretches. You’ll also learn strategies to retrain the pelvic floor so it can move through its full range—tighten when needed and fully relax when not.

2. Past Injuries or Surgeries

Even if years have passed, scar tissue or muscle imbalances from injuries and surgeries can set the stage for pelvic pain. Common examples include:

• Cesarean birth

• Hysterectomy

• Abdominal or pelvic surgery (appendix, hernia repair, etc.)

• Hip or back injuries that change how you move

Why it causes pain: Scar tissue doesn’t move the same way as healthy tissue. It can pull on surrounding muscles and fascia, limiting movement and creating pain signals. Compensations from old injuries can also overload the pelvic floor.

How pelvic floor therapy helps: A PT can perform gentle manual therapy to improve the mobility of scar tissue, release tight connective tissue, and retrain your movement patterns. By restoring balance and mobility, we reduce the strain that keeps pain hanging around.

3. Pelvic Pain Conditions (Endometriosis, Adenomyosis, PCOS)

Some women live with conditions that directly affect their pelvic organs:

• Endometriosis: tissue similar to the uterine lining grows outside the uterus, leading to inflammation and scar tissue

• Adenomyosis: uterine lining grows into the muscle wall of the uterus, causing heavy, painful periods

• PCOS (Polycystic Ovary Syndrome): often linked with hormonal imbalances, irregular cycles, and pelvic discomfort

Why they cause pain: These conditions can make the nervous system more sensitive and reactive. Over time, the pelvic floor muscles may tighten in response to chronic inflammation, cramping, or hormonal changes—adding muscle pain on top of organ pain.

How pelvic floor therapy helps: While PT can’t “cure” these conditions, it plays a powerful role in managing symptoms. Therapy focuses on reducing secondary muscle tension, calming the nervous system, and teaching strategies to decrease flare-ups. This often means less pain during periods, less pain with sex, and improved quality of life.

What You Can Do at Home

While pelvic pain often needs professional support to truly resolve, there are simple strategies you can start at home to ease tension, calm your body, and reduce discomfort. Think of these as small daily practices that build a foundation for healing:

1. Diaphragmatic Breathing
   Deep belly breathing isn’t just calming for your mind—it also helps release pelvic floor tension.

   • Try lying down with one hand on your chest and one on your belly.

   • Inhale through your nose, letting your ribcage and belly expand.

   • Exhale slowly, feeling your pelvic floor soften.
     Just 5 minutes a day can make a noticeable difference.

2. Gentle Stretches & Movement
   Certain yoga-inspired movements help lengthen tight pelvic and hip muscles:

   • Child’s pose for lengthening the pelvic floor

   • Happy baby to gently open the hips

   • Supported deep squat (using pillows or yoga blocks) to encourage relaxation
     Move slowly and never push into pain.

3. Heat Therapy
   Warmth increases blood flow, reduces muscle spasm, and soothes discomfort.

   • Place a warm compress or heating pad on your pelvis, hips, or low back.

   • Try a warm bath with Epsom salts for added relaxation.

4. Pelvic Floor Awareness (Relaxation, Not Kegels!)
   Many women assume that pelvic pain means weakness, so they try to do more kegels. But for those with pain, kegels often make things worse. Instead, practice awareness and relaxation:

   • Imagine your pelvic floor dropping gently like a hammock on your inhale.

   • Release unnecessary gripping in your core, glutes, or inner thighs.

5. Stress Management Tools
   Stress fuels muscle tension and pain sensitivity. Find calming practices that work for you, like:

   • Journaling your symptoms and triggers

   • Gentle meditation or guided relaxation apps

   • Taking a short walk outside

   • Saying “no” to one extra thing this week

6. Supportive Lifestyle Choices
   Small shifts in your daily routine can support pelvic health:

   • Stay hydrated to reduce bladder irritation

   • Eat fiber-rich foods to prevent constipation (straining worsens pelvic pain)

   • Prioritize rest and sleep—your body heals best when it’s not running on empty

These strategies are not quick fixes, but they’re powerful tools to begin calming your system and reducing symptoms. If your pain continues or interferes with daily life, that’s your sign to reach out for pelvic floor therapy.

When to See a Pelvic Floor Physical Therapist

If pelvic pain is interfering with your daily life, intimacy, or overall well-being—it’s time to get help. A pelvic floor PT will look at your whole body (not just your pelvis) to figure out why your pain is happening and create a treatment plan tailored to you.

The Bottom Line

Pelvic pain is not something you need to “just live with.” Whether it stems from tight muscles, scar tissue, or conditions like endometriosis, pelvic floor therapy can give you tools, strategies, and hands-on treatment to feel better.

Your pain is real, it’s valid, and it’s treatable.