Chronic Pelvic Pain

Pelvic pain is rarely one thing

Chronic pelvic pain, defined as pain persisting for six months or longer, can involve the pelvic floor muscles, the nervous system, the bladder, bowel, reproductive organs, connective tissue, or any combination of these. Effective assessment must look at all of them.

Common presentations we see

• Pelvic floor muscle tightness, muscles that are chronically too tight, causing pain with intercourse, urination, or bowel movements and a constant sense of pelvic tension.
• Tight, tender spots in the pelvic muscles, active trigger points within the main pelvic floor muscles, deep hip muscles, or a small muscle at your tailbone referring pain to the pelvis, hips, inner thighs, or tailbone.
• Vulvodynia and pain at the vaginal entrance, localized pain or burning at the vaginal entrance, often associated with nervous system sensitization.
• Tailbone pain, tailbone pain, often related to a fall, childbirth, or prolonged sitting postures.
• Pelvic girdle pain, pain in the sacroiliac joints, the joint at the front of your pelvis, or surrounding areas, common during and after pregnancy.

The brain-pelvic floor axis

When pain persists, the central nervous system can become sensitized, a state where the threshold for pain drops and stimuli that would not normally hurt begin to. This is called an over-sensitised nervous system, and it is common in chronic pelvic pain.

Understanding this changes how treatment is approached. Addressing only the muscles while ignoring nervous system regulation, stress, sleep, and movement patterns produces incomplete results. Our assessment considers the full picture using validated tools including the Central Sensitization Inventory.

How we treat pelvic pain

• Down-training and relaxation, for too tight or guarded pelvic floors, the priority is learning to release rather than contract further.
• Internal and external gentle hands-on muscle treatment, gentle manual therapy targeting trigger points and restricted tissue.
• Breathing retraining, diaphragmatic breathing directly lowers pelvic floor resting tone and nervous system arousal.
• Graduated exposure, slowly re-engaging with feared movements to reduce avoidance and pain-sensitization loops.
• Pain education, understanding that pain does not always mean damage is itself a powerful therapeutic intervention.