What Does Pelvic Floor Pain Feel Like?

Pelvic floor pain is often brushed off as something women and people with vaginal anatomy "just have to deal with" or misdiagnosed by uninformed healthcare providers. So if you're currently dealing with pain in or around your pelvis, we're glad you made it here!

There are many reasons this type of pain can be puzzling. For example:

• Pelvic floor pain is a complex and multifaceted condition that can manifest in different ways and places (including the low back, hips, and abdominals).
• Pelvic floor pain can be both acute (when pain comes on suddenly, but doesn’t last long) and chronic (when the pain sticks around without any physical injury).
• Pelvic floor pain can impact you differently during different stages of life. From puberty to pregnancy to menopause, pelvic floor pain can change.
• Pelvic floor pain can range from a dull ache to a sharp, stabbing pain.

Each type of pelvic floor pain has its unique characteristics and can signal various underlying conditions. If you haven't yet found a doctor who understands your pain, don't hesitate to book a visit at Origin. We are the experts in pelvic floor pain and can help you get relief.

In the meantime, keep reading to learn about 5 common types of pelvic floor pain and how they can show up.

What is pelvic floor pain?

Pelvic floor pain is pain that originates in the muscles and nerves of the pelvic floor. Your pelvic floor is a network of layered muscles, ligaments, and nerves at the bottom of your pelvis and has many important functions. These functions include stabilizing and supporting your pelvic joints and organs through every phase of life — including major growth spurts, pregnancy, childbirth, and menopause. Your pelvic floor also helps to maintain bowel, bladder, and sexual functions, and is critical to balanced posture and healthy breathing patterns.

When present, pelvic floor pain is usually the result of overactivity or tension in the pelvic floor muscles. Over time, it can develop into a complex pain condition known as chronic pelvic pain syndrome (CPPS).

Pelvic floor pain is usually accompanied by bladder, bowel, and/or sexual dysfunction. The pain, combined with these complications, can have a significant negative impact on your relationships and overall quality of life.

Common pelvic floor pain symptoms

Pelvic floor pain symptoms can be different for everyone. For example, for some pelvic floor pain is a tingling, numbness, or aching pain that is localized to the muscles of the pelvic floor.

For others, it can be a stabbing, cramping, or dull pain that radiates to other areas of the body, including your:

• Anus
• Bladder
• Low back or tailbone
• Abdomen
• Anus
• Thighs or groin
• Pubic area
• Hips

Some of the most common symptoms of pelvic floor pain for women include:

• Overactive bladder symptoms including bladder urgency and frequency, UTI-like symptoms such as pain with peeing.
• Sexual pain and dysfunction including pain with penetration (or vaginismus), pain with orgasm
• Bowel dysfunction including constipation, and anal or rectal pain

Pelvic floor pain in women (or anyone with vaginal anatomy)

Pelvic floor pain can happen to anyone, no matter their sex or gender. However, due to anatomical differences in the urinary tract, genitals, reproductive organs, and pelvic floor muscles, pelvic pain presents very differently in those with vaginal anatomy.

1. What does pelvic floor pain during your period feel like?

Your period can be a big trigger for pelvic floor pain for many folks who menstruate. As your body undergoes natural fluctuations in the hormones that regulate your cycle, it can significantly impact your pelvic floor function and lead to discomfort, pain, and other symptoms that extend beyond your typical menstrual cramps.

Here are some ways that pelvic floor pain can show up during your period:

• Dull, aching pain in the pelvic region that may begin a few days before your period, and may even intensify pain throughout the period.
• Increased vulvar and vaginal sensitivity and pain during sex — in other words an exacerbation of your dyspareunia symptoms surrounding the time of your period.
• Increased pain to your lower back, thighs, and abdomen, which can be attributed to the interconnectedness of pelvic floor muscles with other muscle groups.
• More intense urinary symptoms such as urgency or frequency, or pain during urination.

In addition to your hormones, pelvic floor pain during your period can be a result of irritated trigger points in the pelvic floor, as well as in associated muscles such as the lower rectus abdominis, quadratus lumborum, and gluteus medius. This study shows that myofascial trigger point release was effective at easing period paid.

It’s also important to note that certain gynecological conditions such as endometriosis or uterine fibroids, can exacerbate pelvic floor pain during menstruation — this is known as secondary dysmenorrhea — due to their impact on the pelvic anatomy. Your body, including the muscles in your pelvic floor will often respond to this exacerbated pain with more intense muscle tension and increased pelvic pain symptoms.

2. What does pelvic floor pain during pregnancy feel like?

Your body goes through a tremendous amount of change throughout the trimesters of your pregnancy. These changes can bring about a variety of aches and pains, including pelvic floor pain.

Pelvic floor pain can be a result of several factors associated with the changes of pregnancy including hormonal changes that can contributed to relaxation and instability in the joints of the pelvis, shifts in your posture and pelvic positions, and an increased visceral load (this would include the weight of your growing uterus, placenta, fetus, and even increased blood volume that is circulating) that your pelvic floor muscles have to adjust to during pregnancy.

All of this change and strain can add up to new, or worsened, pelvic floor symptoms and pelvic floor pain during your pregnancy. Here are some of the most common ways pelvic floor pain shows up in pregnancy:

• Increased pelvic floor pain during sex: It’s very common for sex to feel awkward as your body changes throughout pregnancy, but pain during sex is an unwelcomed (and not normal) way that pelvic floor pain can show up in almost 70% of people by their 3rd trimester).
• Pubic bone, or low back pain: This is generally referred to as lumbopelvic or pelvic girdle pain and is seen in up to 50% people at some point in their pregnancy. This is often described as a dull aching pain that lingers all of the time, and can even intensify throughout pregnancy. Other times, it can feel like a sharp, stabbing, or burning pain only felt when during certain activities, or making certain movements.
• Constipation: While it is pretty tricky to totally avoid constipation during pregnancy, it has been known to increase low back pain during pregnancy. Constipation can cause increased gas and pressure in the pelvic area and cause pain and discomfort. Your pelvic floor muscles are also commonly involved with constipation as well. Tight and overactive pelvic floor muscles can worsen constipation and exacerbate pelvic floor pain.

3. What does pelvic floor pain after birth feel like?

Pelvic floor pain doesn’t usually spontaneously go away just because your baby is born. Injuries developed in pregnancy can linger in the postpartum. And the processes of a vaginal or cesarean birth can further increase your risk of postpartum pelvic floor pain. Here is how pelvic floor pain can show up differently in the postpartum:

• Tailbone pain: Buttocks and low back pain are common in the postpartum but if the pelvic floor muscles are injured during a vaginal birth, this can further exacerbate tailbone pain (Coccydynia). A vaginal birth can also leave you at risk for an intrapartum coccygeal fracture, or a tailbone fracture that happens during birth. Although fracturing your tailbone is rare, it is more common to have lingering tailbone pain after delivery which can make it difficult to sit for baby care or feeding, and painful to move up and down out of a chair.
• Postpartum low back pain: You can develop new pain in your low back in the postpartum period, but more commonly this is a common symptom of pelvic floor pain that has carried over from pregnancy. This pain is often a result of weakened or injured (by cesarean birth) abdominal muscles, dramatic hormonal fluctuations, new and different shifts in posture, and the physical strain and sleep deprivation that comes along with caring for a newborn.
• Perineal or vaginal pain: At least 85% of people will sustain perineal injury (your perineum is the space between the vaginal and anal openings) during a vaginal birth. This is a very common place to either tear, or have an episiotomy (a surgical cut made to your perineum that is sometimes performed by your obstetric healthcare provider during delivery to assist in birth). It is also common to experience tearing in the vagina, and the pelvic floor muscle during delivery. These birth injuries can increase tension, or aggravate trigger points throughout your pelvic floor and contribute to more intense, or new pelvic floor pain.

Increased pelvic floor pain is common no matter how you gave birth. While it’s more common to injure your muscles or experience perineal tears during a vaginal birth, cesarean births are associated with increased pelvic floor pain during sex.

4. What does pelvic floor nerve pain feel like?

This type of pelvic floor pain is more specifically called pudendal neuralgia. It is characterized by persistent and debilitating pain in the pelvic floor area which can include the vulva, anus, and pelvic floor muscles.

Pudendal neuralgia usually results from damage or irritation to the pudendal nerve, which is an important nerve that brings sensation and function to pelvic floor muscles and vulva. Common causes of this pelvic floor nerve pain include:

• Childbirth
• Surgery
• Chronic constipation (because of excessive and chronic straining
• Repetitive and chronic compression from activities such as cycling
• Direct trauma to the area

The pain experienced can be excruciating, making everyday activities such as sitting, wearing tight clothing like underwear or yoga pants, and any kind of sexual activity extremely uncomfortable or even unbearable.

In addition to pain with sex, common symptoms of pudendal neuralgia include a burning or shooting pain in the vulva and anus, a sensation that there is something in your rectum or vagina (sympathalgia), urinary frequency or pain with a full bladder, pain during bowel movements, and referred pain to the buttocks, pubic bone, inner thighs, and the area of the sciatic nerve.

5. What does pelvic floor pain during menopause feel like?

Pelvic floor pain during menopause is commonly associated with a variety of sexual dysfunction and bladder dysfunction symptoms including pain and sexual dysfunction, pelvic heaviness, and increased urinary urgency and frequency.

This type of pelvic floor pain can be linked to the decreases in estrogen that happens during perimenopause and menopause. Lower levels of estrogen can impact the pelvic floor muscles by:

• Decreasing blood flow to the vulva and clitoris which can impact tissue health, and lead to pain
• Decreased clitoral size which can reduce please and arousal during sex
• Thinning, and drying of the vulvar and vaginal mucosal tissues
• Decreased flexibility of the vaginal tissues

While low estrogen levels can contribute to these pelvic floor pain, it is not the only cause. Pelvic floor pain in menopause can also result from a variety of factors, including daily bathroom habits, past injuries (linger injuries that were not resolved in the postpartum for example), or a history of sexual trauma.

Why you shouldn't ignore pelvic floor pain

The complex nature of pelvic floor pain highlights the importance of recognizing the varied symptoms and potential causes of this condition. From the dull aches and sharp pains that can radiate beyond the pelvic region to the impact it can have on bladder, bowel, and sexual function. Pelvic floor pain can significantly affect your quality of life and it’s not worth ignoring, or suffering with. Understanding the specific symptoms and potential causes of your pelvic floor pain, at any point in your life, is essential in getting effective treatment. And this is important because pelvic floor pain is highly treatable. In fact pelvic floor physical therapy is an effective, and evidence-based treatment option for many of the common causes of pelvic floor pain.

At Origin Physical Therapy, our expert pelvic physical therapists (PTs) are specialized in treating all of these common causes of pelvic floor pain. From pain during your period to pain during menopause, and every moment in between they are highly trained and trusted experts in the field of pelvic health and pelvic floor pain.

If you are experiencing symptoms of pelvic floor pain, do not hesitate to reach out for help. The team at Origin Physical Therapy is here to support you. We encourage you to call and book an appointment with one of our PTs today. We cannot wait to get help you get your pain-free pelvic floor back.