Pelvic Pain and Overactive Pelvic Floor Muscle Dysfunction

Do you ever experience discomfort during a gynecological exam? Is sex painful or unpleasant? Does pain in your tailbone make sitting uncomfortable or downright impossible? If so, then you are not alone. Pain in the pelvic region can be a scary and even isolating event. You might think that what you are feeling is not normal and others won’t understand what you are going through.

A WH PT will perform an internal pelvic examination to assess sensation, mobility, strength, tone, and function of the pelvic floor muscles.

What is the pelvic floor?

Think of it as a hammock of support that starts at the pubic bone, spreads across to the sit bones (ischial tuberosities), and ends at the tailbone (coccyx). The urethra, vagina, and rectum are supported by the pelvic floor muscles. These muscles can sag and lose their ligamentous support, resulting in pelvic organ prolapse, or descent. The pelvic floor muscles can also become short and painful, often in response to negative sensations resulting from a urinary tract infection or postmenopausal changes in estrogen levels that affect vaginal health.

How can you get relief?

A WH PT can evaluate the condition of your pelvic floor muscles to determine if they are weak, tight, or in spasm. They can share solutions for functional problems associated with pelvic floor dysfunction and will work with your physician or other health care provider to support you in your recovery.

What is chronic pelvic pain?

It is a general term for pain or discomfort in the pelvic region lasting 3 months or longer. It is a common disorder that affects 5% to14% of women nationwide. [1,2] The source of pain can originate from the pelvic organs (bladder, colon, or uterus), and can result from failure of ligamentous or muscular structures, or failure of bony structures of the pelvis. [3]

If you have pain, it is important to note that pain is a very individual experience and no one knows it better than you. Recent research indicates that chronic pain can become “driven” by the central nervous system, called “central sensitization,” as much, if not more, than local muscle, nerve, and ligament problems “drive” the pain. A WH PT experienced in working with chronic pain will work with you on strategies to address your pain.[4]

Spasm of the pelvic floor muscles, also known as Levator Ani Syndrome, can cause increased tension of the pelvic floor and contribute to pain in the low back, pelvis, and hip area. Patients with Levator Ani Syndrome often have the sensation of a mass in the rectum or pressure in the anal canal. Simple tasks, such as sitting, toileting, and performing everyday household chores can be difficult. The genitalia can also be affected. [5]

Women experiencing pain with sexual intercourse or speculum examination may have a condition called vaginismus. This condition is caused by excessive tightness of the pelvic floor musculature around the opening of the vagina in the anticipation of pain. This can interfere with a woman’s sex life and compromise her ability to get pregnant.

What can you do?

Gentle stretches, just as a runner might stretch the hamstrings to improve range of motion, can provide relief and increased comfort. A WH PT is skilled in the instruction of techniques, such as the use of vaginal dilators, to gently stretch the muscles. Often this is combined with the use of pressure or EMG Biofeedback, a technique in which the patient is given a visual representation of her muscle’s electrical activity while she tries to relax and stretch the area.[6] Biofeedback is also effective in identifying particular muscles that are weak and could benefit from strengthening. Stretching and strengthening exercise, commonly known as the Kegel exercise, (named after Dr. Arnold Kegel, the gynecologist who developed them in the 1950s), can lead to increased pleasure during sexual activity.[7]

Tightness of the pelvic floor muscles can also contribute to constipation, as the person may not relax the area enough to have a productive bowel movement and will strain to pass stool as a result. Chronic straining can lead to other dysfunctions.


  1. Mathias SD, Kupperman M, Liberman RF, et al. Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet Gynecol. 1996;87:321–327.
  2. Howard FM. Chronic pelvic pain. Obstet Gynecol. 2003;101:594–611.
  3. Steege JF, Metzger DA, Levy BS. Chronic Pelvic Pain: An Integrated Approach. Philadelphia, PA: WB Saunders; 1998.
  4. Butler D, Moseley, L. Explain Pain. Noigroup publications. Adelaide, Australia. 2003.
  5. Irion JM, Irion GL. Women’s Health in Physical Therapy. Philadelphia, PA: Lootters Kluwer, Lippincott Williams & Wilkins; 2010.
  6. Cram JR, Kasman G. Introduction to Surface Electromyography. Baltimore, MD: Aspen Publishers; 1998.
  7. Burgio KL, Robinson JC, Engel BT. The role of biofeedback in Kegel exercise training for stress urinary incontinence. Am J Obstet Gynecol. 1991;154:58–64