Pelvic pain has dozens of possible causes, ranging from tight muscles and digestive issues to reproductive conditions and nerve problems. About 1 in 7 women in the United States experience chronic pelvic pain, and it affects roughly 2% to 16% of men as well. Figuring out what’s behind your pain starts with understanding where it’s coming from, what makes it worse, and what other symptoms show up alongside it.
Muscle Tension in the Pelvic Floor
One of the most overlooked causes of pelvic pain is the pelvic floor itself. These are the muscles that stretch like a hammock across the bottom of your pelvis, supporting your bladder, bowel, and reproductive organs. When those muscles stay clenched and can’t fully relax, it’s called high-tone pelvic floor dysfunction. The result is a deep ache in the pelvis, pain during sex, difficulty emptying the bladder or bowels, and sometimes a burning or throbbing sensation that’s hard to pin down.
Stress and anxiety play a significant role. Up to 66% of women with chronic pelvic pain also have depression or anxiety, and that emotional tension can directly feed into muscle tightness. Over time, the nervous system itself can become oversensitized, amplifying pain signals from the pelvic area even when there’s no injury or infection present.
Pelvic floor physical therapy is considered the first-line treatment. A specialized therapist works with you to release tight muscles, retrain coordination, and reduce pain triggers. If that alone isn’t enough, options like trigger point injections, muscle relaxants, or cognitive behavioral therapy can be added. Many people with this type of pelvic pain go months or years without a diagnosis because it doesn’t show up on imaging.
Causes More Common in Women
Endometriosis
Endometriosis happens when tissue similar to the uterine lining grows outside the uterus, attaching to surfaces like the ovaries, fallopian tubes, or the tissue lining the pelvis. This tissue responds to hormonal cycles the same way the uterine lining does, building up and breaking down each month, but with no way to exit the body. The result is inflammation, scarring, and pain that often intensifies around your period. Some people also experience pain during sex, pain with bowel movements, or difficulty getting pregnant.
Fibroids
Uterine fibroids are noncancerous growths that develop in or on the uterus. They’re extremely common, and many people have them without knowing it. When fibroids do cause symptoms, the feeling is typically pressure or heaviness in the lower abdomen or lower back rather than sharp pain. Larger fibroids can press on the bladder, causing frequent urination, or on the rectum, causing constipation. Sharp pain from fibroids is rare but can happen if a fibroid outgrows its blood supply.
Pelvic Inflammatory Disease
Pelvic inflammatory disease (PID) is an infection of the reproductive organs, usually caused by sexually transmitted bacteria. It often starts with mild, easy-to-miss symptoms: abnormal bleeding, unusual discharge, or pain during sex. Because these signs are nonspecific, many cases go unrecognized. Left untreated, PID can cause serious complications including scarring of the fallopian tubes and chronic pain. Fever over 101°F, severe nausea, or vomiting alongside pelvic pain warrants urgent medical attention, as these can indicate a more serious infection or abscess.
Causes More Common in Men
Chronic prostatitis, also called chronic pelvic pain syndrome, is one of the most frequent causes of pelvic pain in men. Despite the name, it often has nothing to do with a bacterial infection. The pain typically shows up in the area between the scrotum and the anus (the perineum), the lower abdomen, the groin, or the lower back. It can also cause burning during urination, painful ejaculation, and a persistent discomfort in the testicles or penis. Symptoms tend to come and go over weeks or months.
Inguinal hernias are another possibility. These occur when tissue, usually part of the intestine, pushes through a weak spot in the abdominal wall near the groin. The pain often worsens with lifting, coughing, or standing for long periods, and you may notice a visible bulge in the groin area.
Bladder and Bowel Conditions
Interstitial Cystitis
Interstitial cystitis, sometimes called painful bladder syndrome, causes chronic pelvic pain centered around the bladder. The protective lining of the bladder may have defects that allow irritating substances in urine to reach the bladder wall, triggering inflammation. The hallmark symptoms are a persistent, urgent need to urinate, frequent urination in very small amounts (sometimes up to 60 times a day), pelvic pain that worsens as the bladder fills, and relief after urinating. Pain during sex is also common.
Interstitial cystitis frequently overlaps with other chronic pain conditions like irritable bowel syndrome and fibromyalgia. In women, the pain is often felt between the vagina and anus. In men, it appears between the scrotum and anus. Because the symptoms mimic a urinary tract infection, many people go through repeated rounds of antibiotics before getting the right diagnosis.
Irritable Bowel Syndrome
IBS can produce cramping, bloating, and pain in the lower abdomen that feels like it’s coming from the pelvis. The pain is usually tied to bowel movements, either worsening before one or improving after. If your pelvic pain tends to fluctuate with changes in diet, stress levels, or bowel habits, your gut may be the source.
Nerve-Related Pelvic Pain
The pudendal nerve runs through the pelvis and supplies sensation to the genitals, perineum, and anus. When this nerve gets compressed or irritated, it causes a burning, stabbing, or electric-shock sensation in those areas. The key feature that distinguishes pudendal neuralgia from other causes is that the pain gets worse with sitting and generally does not wake you up at night. Standing or lying down tends to bring some relief.
Diagnosing pudendal neuralgia is tricky because no single test confirms it. Clinicians rely on a set of clinical criteria: pain in the territory of the pudendal nerve, worsened by sitting, not waking you at night, no loss of sensation on exam, and relief from a nerve block injection. Pain that’s purely in the tailbone, buttock, or lower abdomen points to a different source.
Pelvic Pain During Pregnancy
Pelvic pain is extremely common during pregnancy, particularly in the second and third trimesters. A hormone called relaxin loosens the ligaments around your pelvic joints to prepare for delivery. While this loosening is necessary, it can make the pelvic joints shift more than usual, especially the pubic symphysis (the joint at the front of the pelvis). Combined with the increasing weight of the fetus pressing down on these joints, the result is often a sharp or aching pain in the front of the pelvis, the hips, or the lower back.
The pain typically intensifies as the pregnancy progresses and the fetus grows heavier. Walking, climbing stairs, and rolling over in bed are common triggers. Adjusting how often you walk, wearing supportive shoes, and working with your provider on pain management strategies can help. For most people, the pain resolves after delivery once hormonal levels return to normal and the joints stabilize.
How Pelvic Pain Gets Diagnosed
The diagnostic process usually starts with a detailed history: where exactly the pain is, when it started, what makes it better or worse, and what other symptoms accompany it. A physical exam, including a pelvic exam for women, comes next. Screening for sexually transmitted infections may be done, particularly for women under 25 or those at higher risk.
Transvaginal ultrasound is typically the first imaging step. It can identify fibroids, ovarian cysts, and some signs of endometriosis. If ultrasound doesn’t reveal a clear cause and symptoms persist, a laparoscopy (a small camera inserted through a tiny incision under general anesthesia) may be recommended. This is considered the most reliable way to diagnose endometriosis and certain other conditions that don’t show up on standard imaging. For bladder-related pain, urine tests and sometimes a cystoscopy (a camera look inside the bladder) help narrow things down.
Treatment Approaches That Work
Because pelvic pain so often involves multiple overlapping factors, treatment that combines several approaches tends to outperform any single one. A 2025 meta-analysis comparing multidisciplinary treatment to single-discipline care found that people receiving combined treatment had meaningfully lower pain scores and greater improvements in sexual function. The combined approaches typically include some mix of physical therapy, psychological support, and medical management tailored to the underlying cause.
For muscle-related pain, pelvic floor physical therapy is the starting point. For conditions like endometriosis, hormonal treatments or surgery may be recommended. For interstitial cystitis, dietary changes (avoiding bladder irritants like caffeine, alcohol, and acidic foods) combined with bladder training can reduce symptoms. Nerve-related pain may respond to nerve blocks, medications that calm nerve signaling, or physical therapy focused on releasing the tissues around the nerve.
The most important step is getting an accurate diagnosis, which sometimes takes time. Chronic pelvic pain is one of the most under-recognized conditions in medicine, and it’s common to see multiple providers before finding answers. Keeping a pain diary that tracks location, timing, intensity, and associated symptoms gives your provider the most useful information to work with.