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If you suffer from chronic pelvic pain, you are not alone—and this post is for you! Chronic pelvic pain (CPP) can feel overwhelming, but the good news is there are effective ways to manage and treat it, starting now. As a pelvic floor physical therapist, I’ve helped many people find relief, and I’m here to share my top tips for addressing chronic pelvic pain from a pelvic floor physio perspective. These strategies are designed to target both the physical and psychological aspects of what can be contributing to your pain and will empower you as you take the first steps on your journey to relief. Read this post to learn a few things you can start right now today!

What are common symptoms of chronic pelvic pain

• Pain during or after sex
• Pain in the vagina, perineal area, or anywhere surrounding the pelvis
• Lower abdominal pain
• Low Back Pain
• Difficulty having an orgasm
• Inability to use a tampon
• Constipation or difficulty having a bowl movement
• Difficulty emptying the bladder
• Urinary Urgency and Frequency

What Causes Chronic Pelvic Pain?

• Tearing from childbirth 
• Chronic stress or tension 
• History of abuse or sexual trauma 
• Chronic pain
• Endometriosis 
• Interstitial Cystitis (IC)
• Irritable bowel syndrome (IBS)
• Decreased pelvic floor muscle awareness and coordination
• Poor posture
• Poor breathing mechanics 
• Chronic core engagement (chronic holding patterns)
• Or, those muscles can naturally be more tense in some cases
• Prolonged sitting
• Lower abdominal organs

My Biggest tips to start treating chronic pelvic pain

1. Breath Training

There are two types of breathing I suggest for treating chronic pelvic pain.

1. Belly Breathing
2. Hypopressive Breathing

Belly Breathing

Belly breathing is a type of breathing that should be done lying on your back or lying on your side. (This type of breathing is not suggested when upright.) For this type of breathing:

1. Find a comfortable position when you have no other distractions.
   • Optional: have a notepad and pen beside you. 
2. Place one hand on the belly and one on the chest. As you inhale, you should feel the hand on the belly rise and fall on exhale.
3. Relax the body. There should be no tension in the body. Do a quick tension check. Scan the body from head to toe. If helpful, contract each muscle in the body and then feel that same muscle relax. Do this throughout the body, including the face to ensure the body is fully relaxed.
4. Don’t allow your mind to wander to any worry or your “to-do” list. If you think of something you need to do, write it down quickly and then return to your relaxation and breathing.

The end of the day may be a good time for this exercise. Once the kids are in bed, and you can lie on the couch or in your bed, take this opportunity to do some belly breathing.

Hypopressive Breathing

Hypopressive breathing is the type of breathing that should be done when you are in an upright position. For this type of breathing:

1. Stand or sit with good posture (ears in line with shoulders, shoulders in line with the hips) and neutral pelvic alignment.
2. Inhale slowly through the nose for a count of 4 seconds, breathing into the ribcage.
3. Exhale slowly through the mouth and lengthen through the spine on your exhale.
4. During each breath cycle, think of growing taller and creating space between the head and shoulders and between the pelvis and the ribcage.

2. Movement

Try not to sit for long periods of time. If your job involves a lot of sitting, try to take frequent standing breaks. Long periods of sitting can decrease blood flow to the pelvic floor and weaken the pelvic floor muscles.

3. Pelvic Floor Muscle Awareness

With chronic pelvic pain, there can be increased tension in the pelvic floor muscles. Often, we are disconnected from what is happening in our pelvic floor, and it isn’t always easy to feel if we are carrying tension there. Throughout the day, try to bring awareness to the pelvic floor muscles and assess if you are tense in the muscles surrounding the pelvis. Are you squeezing your inner thigh muscles or your glute muscles? If so, try to relax and let go.

4. Pelvic Pain Stretches

Specific stretches can help relax and relieve tension in the muscles surrounding the pelvic girdle. I have a FREE guide for this. Grab it in the link below:

Check out this post on pelvic pain stretches

5. Pelvic Floor Muscle Downtraining

Chronic pain can lead to upregulation of the entire nervous system, making it difficult to relax the pelvic floor muscles. Pelvic floor muscle downtraining can help.

Try this: lie on your back with your eyes closed. Bring awareness to the muscles of your feet, calves, thighs, hands, arms, shoulders, neck, and then the pelvic floor. Do some belly breathing and focus on letting go of every bit of tension in your body.

Next: Contract the pelvic floor muscles 3 times. Then, focus on allowing the muscle to fully relax back down to it’s rested and relaxed state. Are you able to feel the difference? Can you tell when you are contracting the muscles and can you tell if you fully relax? Take several minutes between contractions to allow the pelvic floor muscles to fully relax. Take note of any tension that comes throughout the body and focus on letting go.

If you are unsure what is happening in your pelvic floor muscles and would like further help, contact a local pelvic floor physical therapist. This link may help you find one in your area.

6. Pelvic Floor Trigger point release

It is best to first consult with a pelvic floor physical therapist before trying a pelvic floor trigger point release yourself. But I wanted to put this information in here so that you know this is an option for your future self-treatment. Trigger points can develop in the pelvic floor muscles, just as in any other muscle in the body. They are painful knots inside the muscle belly that are caused by overuse of the muscle. These painful knots can cause local pain inside of the muscle and also refer to pain in other parts of the body.

The best treatment for a trigger point is sustained pressure in conjunction with muscle relaxation techniques. Trigger point release can improve blood flow to the muscle, helping to reduce and heal a trigger point. In order to do a self-trigger point release in the pelvic floor muscles, you need a tool, like the one listed here.

Here is the wand I would suggest: IntimateRose Pelvic Wand, Pelvic Floor Muscle Trigger Point Massager

Again, please seek a pelvic floor physical therapist in your area prior to starting any trigger point release program for your pelvic floor muscles.

How does breathing help with pelvic floor dysfunction:

1. Improving blood flow
2. Optimizing pelvic floor muscle function

The respiratory and pelvic diaphragms work together. They move simultaneously in a pistoning effect to move blood and lymph to all of your organs. When you breathe in, your respiratory diaphragm moves down to allow air to fill the lungs, and your pelvic diaphragm moves down with it. Then, on exhalation, the respiratory diaphragm moves back up to push air out of the lungs, and the pelvic diaphragm follows again.

To imagine this, you can use your hands: 1. place your right hand, palm down, just below your breast line, and your left hand, palm up, right above your pelvis. 2. As you inhale, move the hands down together and return them up simultaneously on exhale.

How you breathe can directly impact the function of the pelvic floor muscles, which in turn can affect the blood flow to the genitals involved in sexual arousal.

How do the pelvic floor muscles play a role in Sexual Dysfunction

Your pelvic floor muscles help to facilitate blood flow to the genitals, which is essential for arousal and orgasm. Sexual arousal requires both mental and physical properties. The pelvic floor muscles must function appropriately to assist in adequate blood flow for the achieved arousal.

How does pelvic floor dysfunction play a role in Chronic Pelvic Pain?

As mentioned briefly above, overactivity of the pelvic floor muscles can lead to the development of painful trigger points. Trigger points are knots that can form inside of a muscle belly that often refer pain to other parts of the body or reproduce a common pain or other symptom. You may have experienced this concept in your upper trapezius muscle (between your neck and shoulder). If you push on a knot in the upper trapezius, you may feel it referring to pain in another area of the body, usually the neck or the side of the head. (I have a trigger point in my left upper trapezius that reproduces a headache I often get in the left temporal region of my head). This same thing can occur with the muscles of the pelvic floor. The trigger points in the pelvic floor muscle can refer pain to other areas of the body surrounding the pelvis or they can even reproduce the urgent feeling of needing to urinate.

Summary: What you can try now to work toward relief of chronic pelvic pain

1. Breathwork

Belly breathing when lying down; hypopressive breathing when upright.

2. More movement, less sitting

3. Pelvic Floor Muscle Awareness

4. Pelvic floor muscle Downtraining

5. Pelvic Pain Stretches

6. Trigger Point Release

Other related posts

1. Pelvic Pain Stretches
2. Hypopressive Breathing
3. Low Pressure Fitness Basics
4. What is Low Pressure Fitness

Medical disclaimer

Information on this website is not intended to replace professional medical advice. Please consult your primary care physician or specialist before adding any new treatment or exercises. I advise to see a pelvic floor physical therapist in your area for further guidance on this treatment.

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