Pelvic pain can affect many aspects of daily life, from sitting and exercising to using the bathroom or being intimate with a partner. Conditions such as dyspareunia, vulvodynia, pudendal neuralgia, and coccydynia can be painful, frustrating, and sometimes difficult to diagnose. Pelvic floor physical therapy provides a conservative, personalized approach to identifying and treating musculoskeletal and movement-related factors that may be contributing to pelvic pain. Treatment is often coordinated with other healthcare providers for a multidisciplinary approach.
Give us a call to learn more or book your free 15 minute consultation with Dr. Koch
What can cause pelvic pain?
Pelvic pain can have many different causes, and symptoms may originate from the pelvic floor muscles, nerves, joints, connective tissues, or surrounding areas of the body.
Some conditions associated with pelvic pain include:
- Dyspareunia, or pain with intercourse
- Vulvodynia, or chronic vulvar pain
- Pudendal neuralgia, a condition involving the pudendal nerve s
- Coccydynia, or tailbone pain
- Pelvic floor muscle tension or dysfunction
- Sacroiliac joint pain
- Hip or lower back problems
- Pregnancy and postpartum changes
- Previous pelvic or abdominal surgery
- Scar tissue or tissue restrictions
Because pelvic pain can have multiple contributing factors, a thorough evaluation is important to understand what may be driving your symptoms.
What is dyspareunia?
Dyspareunia is pain that occurs during or after sexual intercourse. Pain may be experienced at the opening of the vagina, deeper within the pelvis, or in surrounding muscles and tissues.
Dyspareunia can have many potential causes, including pelvic floor muscle tension, previous injury, hormonal changes, scar tissue, nerve sensitivity, or other pelvic health conditions.
Pelvic floor physical therapy can evaluate the muscles and tissues involved and help address impairments in muscle tone, strength, coordination, and mobility based on evaluation findings.
Can pelvic floor physical therapy help with painful intercourse?
Yes. Pelvic floor physical therapy can help identify and address musculoskeletal factors that may contribute to pain with intercourse.
Treatment may focus on reducing excessive pelvic floor muscle tension, improving muscle coordination and mobility, addressing scar tissue or surrounding tissue restrictions, and improving awareness of how the pelvic floor responds to breathing and movement.
Treatment is individualized and always performed with patient comfort, communication, and consent in mind.
What is vulvodynia?
Vulvodynia is defined as vulvar pain lasting greater than 3 months without an identifiable underlying cause. Symptoms may include burning, stinging, irritation, aching, or sensitivity. Symptoms may occur spontaneously or in response to pressure, touch, or sexual activity.
Vulvodynia can significantly affect exercise, clothing choices, sitting, sexual activity, and everyday life. Because the pelvic floor muscles can become tense or guarded in response to ongoing pain, pelvic floor physical therapy may be part of a comprehensive approach to managing symptoms.
How can physical therapy help with vulvodynia?
Pelvic floor physical therapy focuses on identifying musculoskeletal and movement-related factors that may be contributing to or maintaining pelvic pain.
Depending on the individual, treatment may include techniques designed to reduce pelvic floor muscle tension, improve mobility, address muscle coordination, and reduce sensitivity in surrounding tissues.
Your physical therapist may also provide education and strategies to help you better understand your symptoms and manage activities that may aggravate pelvic pain.
Because vulvodynia can have multiple contributing factors, pelvic floor physical therapy may be used alongside other medical care when appropriate.
What is pudendal neuralgia?
Pudendal neuralgia is pain associated with dysfunction of the pudendal nerve, which travels through the pelvis and provides sensation to portions of the pelvic and genital regions while also contributing to nerve signals involved in bladder and bowel function.
Symptoms may include burning, aching, tingling, numbness, or sharp pain in the pelvic or genital area. Pain is worse when sitting and relieved when lying down. A thorough evaluation by a physician is required to accurately diagnosis pudendal neuralgia as the symptoms overlap with other conditions.
Can physical therapy help with pudendal neuralgia?
Physical therapy may help address associated musculoskeletal factors contributing to irritation or sensitivity of the pudendal nerve in those suspected or diagnosed with pudendal neuralgia.
Based on evaluation findings, treatment may focus on pelvic floor muscle relaxation and coordination, movement strategies, activity modification, optimizing posture and ways to improve tolerance to sitting and daily activities.
Because nerve-related pelvic pain can have a variety of causes, your physical therapist will often coordinate care with your physician and other healthcare providers.
What is coccydynia?
Coccydynia is pain involving the coccyx, commonly known as the tailbone. It may develop after a fall, childbirth, prolonged sitting, repetitive stress, or other trauma to the area.
Tailbone pain may make sitting, standing up from a chair, driving, exercising, or using the bathroom uncomfortable.
The muscles and connective tissues that attach around the pelvis and tailbone can also contribute to symptoms. A pelvic floor physical therapist can evaluate these surrounding structures and determine whether muscle tension, weakness, mobility restrictions, or movement patterns may be contributing to your pain.
How can physical therapy help with tailbone pain?
Treatment for coccydynia depends on the underlying cause of the pain. Physical therapy may include manual therapy, movement retraining, pelvic floor rehabilitation, posture education, and exercises depending on the evaluation findings. Treatment may also include strategies to decrease pressure on the tailbone such as modifying sitting postures or using an appropriate cushion.
The goal is to reduce pain while improving your ability to sit, move, exercise, and perform everyday activities more comfortably.
Can pelvic floor physical therapy treat different types of pelvic pain?
Yes. One of the benefits of working with a pelvic health physical therapist is the ability to look at the entire pelvic region rather than treating one symptom in isolation.
The pelvic floor works together with the hips, pelvis, lower back, abdomen, diaphragm, and surrounding muscles. Problems in one area can sometimes contribute to symptoms elsewhere.
A personalized evaluation can help identify whether muscle tension, weakness, poor coordination, mobility restrictions, nerve sensitivity, or other movement-related factors may be contributing to your pelvic pain.
What treatments may be used for pelvic pain?
Treatment is always individualized based on your symptoms, evaluation, comfort level, and goals. Depending on your condition, pelvic floor physical therapy may include:
- Pelvic floor muscle relaxation, coordination and strengthening when indicated
- Therapeutic Exercise and Functional Movement Training
- Core and pelvic stabilization as indicated
- Breathing and coordination exercises
- Manual therapy and Scar Tissue Mobilization
- Postural and movement education
- Dry needling when appropriate
- Focused shockwave therapy for select conditions
- Home exercise and self-care strategies
The goal is to improve how the pelvic floor and surrounding structures function while helping you reduce pain and return to activities that are important to you.
Is pelvic floor physical therapy painful?
Pelvic floor physical therapy does not have to be painful. Treatment is individualized, and your comfort and consent are important parts of the process.
Depending on your symptoms and goals, treatment may involve external techniques, movement exercises, education, and other approaches. When an internal pelvic floor assessment or treatment is appropriate, your physical therapist will explain what to expect and obtain your consent before proceeding.
Communication throughout treatment allows your therapist to adjust techniques based on your comfort and response.
When should I seek physical therapy for pelvic pain?
Consider seeking an evaluation if pelvic pain is affecting your daily activities, exercise, sleep, sitting, bowel or bladder function, or intimate relationships.
You may benefit from pelvic floor physical therapy if you experience:
- Pain during or after intercourse
- Burning or aching vulvar pain
- Pelvic or genital nerve pain
- Tailbone pain
- Pain with prolonged sitting
- Pelvic muscle tightness or spasms
- Pain associated with movement or exercise
- Persistent pelvic pain without a clear explanation
You do not have to wait for pelvic pain to become severe before seeking help.
Seek prompt medical evaluation for sudden or severe pelvic pain, pelvic pain associated with a high fever, heavy or unexplained bleeding or pain associated with pregnancy or possible pregnancy. New loss of bladder or bowel control, difficulty urinating or numbness of the groin or saddle region should be assessed immediately by a medical doctor.
Why choose Dr. Kristina Koch for pelvic pain physical therapy?
Dr. Kristina Koch, PT, DPT, specializes in pelvic floor dysfunction and brings nearly three decades of clinical experience to her practice. She earned her Master of Science in Physical Therapy in 1996 and her Doctorate in Physical Therapy in 2021.
Dr. Koch has extensive orthopedic experience in addition to her specialized pelvic health training. Her understanding of the relationship between the pelvic floor, hips, pelvis, spine, and movement allows her to evaluate pelvic pain from a broader perspective.
She is also a faculty member and curriculum developer for the Herman & Wallace Pelvic Rehabilitation Institute and has educated physical therapy and medical students about pelvic health and pelvic floor disorders.
Her treatment approach may combine manual therapy, muscle re-education, functional movement training, strengthening, dry needling, focused shockwave therapy, and individualized self-care strategies. Her goal is to help patients better understand their symptoms, reduce pain, improve function, and return to the activities that matter to them.
How do I know if pelvic floor physical therapy is right for my pelvic pain?
If pelvic pain is affecting your comfort, movement, exercise, ability to sit, or intimate relationships, pelvic floor physical therapy may be an appropriate treatment option.
A comprehensive evaluation can help identify musculoskeletal and movement-related factors that may be contributing to your symptoms and determine whether pelvic health physical therapy can help.
Pelvic pain is not something you simply have to live with. With an individualized treatment approach, physical therapy may help reduce pain, improve pelvic floor function, and give you greater confidence in your ability to move and participate in everyday life.