What causes chronic pelvic pain?

Chronic pelvic pain — pain in the lower abdomen and pelvis lasting more than six months — has many possible contributors: endometriosis, pelvic inflammatory disease, ovarian cysts, fibroids, interstitial cystitis, pelvic floor dysfunction, adhesions, and irritable bowel syndrome. It frequently involves a combination of structural, inflammatory, neurological, and psychological factors. Thorough investigation is important as causes have very different management pathways.

What complementary approaches help chronic pelvic pain?

Pelvic floor physiotherapy is central to management — addressing both hypertonic (too tight) and hypoactive (too weak) pelvic floor dysfunction. Acupuncture has evidence for endometriosis-related and other pelvic pain. Mindfulness and psychological approaches address the central sensitisation and psychological dimensions that develop in chronic pain. Nutritional approaches addressing inflammation are relevant where endometriosis or inflammatory pathology contributes.

How does endometriosis relate to pelvic pain?

Endometriosis — tissue similar to the uterine lining growing outside the uterus — is one of the most common causes of chronic pelvic pain in women of reproductive age, affecting approximately 1 in 10. It is notoriously underdiagnosed, with an average diagnostic delay of 7–10 years. Cyclical pelvic pain, painful periods, painful sex, and bowel or bladder symptoms around menstruation are characteristic features that warrant gynaecological investigation.

When should pelvic pain be urgently assessed?

Sudden severe pelvic pain — particularly one-sided — may indicate ovarian torsion, ruptured ovarian cyst, or ectopic pregnancy, all of which require emergency assessment. Pelvic pain accompanied by fever, foul-smelling vaginal discharge, or signs of infection should be assessed promptly for pelvic inflammatory disease.

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Pelvic Floor Dysfunction

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Reviewed by Dr. Ian Henderson · Microbiobial Health & Medicine26 March 2026Emerging evidence

Quick answer

Pelvic floor dysfunction encompasses a range of conditions involving weak, tight, or poorly co-ordinated pelvic floor muscles, causing pain, incontinence, prolapse, or sexual dysfunction. Specialist pelvic floor physiotherapy is the gold-standard intervention, often supported by breathing and postural work.

Do any of these feel familiar?

Pelvic floor dysfunction encompasses a range of experiences — including pelvic pain, urinary or bowel leakage, urgency, a sense of heaviness or prolapse, or difficulty with penetration
Many people describe a persistent low-grade pelvic ache or pressure, sometimes worsening with prolonged sitting, standing, or physical activity
Leaking with sneezing, coughing, or exercise is a very common experience, often normalised after childbirth but not inevitable or untreatable
Some describe tightness and pain with intimacy
Many people carry significant embarrassment and delay seeking help, assuming nothing can be done

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