What causes pelvic pain?
The pelvis is a working structure: muscles, joints and nerves that carry load, control the bladder and bowel, and coordinate with your hips and low back every time you stand up. When one part of that system stops doing its job, pain shows up. Naming the driver is the first real step.
A muscle that stays switched on behaves like a fist that never opens. In the pelvic floor that can feel like a deep ache, pain with sitting, burning that comes and goes, or trouble fully emptying the bladder or bowel. Most people respond by trying to strengthen it, which makes a tight muscle tighter. The work runs the other way: down-training, breathing that lets the floor lengthen, and hands-on release of the hip and abdominal muscles holding the same tension.
The opposite problem is just as real. When the pelvic floor cannot generate force, or fires out of sequence with the deep abdominals, the pelvis loses support under load. That shows up as heaviness, leaking with a cough or a run, and an ache that builds through the day. Squeezing harder is not the answer. Timing is. We retrain the floor to work with your breath and your hips instead of bracing against them.
The pelvic floor attaches to the same bony ring as your hips and your low back, so pain rarely stays in one lane. A stiff hip, an irritated sacroiliac joint, or a low back that has been guarding for months can all refer pain into the pelvis and groin. Looking at the pelvic floor alone can miss the driver, so we assess the whole girdle, including how you walk and how you load a single leg, before deciding what to treat.
Carrying a pregnancy changes how the pelvis takes load, and birth, whether vaginal or by cesarean, asks a great deal of the same tissues. Pubic bone pain, pressure, pain with intercourse, or a floor that still feels unreliable months later is common, and common is not the same as untreatable. Dr. Brittney Mulligan works with pregnancy and postpartum patients here. Being told to wait it out is not a plan. We start where you are, at a pace you set.
Cesarean, hernia repair, hysterectomy, prostate surgery, endometriosis excision: any incision through the abdomen or pelvis heals with scar tissue, and scar tissue does not glide the way healthy tissue does. Months or even years later that restriction can pull on the muscles and nerves around it and produce pain that feels unrelated to the original operation. Gentle work over and around the scar, paired with movement that restores glide, often changes symptoms that had seemed permanent.
When pain lasts beyond normal tissue healing, the nervous system gets better at producing it. The area turns more sensitive, protective muscle guarding sets in, and ordinary sensations start to register as threat. That does not mean the pain is imagined. It means the treatment target has widened to include how sensitive the system has become. Graded exposure, breathing, and a plan that never pushes past what you agreed to are how that sensitivity settles.
