Why Does My Pelvis Hurt? A Guide to Chronic and Unexplained Pelvic Pain
Dr. Mallorie Hopkins, PT, DPT
Pelvic pain can be deeply unsettling, especially when it’s hard to describe, hard to locate, or comes and goes without warning. You may feel sharp, stabbing pain one day, dull aching or heaviness the next, or a raw, burning sensation that leaves you wondering: Is this my ovaries? My bladder? My pelvic floor? Is something wrong with me?
If you’ve ever felt confused by pelvic pain, you are not alone. Pelvic pain affects people of all genders and ages and is widely underdiagnosed and misunderstood in healthcare. And yet, it can significantly impact daily life, relationships, exercise, work, and mental health.
Let’s slow this down and walk through it together, because understanding pain is often the first step toward healing.
What Is Pelvic Pain?
Pelvic pain is defined as pain located in the lower abdomen, pelvis, or pelvic floor region. It may be:
Intermittent or constant;
Sharp, stabbing, burning, achy, gnawing, or pressure-like;
Felt internally, externally, or deep within the body;
Associated with sex, movement, bowel or bladder function, stress, or hormonal changes.
Pelvic pain doesn’t always behave the way we expect pain to behave, which can add to the confusion. It may shift locations, fluctuate in intensity, or exist without a clear explanation on imaging or lab work.
Let’s Talk About Pain (Because It’s Not What You Think)
Pain is often framed as something “bad” or dangerous, but it’s less black and white than we might think.
Medically speaking, pain is defined as “an unpleasant sensory and emotional experience.” This means pain is not just a physical, or '“sensory,” signal—it’s also shaped by how the nervous system interprets the signal.
Think about it:
Burning muscles during a workout can feel empowering, but
Burning pain in the vagina can feel alarming or terrifying.
The sensation may be similar, but the meaning we take from it changes everything.
Pain can show up as burning, rawness, itching, sharpness, aching, radiating discomfort, or even numbness. All of these fall under the umbrella of pain. What determines how we respond is our perception and understanding of what’s happening.
That’s where education becomes powerful: When you don’t know what’s happening in your body, fear fills in the gaps. Our role as Pelvic Health PTs is to help you understand your body’s signals so you can regain a sense of safety, control, and trust.
Pelvic Floor vs. Pelvic Health: What’s the Difference?
These terms are often used interchangeably, which often adds to the confusion.
The pelvic floor is a group of muscles at the bottom of the pelvis. These muscles respond to breath, movement, intercourse, posture, and elimination (peeing and pooping).
Pelvic health refers to everything within the abdominopelvic cavity, from the diaphragm, through the abdomen, and down into the pelvic floor.
Pelvic floor therapy (or pelvic health therapy) is specialized care provided by trained physical or occupational therapists to assess and treat pelvic pain and dysfunction.
(For a deeper anatomy breakdown, refer to our blog What Is Pelvic Floor Physical Therapy? A Beginner’s Guide to Anatomy, Function, and Who It Helps.)
Now that you know what pain, pelvic floor and pelvic health therapy means, let’s talk about chronic and unexplained pelvic pain.
What is “Chronic” Pelvic Pain?
This part is important: Chronic does NOT mean forever.
In medical terms, chronic pain simply means pain that has lasted longer than three months. For chronic pelvic pain, that three month parameter increases to six months – the definition changes, and those who experience pelvic pain are not "labeled" as chronic until pain has been present longer than 6 months.
Chronic pelvic pain usually has a diagnosis attached, such as endometriosis, pudendal neuralgia, or interstitial cystitis. These diagnoses can be long-lasting and incredibly challenging, and we deeply acknowledge how difficult they are to live with.
At the same time, we have seen many people improve, even heal, when all contributing factors are addressed. Pain is rarely caused by one single thing, so a holistic approach can drastically help in improving symptoms.
What Is Unexplained Pelvic Pain?
Unexplained pelvic pain is when pain exists despite normal imaging, normal lab work, multiple provider visits, and generally being told “everything looks fine.”
This can be one of the most frustrating experiences a person can go through. With no answers, and symptoms still present, it is easy to feel discouraged and stuck each time symptoms arise. If you’re here, we want you to know we believe you.
While it may not feel like it, “everything looks fine” can actually be meaningful information. It tells us that life-threatening disease or structural damage has likely been ruled out, which allows us to step in next to consider what else contributes to pain.
We specialize in what lives between the lines: the connection between the body, nervous system, hormones, and lived experience. And when a condition does require medical diagnosis, like endometriosis, we know the signs and have trusted providers to help you get answers faster.
To summarize:
Unexplained pelvic pain can be chronic
Chronic pelvic pain is not always unexplained
So… Why Does My Pelvis Hurt?
At Tonic & Phasic, we don’t look for one single cause. Instead, we look at the full picture, what we call The Pelvic Blueprint™.
Pain sits at the center, and four major systems branch outward:
1. Structural Factors
This is what many people expect from pelvic floor therapy. We assess:
Breathing patterns
Movement strategies
Muscles, fascia, ligaments, joints, and organs
Strength, coordination, tension, and mobility
This helps us determine whether your pain is being driven or maintained by the way your body is moving or holding tension.
2. Hormonal Factors
We assess the hormonal influences, including:
Menstrual cycle patterns (or absence of cycles)
Cortisol and stress response
Thyroid function
Perimenopause and menopause
Hormones can influence tissue sensitivity, inflammation, pain thresholds, and nervous system regulation.
3. Nervous System Factors
Pain is deeply tied to the nervous system.
Using principles from polyvagal theory, we assess whether your body is spending more time in fight, flight, freeze, or fawn states. Pain exists to signal threat, and if your system feels unsafe, pain stays loud.
We explore:
Daily stressors
Emotional processing
Past experiences
How your body learned to protect itself
This is not about blame, it’s about understanding and we are here to explore your full experiences, not just your pain today, but the pain you’ve held.
4. Systemic Factors
If progress stalls, we go deeper. We review:
Previous labs and imaging
Gut health and inflammation
Immune responses
Patterns that indicate the need for further referrals
We collaborate closely with other providers to ensure nothing is missed.
Your Pelvic Blueprint™ Is Unique
There is a reason your pelvis hurts, and we want to understand it just as much as you do. Our goal is not just symptom relief, but helping you return to a full, meaningful life, one where pain no longer defines your decisions or limits your world.
Thank you for trusting us with your questions and your body. We hope this gave you clarity, reassurance, and a sense that you’re not alone in this.
Until next time,
The Tonic & Phasic Holistic Pelvic Health Team
