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Coccyx pain (coccydynia)

The coccyx (or tailbone) is a small bone at the bottom of your sacrum, and there is a small joint between the two bones. Coccyx pain can be linked with both PGP and pelvic floor problems. You may have coccydynia if you have sharp pain in your coccyx when you sit down, and may also have this pain when you stand and walk. 

As with PGP, coccyx pain usually responds well to manual therapy. Your therapist may move the joint from the outside or examine you internally through your rectum to move the joint and relieve the pain. 

Often, using a special coccyx cushion with a hole cut out at the back enables you to sit without the coccyx coming in contact with the chair.

Women are often given painkillers or painkilling injections, but these won’t treat the underlying problem and often provide only temporary pain relief. Women may be told it is something they just have to put up with, or that it will get better with time. However, this is not usually the case, and it can go on for years without treatment. Most women find that the manual therapy, although it may be uncomfortable at the time, gives the best long-term results.

Bladder/urinary problems

Urinary tract infection (UTI)

This problem is quite common in women as their urinary tract is shorter than in men and so bacteria from the vagina or rectum can easily be passed into the ureter. About 50% of women will experience a UTI in the course of their life.


This is a common type of a UTI, particularly for women, and is caused by inflammation of the bladder, usually from a bladder infection. 

Symptoms can include:

  • pain in the abdomen, pelvis, bladder, urethra and/or vagina
  • a stinging or burning sensation when urinating
  • wanting to urinate urgently and more frequently than normal
  • passing water that is smelly, darker or cloudier than usual
  • feeling unwell, tired and achy

For more information about cystitis, its treatment and management visit the  Cystitis & Overactive Bladder Foundation or the Bladder and Bowel Community.

Interstitial Cystitis (IC)/Bladder Pain Syndrome (BPS)

Some women seem to be prone to experiencing chronic cystitis symptoms which do not respond to antibiotics. IC/BPS differs from cystitis because there is no obvious infection and women often require other treatments including lifestyle adjustments and specialist pelvic health physiotherapy to help manage this condition.

Symptoms can include:

  • pain in the abdomen, pelvis, bladder, urethra and/or vagina
  • a sudden and urgent need to urinate
  • wanting to urinate more often than before
  • waking several times in the night to urinate
  • pain during sexual intercourse

For more information about IC/BPS, its treatment, and management, visit the  Cystitis & Overactive Bladder Foundation or the Bladder and Bowel Community.

Urinary incontinence

This condition is where urine escapes from the bladder unintentionally. It is very common, particularly in women after childbirth. 

Types of urinary incontinence include:

  • urine leaking because of pressure affecting the bladder such as when coughing or laughing – known as ‘stress incontinence’
  • urine leaking just after feeling a sudden urge to urinate – known as ‘urge incontinence’ and often caused by an overactive bladder
  • where the bladder is unable to empty fully when urinating, the remaining urine leaks out – known as ‘overflow incontinence’
  • where the bladder doesn’t function properly to store urine at all, resulting in a constant leak or frequent leakages – known as ‘total incontinence’.

For more information about urinary incontinence, its treatment and management, see our ‘Pelvic floor and PGP’ page.

The Bladder and Bowel Community and the NICE Guidance on urinary incontinence in women.

Kidney stones

Kidney stones can form when the urine includes too many minerals and salts that can collect together within the kidney to form a hard stone which might resemble a tiny pebble or even grow to reach the size of a golf ball. There are different kinds of stones but the most common are made of calcium.

Symptoms can include:

  • pain in the back and side
  • pain in the pelvis, groin and genital areas
  • a fever
  • a burning sensation when urinating and the flow may be slow
  • a feeling of nausea or a loss of appetite
  • blood appearing within the urine

For more information about kidney stones, their treatment and management, visit the Bladder and Bowel Community.

Return to ‘If it’s not PGP, then what could it be?’ page.

Bowel problems

Irritable bowel syndrome (IBS)

This is a common, long-term condition of the digestive system. IBS is characterised by periods of stomach cramps, feeling bloated, diarrhoea and constipation. There is often an absence of any obvious mechanical cause. 

Symptoms can include:

  • stomach pain and cramping which may pass with a bowel movement
  • low back pain
  • a change in bowel habits where the bowels move through periods of diarrhoea, constipation or sometimes both
  • excessive wind (flatulence)
  • a sensation of the abdomen bloating and swelling
  • a sensation that you want to have another bowel movement even when you have just had one, as if the bowel hasn’t emptied properly
  • passing mucus from the anus

For more information about irritable bowel syndrome, its treatment and management, visit: The IBS Network, the Bladder and Bowel Community and see the NICE Guidance on irritable bowel syndrome in adults.

Inflammatory bowel disease (IBD)

IBD is a term mainly used to describe two conditions: ulcerative colitis and Crohn’s disease. Both are long-term (chronic) conditions that involve inflammation of the gastrointestinal tract (gut).

Ulcerative colitis

In this condition, inflammation affects only the colon (large intestine).

Crohn’s disease

This condition can affect the whole of the digestive system from the mouth to the anus.

The main symptoms of both conditions are similar. They can include:

  • pain, bloating and swelling within the abdomen, or cramps
  • extreme tiredness
  • recurring diarrhoea, which may include traces of blood and mucus
  • weight loss

For more information about ulcerative colitis and Crohn’s disease, their treatment and management, visit Crohn’s & Colitis UK, the Bladder and Bowel Community, and see the NICE Guidance on Crohn’s disease and ulcerative colitis.

Diverticular disease and diverticulitis

These are two related conditions where inflammation affects the colon (large intestine). In diverticular disease, small bulges or pockets (diverticula) develop in the lining of the intestine. The condition becomes diverticulitis when these pockets become inflamed or infected.

Diverticular disease may show no obvious symptoms at all. However, when the condition becomes inflamed or infected in diverticulitis, the symptoms are more serious and more obvious.

Symptoms can include:

  • severe abdominal pain on the left side
  • a high temperature (fever) of over 38°C (100.4°F) and possibly nausea.
  • diarrhoea or frequent bowel movements

For more information about diverticular disease and diverticulitis, their treatment and management, visit the Bladder and Bowel Community.

Faecal incontinence

Faecal incontinence occurs when stools or diarrhoea escape before a person can manage to get to a toilet. This is usually because of a physical problem with areas of the body that control the bowel.

Symptoms can include:

  • problems with your rectum
  • problems with your pelvic floor muscles
  • problems due to damaged nerves

For more information about faecal incontinence, its treatment and management, visit our ‘Pelvic floor and PGP’ page and the Bladder and Bowel Community.

Gynaecological problems

Dysmenorrhea (painful periods)

Dysmenorrhea can cause many women to experience discomfort during their menstrual cycle. This pain can begin a few days before the menstrual period starts and then reduces as bleeding finishes. For a small percentage of women, the pain is severe and interferes with carrying out normal everyday tasks. There are two main types of dysmenorrhea: 

  • primary dysmenorrhea where the pain occurs within healthy women and is not related to any specific problem within the uterus or other pelvic organs 
  • secondary dysmenorrhea where the menstrual pain is linked to an underlying disease or structural abnormality within or outside the uterus, such as endometriosis, fibroid tumours and ovarian cysts, or from the use of an intrauterine device for birth control 

Symptoms can include:

  • pain before and during periods in the lower abdomen
  • cramping pain in the lower abdomen and sometimes back pain
  • heavy vaginal bleeding
  • irregular periods

For more information about dysmenorrhea (painful periods), its treatment and management, visit the Pelvic Pain Support Network


Endometriosis describes a condition where the lining of the uterus grows on the outside of the uterus. This can result in tissue attaching to the ovaries or fallopian tubes and sometimes to the bladder or intestines. This tissue is not shed during menstruation, unlike the lining of the uterus. 

Symptoms can include:

  • pain typically a few days ahead of a period and usually lasting throughout the period (where normal period pain is less severe and doesn’t usually last for the duration of the period)
  • pain that is worse ahead of the period starting and affects the lower abdomen and pelvic area where it can be a constant ache
  • painful sex, including the pain being experienced deep within the body and lasting a few hours after sex
  • other symptoms such as bleeding between periods and pain on emptying the bowel or bladder

For more information about endometriosis, its treatment and management visit Endometriosis UK and see the NICE Guidance on endometriosis.


Adenomyosis is a condition where the lining of the uterus starts to grow directly into the muscle wall of the uterus. During a period, the lining cells of the uterus bleed and the misplaced cells within the muscle wall also bleed which causes pain. Trapped in the muscle, the blood cannot escape from the cervix as it normally would. As a result, the blood and tissue accumulate and cause swelling in the uterine muscle wall. 

Symptoms can include:

  • accumulation of blood and tissue which can cause both intense pain and cramping
  • feelings like labour pains which result in a sensation of pressure on the bladder and bowel.
  • heavy bleeding when the blood is finally released from the muscle wall
  • loss of energy result from associated anaemia 

The cause of adenomyosis is not fully understood, but it may be a link between various hormones. 

For more information about adenomyosis, its treatment and management, visit the Pelvic Pain Support Network.

Pudendal neuralgia and nerve entrapment

This condition can affect both men and women where the pudendal nerve has been damaged, trapped or irritated. It is usually a chronic condition and can be very painful and distressing. The pudendal nerve is a key nerve in the pelvis and runs through the lower buttocks, the area around the buttocks and genitals (perineum) and the area around the anus, as well the vulva, labia and clitoris in women. 

Symptoms can include:

  • a feeling of burning, shooting pain or prickling
  • an over-sensitivity to touch such that even clothing hurts
  • the feeling being worse when sitting and can improve when standing
  • a tendency for the feeling to stay constant, although sometimes it isn’t as severe
  • pins and needles or numbness in this area
  • a feeling of swelling around the perineum
  • needing to go to the toilet more frequently
  • pain during arousal or sex

For more information about pudendal neuralgia and nerve entrapment, their treatment and management, visit Pudendal Education.


Uterine fibroids are growths that can form on the inside walls of the womb (uterus) and they are also known as myomas or leiomyomas. They are made up of muscle and fibrous tissue and can vary in size; they are non-cancerous. It is possible that a woman might be unaware of their growth because fibroids don’t always cause symptoms. One in three women may experience them, most commonly between the ages of 30 and 50 years. 

Symptoms can include:

  • heavy or painful periods
  • pain in the abdomen and pelvis
  • discomfort or pain in the lower back
  • more frequent need to urinate than usual and constipation
  • discomfort or pain during sex

For more information about fibroids, their treatment and management, visit The British Fibroid Trust  and see the NICE Guidance on heavy menstrual bleeding.


There are various types of cysts that can appear under the skin or within other parts of the body. They are usually fluid-filled sacs of tissue and are mostly benign (non-cancerous). Cysts often have no symptoms and can come and go without any associated problems or pain. However, if they grow large or become infected, they can become painful and unpleasant. Two kinds of cyst are associated with a woman’s reproductive organs: vaginal cysts and ovarian cysts. 

Symptoms can include:

  • pelvic pain – this can range from a dull, heavy sensation to a sudden, severe and sharp pain
  • pain during sex
  • difficulty emptying your bowels
  • a frequent need to urinate
  • heavy periods, irregular periods or lighter periods than normal
  • bloating and a swollen tummy (and feeling full after eating little)

For more information about cysts, their treatment and management, visit the Pelvic Pain Support Network

Pelvic inflammatory disease (PID)

PID is caused by an infection which can affect the pelvic organs such as the uterus, cervix and fallopian tubes. It usually involves sexual contact where bacteria enter the cervix and then spread, although it can develop as a result of childbirth, a termination of pregnancy or pelvic surgery.

Symptoms can include:

  • pain in the lower abdomen and pelvic area
  • pain during sex
  • discomfort or pain when urinating
  • vaginal bleeding after sex
  • heavy and painful periods
  • abnormal vaginal discharge that may appear yellow or green
  • fever, nausea and vomiting

For more information about pelvic inflammatory disease (PID), its treatment and management, visit the Royal College of Obstetricians & Gynaecologists.

Vulval pain or vulvodynia

The vulva is the external area of a woman’s sex organs or genitals. It gives protection to the sex organs and the urinary tract. It is directly between a woman’s legs and is the key site of sexual arousal and response. Vulvodynia can affect women of all ages and who are otherwise healthy. It is persistent, unexplained pain around the vulva, the skin at the entrance to the vagina. It is often a long-term (chronic problem) and can be uncomfortable and distressing. The vulva may look no different but the pain may take a number of forms.

Symptoms can include:

  • a burning, stinging sensation
  • pain provoked by touch, such as during sex
  • pain brought on by inserting a tampon
  • low-level pain, but apparent all the time
  • more pronounced pain when sitting for a while
  • pain which is just in the vulva
  • pain that spreads beyond the vulva and around the buttocks and inner thighs

Sometimes, vulval pain is apparent with other conditions such as IBS, painful periods or cystitis.

For more information about vulval pain or vulvodynia, its treatment and management, visit the Vulval Pain Society or the Pelvic Pain Support Network

Pelvic organ prolapse

This is a condition where one or more pelvic organs, such as the uterus, vagina, bowel or bladder, start to come down from their original positions within the pelvis and push against the vagina. This is often as a result of childbirth which can weaken the pelvic floor or damage the walls of the vagina.

Symptoms can include:

  • a feeling of pressure or of tissue/organs pushing against the vagina
  • the sense that these organs are starting to descend into the vagina and which might require pushing back again
  • a dragging feeling in or around the vagina
  • discomfort during sex or difficulty accessing the vagina because of bulges from descending organs
  • a sensation of pulling or stretching in the groin or lower back which might be associated with aches or pains
  • difficulty passing water or leakage of urine associated with stress incontinence
  • problems with bowel movements or a feeling that the passage is blocked so that it is hard to have a bowel movement

For more information about pelvic organ prolapse, its treatment and management, visit our ‘Pelvic floor and PGP’ page and the Royal College of Obstetricians & Gynaecologists.

Pelvic cancer

As mentioned above, pelvic pain can be a sign of a number of different problems, but in rare instances it can indicate cancer. 

Cervical cancer

A regular smear test cervical/vaginal swab test for cancer is the best way to check for cervical health. Sometimes there are no apparent symptoms. However, it is possible to have symptoms with cancer that are similar to other conditions.

Symptoms can include:

  • vaginal spotting, where blood appears between periods. Anything unusual might suggest cancer symptoms but, again, these symptoms are common to other conditions
  • vaginal discharge: usually some discharge is healthy but any that appears to be different – watery, thick, foul smelling or includes mucus – could indicate cancer, although it could also suggest other issues.
  • painful sex and pain during urination

For more information about cervical cancer, its treatment and management, visit Cancer Research UK or Macmillan Cancer Support.

Ovarian cancer

Ovarian cancer often develops without any obvious symptoms, and as a result it has been called the ‘silent killer’. It is not picked up through a routine vaginal swab test for cancer but it is relatively rare.

Symptoms or signs can include:

  • bloating which doesn’t seem to be linked to eating particular foods (such as gluten, lentils and pulses) but is present most, if not all, of the time. If it persists for two weeks without fading at all, it is worth checking with your GP
  • pelvic pain. This is common in all kinds of conditions, but if you experience pelvic pain like menstrual cramps or ovulation pain and the pain is not coinciding with these stages in your menstrual cycle, it is possible that this is an early sign of ovarian cancer
  • feeling full quickly when eating when you haven’t eaten much or you haven’t finished eating a very modest portion (and you don’t normally experience this feeling) could be an indication of ovarian cancer
  • frequent urination or a strong urge to urinate (although this can occur with other conditions)

For more information about ovarian cancer, its treatment and management, visit Cancer Research UK or Macmillan Cancer Support and see the NICE Guidance on ovarian cancer.

Musculoskeletal problems

Diastasis Symphysis Pubis (DSP)

DSP is a true separation at the symphysis pubis joint of more than 1cm out of alignment, either horizontally or vertically. It can happen if you have had a fall or another trauma to your pelvis (including a very difficult birth).

The majority of women with pregnancy-related pelvic girdle pain (PGP) do not have DSP. If your PGP symptoms do not get better with good manual therapy treatment from an experienced practitioner (remembering it can take time to find the right practitioner), it can be helpful to have further investigations to exclude DSP.

The normal range of movement (vertical shift or horizontal gap) is 0-3 mm, and moderately abnormal is 3-10 mm. Women can still function very well with this amount of movement, but it may need to be taken more into account when looking at types of exercises in the rehabilitation phase of treatment. If the shift is over 10 mm this can be more difficult to manage but if you have not yet had any manual treatment you should discuss the options with an experienced practitioner before deciding on further treatment, and it is usually worth trying this before exploring more invasive treatment such as steroid injections or surgery.

Lumbar spine disc problems

Misleadingly known as a ‘slipped disc’, this is actually where damage to the outer fibrous ring of a disc between the bones in your spine allows the soft, central portion to bulge out and puts pressure on a nerve.

Symptoms can include:

  • pain in the lower back/pelvic area
  • sciatica (pain down the back of the leg) including referred pain in the upper back, buttocks, genitals, legs and feet
  • numbness in part of the leg
  • leg muscle weakness – this is an important sign that a nerve is under pressure and you should contact your GP for an urgent review
  • suddenly becoming incontinent of urine or faeces – this is a sign that a nerve is under severe pressure and you should contact your GP or emergency department for an immediate review 

For more information about lumbar spine disc problems, their treatment and management, visit Backcare or see the NICE Guidance for managing low back pain and sciatica

Labral hip joint tears

A labral tear usually affects just one side of the hip and is where there is a rip in the labrum (the cartilage that surrounds the rim of the hip socket). It is not very common, but can be confused with PGP pain that is not improving despite effective manual therapy treatment

Symptoms can include:

  • a sharp pain in the hip
  • feeling that the hip is locking during activity
  • a grinding or popping sensation when the hip is rotated outwards
  • a dull, subtle pain felt on the outside of the hip joint and near the groin

For then show up during or after pregnancy.

Symptoms can include:

  • pain in one or both hips
  • difficulty walking – walking with a limp
  • referred pain in the pelvic area
  • early onset of osteoarthritis (wear and tear) in the hip joints

For more information about hip dysplasia, its treatment and management, visit the International Hip Dysplasia Institute.

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