Pelvic Pain Trigger Points Explained

In Pelvic Floor Physical Therapy by Stephanie Prendergast139 Comments

If you have pelvic pain, chances are you have trigger points somewhere within or adjacent to your pelvic floor muscles.

Indeed, trigger points are a key factor in many pelvic pain syndromes. For that reason, I’m dedicating this week’s blog post to them. I’ll begin with an overall explanation of what they are. Then, I’ll explore the part they play in pelvic pain syndromes. And lastly, I’ll wrap up with a discussion of how pelvic pain trigger points are diagnosed and treated.

The Trouble with Trigger Points

A muscle is made up of numerous fibers. A trigger point is a small, taut patch of involuntarily contracted muscle fibers within a muscle or muscle fascia. The tightly contracted fibers that form a trigger point effect blood supply to the nearby tissue, which in turn makes the area hyperirritable when compressed.

In addition to the local pain they cause, trigger points often refer pain elsewhere. On top of that, they can pull on tendons and ligaments associated with the muscle they are in, and can even cause pain deep within a joint where there are no muscles.

Once trigger points made it onto the medical map, it became obvious that a handful of different kinds existed. For instance, there are active trigger points, which as their name suggests, actively cause pain and other symptoms. There are latent trigger points, which are dormant, but have the potential to cause trouble. And there are satellite trigger points, which can crop up in another trigger point’s referral zone. For instance, a trigger point in the levator ani muscle can cause a trigger point to occur in the abdomen.

So not only can trigger points refer their pain to other regions, they can actually cause other brand new trigger points to crop up in other places. That’s why it’s important to keep in mind that trigger points can be very misleading, and when dealing with them it’s a mistake to always assume the problem is where the pain is.

For example, in women, trigger points in the obturator internus muscle of the pelvic floor can refer pain/irritability to the urethra. So say Jane Doe has an active trigger point in her obturator internus. As a result, Jane begins to experience urethral burning and urgency. So she visits her doctor believing she has a urinary tract infection. But a battery of tests shows that there’s nothing wrong with Jane’s urinary tract. Jane’s doctor tells her that everything is fine. But Jane is frustrated because everything’s not fine. She’s in  pain and feels like she constantly has to urinate.

What both the doctor and Jane are missing is that the cause of her urinary symptoms is a patch of constricted muscle fibers in a small, out-of-the-way muscle in Jane’s pelvic floor.

This is a frustratingly common scenario. Indeed, pretty much everyone will deal with trigger points at some time in their lives. If you have lingering pain, tightness, or muscle restriction, chances are you have trigger points. Plus, trigger points are at the root of many ailments you wouldn’t expect such as dizziness, nausea, tooth pain, restless leg syndrome, painful periods, and irritable bowel syndrome. However, oftentimes issues caused by trigger points are misdiagnosed as arthritis, tendonitis, bursitis, or ligament injury.

The good news is that inroads are being made, new research on trigger points is being undertaken, and the medical community is increasingly starting to recognize them as causes of  pain. More good news is that even though there are some 620 potential trigger points possible in human muscle, they show up in pretty much the same places in everyone. So trigger point maps do exist complete with referral patterns, and that goes for the pelvic floor too.

Trigger Points and the Pelvic Floor

Now let’s get to the main reason you’re reading this blog about trigger points: their relationship with the pelvic floor.

Trigger points play a role in the vast majority of pelvic pain syndromes. Indeed, in some cases, they’re the only culprits.

For instance, I recently had a male patient, let’s call him Ben, who had trigger points in his rectus abdominus from doing too many sit ups over a period of years. His main complaints were lower abdominal pain and penile pain. After about eight months of working to release those trigger points, Ben is now symptom-free.

However, while it is possible for trigger points to be the sole cause of pelvic pain,  it’s much more common for them to be just one component in a multi-layered problem.

For instance, another patient of mine, Lori, had trigger points in her bulbospongiosus, obturator internus, and piriformis muscles. However, in addition to these trigger points, she had connective tissue dysfunction, an overall hypertonic (or tight) pelvic floor, and urinary urgency and frequency.

In Lori’s case, her pain began after a urinary tract infection followed by a stubborn yeast infection. The pain from the infections kicked off a so-called “guarding” reflex within her pelvic floor. (Guarding occurs when muscles contract rigidly around a painful area to protect it from further damage. But, guarding causes further damage because it restricts blood flow, which in turn causes more guarding and more pain.)

With Lori, it’s impossible to know exactly what part trigger points played in the creation of her pain cycle. An ongoing guarding reflex in and of itself is sufficient enough to overload pelvic floor muscles and cause the development of trigger points. But the overall muscle tightening that followed the guarding could also have caused them to develop, not to mention Lori’s new habit of holding her bladder because of her urgency/frequency issues.

Aside from an overuse/repetitive strain situation as with Ben or pain from infection or guarding as with Lori, trigger points in the pelvic floor can develop for a slew of different reasons. For example, local trauma can cause them to crop up, such as infertility treatments, rectal/vaginal ultrasound, a colonoscopy, a tailbone fall, a bartholin’s abscess, or childbirth. Mechanical and physical stressors, like a hip tear or endometriosis, can also cause the development of trigger points.

Whatever the reason for their development, trigger points are famous for complicating already painful situations, and in many instances, they stick around long after the original problem clears up.

Trigger Point Diagnosis and Treatment

Physical Therapists treating pelvic pain should know how to identify and treat trigger points in pelvic floor and pelvic girdle muscles. In addition, he or she MUST be knowledgeable about the mapped out regions where trigger points typically occur within the pelvic floor as well as the dozens of referral patterns.

For instance, trigger points in the piriformis muscle can refer pain down the back of the leg or into the hip or a trigger point in the levator ani muscle can create the feeling of having a golf ball in the rectum. Having this level of knowledge is an important part of putting the pieces of the puzzle of a patient’s pelvic pain symptoms together and forming a proper treatment plan.

When it comes to diagnosing and treating trigger points, it’s important that a PT evaluate all of the muscles and muscle fascia, both internal and external from the navel to the knees, front and back.

Liz does  a great job of explaining what happens when she finds a trigger point, so I’m going to defer to her here. Take it away Liz.

“While going perpendicular along the muscle’s direction, when you come across a trigger point, you will feel a very noticeable change. To me, it feels sort of like a lentil. Plus, when I find a trigger point, I always get a reaction from my patient, so I’m always tuned into him or her for feedback.”

In addition, sometimes a twitch can be felt when a trigger point is compressed, and sometimes that twitch response will cause the entire muscle to contract. Lastly, the trigger point may feel hotter to the touch than the area around it.

A handful of strategies exist for treating trigger points including:

  • Manual release techniques: A good PT has a handful of trigger point release techniques in her toolbox.
  • Dry needling: Almost all states, but not all, allow PTs to administer dry needling. California, where we practice, does not.
  • Trigger point injections: These are administered by physicians and typically contain anesthetic; however, it’s the actual injection that will successfully release the trigger point, not the anesthetic. The anesthetic is simply on board to soothe and numb the tissue.

I hope I’ve answered all of your questions about pelvic pain trigger points  in this post! If not, please don’t hesitate to ask any additional questions you might have in the comments section below or email me at [email protected].

If you would like to do some further reading on trigger points, below are some resources that I recommend:


  • “Myofascial Pain Syndromes–Trigger Points” by David Simons and Jan Domerholt, Journal of Musculoskeletal Pain, Vol. 13(1) 2005
  • “Myofascial Pelvic Pain” by Rhonda Kotarinos
  • “Myofascial Trigger Points and Myofascial Pain Syndromes: A Critical Review of Recent Literature” by  David Simons and Jan Domerholt


  • The Trigger Point Manual by Drs. David Simons and Janet Travell
  •  Myofascial Trigger Points: Pathophysiology and Evidence-Informed Diagnosis and Management by Jan Domerholt and Peter Huijbregts


Are you unable to come see us in person? We offer virtual appointments!

Due to COVID-19, we understand people may prefer to utilize our services from their homes. We also understand that many people do not have access to pelvic floor physical therapy and we are here to help! The Pelvic Health and Rehabilitation Center is a multi-city company of highly trained and specialized pelvic floor physical therapists committed to helping people optimize their pelvic health and eliminate pelvic pain and dysfunction. We are here for you and ready to help, whether it is in-person or online. 

Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. The cost for this service is $75.00 per 30 minutes. For more information and to schedule, please visit our digital healthcare page.

In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page


All my best,



  1. Awesome article and so very well explained. I really appreciate your advocacy of the role of trigger points in pelvic pain. I am a believer and I have benefited from a knowledgeable physical therapist.

    I also know from personal experience that muscle tension from stress and resisting feeling emotions also contributes to trigger points. Much relief can be found with calming the mind and learning to feel emotions, along with trigger point work and stretching and strengthening the muscles with yoga or Pilates or some other physical activity.

    A couple of other books that are very informative about trigger points are “A Headache in the Pelvis,” by Dr. David Wise, and “The Trigger Point Therapy workbook” by Clair Davies.

    1. Gail,
      My husband attended the Wise clinic this past July with Dx of Hypertonic pelvic floor. severe rectal pain and burning. usually VAS score 9-10. He has been doing the protocol faithfully without improvement. He is extremely frustrated. Any thoughts would be appreciated. thanks.

      1. I see that this post is a bit older, but in case it helps anyone – I had a similar response to treatment the first time around, and decided to go with PF Botox injections 3 months ago. It has really helped so far.

        1. Krissy, I’m very glad to hear that the Botox is working for you. Since that post I’ve been going to pelvic floor therapy twice a week, bladder instillations for IC twice a week, and I had a nerve block which confirmed pudendal neuropathy. So Botox and a neuro stimulation modulator are awaiting approval from FDA. The pelvic floor therapist has been good for me even though the thought of it was not. I have another nerve block in May and another in June. Hopefully the Botox will start soon after that and that my body will respond well like yours has. Keep feeling good!!!!

        2. Hi Krissy
          I have had a nerve block – first one was good but didnt last which I was made aware of by my doctor. Next I had the cortizone nerve block – no help. I am hopeing the get the botox soon as I am going overseas for 6 weeks. Are there any side effects? and how long does it last if you are comfortable giving me any extra info It would be great. The main symptom for me is urgency ! so stressful having that feeling all the time.

        3. I saw that you had pelvic floor injection for a tight pelvic floor (although this post was from 2014). Did your doctor inject these into the sphincter muscles, or was there another way to inject these directly into the pelvic floor muscles? My doctor used 50 units of botox into the anal sphincter muscles (as I am a male). Please let me know. Thanks.

        4. That would be great if I could find a physician here in metro Atlanta. Thank you.

      2. HI Deb,
        I’m in a similar situation, 20+ yrs…have had no luck with PT unfortunately. It all makes sense, but no improvement. I’m focusing on TMS ( Tension Myoneural Syndrome) and meditation…pretty desperate and despairing, but I’m walking around, so it beats a lot of things…there is something out there that will help that I have yet to find apparently…happy to connect if you want to [email protected]

  2. In past had Pelvic Floor PT do external PT for pelvic floor with good results (2/week for 24 weeks). Now, the Veterans Hospital is only allowing once every 3 weeks and she wants to do internal PT pelvic floor work. I’ve been very triggered by sexual assault plus work is done in noisy clinic where mens voices are easily heard through walls.

    I need therapy but afraid under these circumstances it will make it worse. I spoke to PT pelvic floor ther therapist as part of my history.. I’m shaking just typing this. How to handle?

    1. Author

      Dear Rose,

      I am so sorry so here about the assault and the current problem with your treatment plan. Clearly your PT thinks your pelvic floor is involved in your present symptoms. As you know and have experienced, external structures can also contribute to pelvic pain and treating them can also lead to improvement. If you are not comfortable with internal work it is the professional responsibility of your therapist to help you decide on other reasonable treatment options. As a patient, it is your responsibility to communicate your concerns and voice your choices. If PT is not a good choice right now cognitive behavior therapies, guided imagery, or pharmaceuticals may be useful.

      Please let me know if you have any further questions!

      All my best,

    2. I highly suggest you do the internal pt, it is the only thing that worked for me xoxo it’s such a release

  3. How does a pelvic PT do dry needling to muscles in the pelvic floor? Internally through the vagina or externally through the perineum floor? My pelvic PT tells me I have trigger points in my obturator internus but she doesn’t do dry needling. I’ve heard good results from it, though, from others.

    Thank you.

    1. Author

      Hi Isabel,

      Thank you for your question!

      Unfortunately California is one of the few states where physical therapists are not yet able to dry needle. Your question would be best answered by Dawn Sandlacini, in Denver. She teaches courses on pelvic floor dry needling. Her email address is [email protected].

      Please let me know if you have any further questions!

      All my best,

  4. I have found that by practicing “belly breathing” I can get the pelvic floor to relax. I have trigger points in my leg, back, neck, and shoulder so I believe that old levator ani pain is very familiar and an undiscovered source of some of my chronic pelvic pain. I learned about belly breathing from dr. Oz.

    1. Author

      Thank you for sharing Cynthia! “Belly breathing” or “diaphragmatic breathing” is indeed a great way to relax the pelvic floor!

  5. I am currently in Pelvic Floor Pt 18 mths post op for repairs. I’ve never really been pain free since surgery. PT is almost certain my issues are nerve related (pudendal) with lots of burning and heaviness/aches from belly button to knees at times. She has done lots of internal trigger point massage and has just recently started massage for a ton of connective tissue restriction. I don’t take anything stronger than Naproxen 500 or a few advil for pain but sometimes the burning is almost unbearable. Dr. has me currently doing bladder retraining as I go to the bathroom 10-12 times a day. Any suggestions for pain relief when a flare up occurs? Does it sound like the PT is on the right track?

    1. Author

      Dear Debbie,

      Burning and heaviness from the belly button to the knees extends beyond the territory of the nerve. It is possible your nerve is involved, however, it sounds like there is more going on than just the pudendal nerve. It is very important that your physical therapist and doctor help you figure out what exactly is causing your pain. While you are figuring that out, it makes sense to consult with a pain management physician to help you manage your pain. Medication and injections do not have to be a long-term solution, however, they can help keep you more comfortable during the treatment process and help you avoid sensitizing the nervous system. Your PT can also help you figure out things that are pain relieving based on your specific impairments.

      All my best,

  6. Hi,

    I have been doing pelvic intravaginal therapy for the past few months after a bad UTI. The main symptoms i have are a hard lump in the lower abdominal that would come and go, post urination sensation and there seems to be an achy feeling and something stuck in the anus/tailbone.
    The something-stuck-in anus sensation usually comes when i try to relax my pelvic floor. i have the habit to hold up my pelvic/squeezing my vaginal up especially when i am nervous.
    What would you advise? I have long history of constipation and straining.

  7. Hi. I have been helping my 71 year old father find diagnosis and treatment for his chronic pelvic pain. We have been to many specialists and are confident of 2 things:
    His pain is not from a urology condition
    He has not had much relief from physical therapy although there’s a general belief his problem is muscular skeletal.

    He is giving up hope and turning into a very old man.

    Can you recommend a qualified physical therapist in the pittsburgh pa area? He will travel to Cleveland clinic if needed but prefers pittsburgh.

    We both appreciate any suggestion you may have.
    Thank You

    1. Author

      Dear Kim,

      I’m so sorry to hear about the issues your father is having. It is so hard to see our loved ones deal with chronic pain.

      We do have two PTs who have taken our class that we refer to in Pitts; they are:

      Christine Woods: 412 967 9229 and Janice Bryant: 412 422 4775.

      Please let me know if you have any further questions.

      All my best,

  8. Thank goodness for liberated people. I recently went to see a sexologist to address painful intercourse. Don’t laugh, I’d never had pain free intercourse so thought it was normal and it definitely supported why I believed many women didn’t enjoy intercourse.
    Bottom line, the resting tone in my pelvic floor was extremely high in spite of 7 hours of yoga and pilates a week. Many reasons for this “spasticity” have been identified and a specialized physiotherapist has treated me 3 times with internal trigger point therapy. I cannot believe the difference in just 3 weeks. The strength of my pelvic floor at age 52, according to my PT is as strong as an 18 yr old. Yoga will do that!
    I so wish more women would take the time to have their pelvic floors examined, even if they think they have strong ones, it’s made such a difference in my life. Without intending to over share, I’ve had painfree intercourse for the first time in my life!
    Thanks for the work you are doing in this still somewhat tabo field.

    1. Author

      Dear Liz!

      Thank you so much for sharing! And I am so happy to hear that you have had such wonderful results in PT! These are the things that make my day!

      But, just wanted to clear one thing up…the yoga you do is likely NOT the cause of your having a good amount of pelvic floor strength, unless you have been doing very targeted Kegel-like exercises during your yoga classes, which I’m thinking isn’t the case.

      All my best,

      1. Hi,

        Why would yoga not be the cause of good pelvic muscle strength? Since yoga also primarily focuses on deep breathing, I would assume that the relaxation of the pelvic floor as well as activation of the core would enhance strength. At 52 yrs., what else would be the cause?


        1. Author

          Dear Molly,

          Yoga could absolutely contribute to pelvic floor strength in a person that has normal tone in their pelvic floor. In a person who has a tight or hypertonic pelvic floor yoga could exacerbate that hypertonus because of all the core strengthening. Increasing abdominal pressure, as one does with core strengthening, will increase pelvic floor muscle tone. However, the deep breathing in yoga definitely helps to relax the pelvic floor musculature. As far as your last question, are you asking what else could be the cause of pelvic floor strength in a 52 yr old woman? There are many things that will influence the strength of the pelvic floor, such as whether or not you’ve had a child, if you’ve gone through menopause, if you are on hormone replacement, if you’ve had any pelvic surgery, what your activity level is and has been like during your life, etc… All of these things, plus many other factors will influence a person’s pelvic floor muscle strength.

          All my best,

  9. It’s after midnight, and I was really encouraged reading this post. Your Jane Doe story above sounds like me. I fell on my butt one winter then I couldn’t sit for year. My chiro. helped me with trigger release in back and thighs. Since then I have been having pain in urethra, urgency, and pinching in clitoris area. Tests come back negative. I believe trigger points are a great deal of my problem (I sit too much) and I have myofascial syndrome and perhaps fibromyalgia.

    I live in Bucks County, PA. Do you know any PTs in my area that you might recommend?

    I want to head this problem off before it gets worse.

    Thank you very much!

    1. Author

      Dear Kristen,

      Below are the PTs who have taken our class in PA. All my best, Li

      Baldridge Nicole PT Monroeville PA (412) 380-0551
      Bryant Janice Pittsburgh PA (412) 422-4775
      Buss Melissa Pittsburgh PA (412) 851-8850
      Curtis Cheryl Erie PA (814) 877-3215
      Dangrow Rebecca Greenville PA (724) 588-3001
      Haroldson Margo Greenville PA (724) 588-3001
      Kulifay Amanda Cranberry TWP PA (724) 742-9770
      Lennon Lisa Pittsburgh PA (412)630-9750
      Patterson-Avery Martha Charleroi PA (724) 489-8111
      Pfaff Jennifer Shippenville PA (814) 678-4654
      Shafran Andrea Delmont PA (724) 468-4541
      Taylor Krista Erie PA (814) 877-2537
      Woods Christine Pittsburgh PA (412) 967-9229
      Garges Lauren PT Bethlehem PA (484) 854-2251
      Horeis Megan DPT Peckville PA (570) 348-1332
      Miller Rachel PT Dawningtown PA (610) 873-3076
      Snowden Karen PT Allentown PA (610) 402-9712
      Lande Jennifer PT Pittsburgh PA (412) 851-8850
      Schomburg Colleen PT Wexford PA (412) 692-4305
      Wincer Carolyn PT Gibsonia PA (724) 449-2100
      Sheth Hina PT Philadelphia PA 267-282-1301
      Haring Lori PT Allentown PA 6104376975
      Pope Albright Diana DPT Scranton PA 5703481305
      Rejba Amy MSN, CRNP Philadelphia PA 2158638100
      Drake Janet PT Pipersville PA 2157669914
      Suniaga Jaquelyn PT West Chester PA 6108530508

  10. Hi Liz,
    Thank you so much for this post. I’ve been dealing with what I believe to be this very issue for the past several years. I’ve had a very difficult time finding the right person to treat this issue. I’ve been to an OB/GYN, orthopedist, had x-rays and a pelvic MRI, but had trouble getting an initial diagnosis. I believe I injured my pelvic floor with weight lifting and have developed a trigger point right where my obturator internus is. I’ve had some luck with one practitioner who was actually willing to do trigger points in my pelvic floor, but have recently moved to Columbus, Ohio. I’ve just started with a new trigger points therapist who works in combination with a chiropractic clinic in town. He too is reluctant to look for/treat the trigger point on the bottom of my pelvic floor by the sits bone. Do you have any advice or any practitioner recommendations in or near the Columbus, OH area? The pain has truly become intolerable and I’ve developed hip, lower back, and ankle issues on the right side of my body as a result. I feel stuck…literally and figuratively! Any advice you could offer would be much appreciated.

    Take care,

    1. Author

      Dear Katie,

      I recommend that you see a pelvic floor PT who can evaluate you and work on any trigger points you have internally, externally as well as anything else that might be going on with your pelvic floor.

      This is an article about good pelvic floor PT:

      Here are all the PTs who have taken our class in Ohio, sorry none are in Columbus:

      Morris Michelle PT Perrysburg OH (419) 383-5040
      Arbogast Hannah PT Kettering OH (937) 208-7055
      Dubbs Jill PT Rocky River OH 2162272610
      O’Dougherty Betsy PT Lakewood OH 2164458000

      Also, this is a blog post about how to find a good pelvic floor PT:

      All my best,

    2. In columbus, Mount Carmel east has a great women’s health program with pelvic floor PTs. Also, ohio state has added a few PTs who specialize in pelvic floor pain.

    3. Hi Katie,

      I’m not sure when you posted your comment. However I’m sorry to hear you’ve been struggling with pelvic floor and lower extremity issues. I myself have also been experiencing similar problems with my left lower extremity and pelvic floor ever since a bad ankle injury 7 years ago. I feel stuck and like I can’t distribute and load weight through my left leg correctly without getting pain at the different joints. I’ve basically been checked out from head to toe with MRIs and everything looks fine but I’m still having problems. In addition bowel movements urination and sexual function and even breathing at times are difficult. I think it’s due to and imbalanced pelvis and an over tight and weak pelvic floor. I of course I’m a guy but I too live in Columbus Ohio and was wondering if you ever found some good hands on pelvic floor physical therapists in the area? Thanks so much I hope you are feeling better.


  11. Hi,
    I am an acupuncturist in Boulder, CO and I do trigger point acupuncture and injection therapy. I am very interested in learning more about pelvic trigger points and it’s difficult to find information on this. You mentioned Dawn in Denver in your responses to another commenter on here but she’s a pediatric specialist. Are you connected with anyone else in the Denver area that specializes in pelvic trigger points?
    Thanks very much.

    1. Author

      Hi Sheila,

      Below is list of PTs who have taken our pelvic floor PT class in Denver; perhaps they might have a lead for you. All my best, Liz

      Neujahr Hollie PT Denver CO (303) 260-5092
      Gerig Nel MD Denver CO 3033889321
      Brady Marie PA Denver CO 3033889321
      Waliser Thomas MD Denver CO 3038301181
      Nishimoto Terri PT Denver CO 7204023801
      Eral Laura Denver CO (720) 394-9453
      Fries Elizabeth Denver CO (303) 260-5092
      Klein Lea Denver CO (303) 333-3493 ext 1
      Mueller Angie Denver CO (303) 799-6336
      Nangle Amie Denver CO (720) 402-3801
      Nichols Diana Denver CO (720) 493-1181
      Raschke Kimberly Denver CO (720) 402-3801
      Richardson Mary Boulder CO (303) 441-0452

  12. I’m so glad to see this issue addressed. I haven’t had sex in seven years because of pain during intercourse. I’ve been to several gynecologists who all told me it was all in my head, and I should drink alcohol to solve the problem. Get drunk!!?? Finally Dr.s are realising that when there is a physical symptom there is a physical cause! Wow, what a concept.

  13. I have dealt with chronic pelvic pain on and off since 1998. It has been diagnosed as different things over the years, beginning with prostatitis and currently PNE. It started in 1998, and went away suddenly in a few months. It reappeared four months later and this time stayed for two years. I went nuts trying to find a diagnosis, and finally the Cleveland Clinic helped putting me into PT. It went away and stayed away for TEN YEARS only to reappear recently as suddenly as it went away. No one seems to be able to tell me why it appears and why it disappears. I am back in PT and working diligently with a therapist to help me get back to a better quality of life again. What is most irksome is that most caregivers brush this aside as a minor issue. Without my PT, I would basically be left to pharmaceuticals and shrugs. Is there anything out there to help me understand what causes this, because I surely would avoid that whenever I get back to normal again.

    1. Author

      Dear Mike,

      There are many many things that cause pelvic floor dysfunction, and usually it’s a confluence of factors for each patient. Check out our website and read the blog posts on this blog for more information. Start with this post on male pelvic pain: also read this one about the diagnosis of “PNE,” which you likely do not have. This is a diagnosis that is way over diagnosed by physicians, likely because there is a surgery involved.

      Since your symptoms have gone away in the past with PT, they likely will do so again. Talk to your PT about any lifestyle modifications or triggers. She should be able to help you with this.


  14. Liz,

    Thanks for the reply. Any lifestyle modifications or triggers that can be identified with me would be welcome news. My PT is a wonderful therapist who understands this condition and has specialized in pelvic floor cases exclusively. She is busy all the time which goes to show you just how many people need the assistance and cannot find it. Her willingness to work with men and women is also really important. I keep my hopes up that I can once again enjoy life without pelvic pain.


  15. Hello

    I’m a 33 yr old male in the UK who has experienced urinary frequency, pelvic pain, back pain and fever following an antibiotic regime for first time Urethritis. The urinary frequency was the most worrying bit, it started after a fever on the final day of 2 weeks antibios. I am a Personal Trainer so I weight train, and have been stressed about a potential new business. My worry is will I be able to return to my passion of weight training?? I know I am tight through my adductor line, and do know a roofer in my area….how should I proceed??? All this has happened in the last 5 days..thank you, great blog

    1. Author


      I’m sorry about what you are going through; please see the info on the pelvic floor PT that we refer to in London. I’m sorry that we can’t answer your specific questions, but without knowing what is causing your symptoms we simply can not give you advice on your weight lifting concerns.

      All my best,

      1. Liz
        My situation is similar to Matt above, however I have had it for many years.
        Can you please advise on the pelvic floor PT in London?
        You mention that you know of some.

  16. Are there any pelvic floor PT’s in the Milwaukee area? I am new to all this and so thankful I found this website. Your website/blogs are so very informative.

    Thanks so much.

    1. Author

      Dear Karen,

      I’m sorry but we don’t know of a PT in Milwaukee; however below is a list of PTs in Wisconsin, perhaps one may be near you. In addition take a look at our blog post about finding a PT in your area; perhaps it will have some tips that will help you in your search.

      Hoffman, MD Donna MD Onalaska WI 6087751851 [email protected] Gunderson Lutheran Med Ctr
      Walz Colleen PT Onalaska WI 6087751840 [email protected] Gunderson Lutheran Med Ctr
      Bartelsen Beth PT Nashotah WI 2625696306 [email protected] ProHealth Care Musculoskeletal Institut
      LaBorde Linda PT Waukesha WI 4143020770 Spinal Dynamics of WI
      Hildenbrand Sherese OT Mequon WI 2622401202 [email protected] Continence and Pelvic Wellness Clinic
      Callif Debbie OT Mequon WI 2622401202 [email protected] Continence and Pelvic Wellness Clinic

  17. Is there a support group in West Michigan? Coping with all the indignities and invasion of privacy is almost as miserable as the pain, surgery, injections, pelvic floor rehab, etc. I thought dealing with Crohn’s disease was rough, but this is more challenging for me. I had sacrocolpopexy and a rectocele surgery in August 2013. There were complications (Cdiff and a blood clot) Then of course the Crohns flared. Now it appears that the mesh is eroding into the bladder, a new rectocele has formed, and pelvic pain is chronic. Tomorrow I am being “put under” for trigger point injections and starting pelvic rehab therapy next week. Any words of wisdom for how to get past feeling so utterly exposed, ashamed, fearful, and humiliated?

    1. did you find a support group? It is important to have people to support you. your mental health is very important also. I also live in w. michigan and am going through pelvic floor stuff and it is embarrassing. I hope you have found some relief.

  18. I am a Massage Therapist working in Trigger Point Massage and familiar with Dr’s Janet Travell And David Simon. Reading your article I am disappointed that you have such incorrect information. David Simons and Janet Travell ( Janet Travell now deceased) were both Doctors, not a PT and were never a “husband and wife” duo. She alone coined the term “trigger point”. She didn’t meet Dr. Simon Travell until around 1963. Get your facts straight. This mistake doesn’t lend any credibility to your article.

    1. Author

      Dear Nancy,

      We appreciate your comment. However, our blog does not discuss David Simons or Janet Travell, much less their personal relationships. We do however, offer links to their research, and their book.



  19. can you recommend a pelvic PT in the Boston, MA area? my 23 yr old daughter has chronic pelvic pain due to 4 surgeries for endometriosis since 2007. Situation is very bad – would really appreciate a recommendation – thanks

    1. Author

      Dear Will,

      I am sorry to hear about your daughter’s situation. Fortunately, pelvic physical therapy is very effective for patients who have had endometriosis. We do not have referrals for a therapist in Boston, but I can refer you to a therapist in Framingham, MA. Additionally, we are proud to announce that our 5th extension will open early Spring in the Boston Area.

      Marie Wade, PT
      Framingham, MA
      Franklin Memorial Hospital
      (207) 779-2256

      All my best,


      1. 1) thanks

        2) Franklin Memorial Hospital is in Farmington, Maine, not Framingham, Massachusetts

        3) thanks anyway

  20. After seeing two urologists, two neurologists, three PTs, a general surgeon, pain physician, and massage therapist, we contacted a physiatrist who determined trigger points were causing my levator ani pain, tightness, and burning. The pain always goes away over night but returns.

    He concluded that the pain was caused by trigger points in the gluteus maximus, gluteus medius, medial hamstring, adductor magnus, adductor longus, and obturator internus.

    Can you suggest a good PT in Spokane, Washington that is qualified in assisting in these areas can address releasing these trigger points to alleviate this two year old daily pain and discomfort.

    1. Author

      Hello David,

      We do not have a therapist recommendation in Spokane, WA but I can recommend a therapist in Seattle and Bellevue. Their information is located below.

      Tina Allen, PT
      University of Washington-Roosevelt
      Seattle WA
      (206) 598-2889

      Sagira Vora, PT
      Overlake Hospital Medical Center
      Bellevue, WA



    2. Dr Ryan Burklund at Anesis Spine and Pain
      1414 N Vercler Rd building 5, Spokane, WA 99216
      He’s an amazing pain doctor. I did nerve ablation with him. See what he says…. He’s the best doctor I’ve EVER seen!

  21. I have been working through pelvic pain issues over the last three years. I had a vasectomy in 2011 and since that time have had increased discomfort starting with testicular pain and then spreading into rectal and abdominal pain. I eventually ended up with a Urologist who put me on antibiotics as I had a “mushy” prostate and that solved it for a short time but it recurred after 4 months and repeating that same treatment didn’t solve it.

    I am fortunate to have a urologist who is up to speed with what is going on in this arena and she was able to refer me to a PT who specializes in pelvic floor pain via myofascial release. I have seen her 9 times and feel considerably better. She has resolved almost all of my discomfort and I no longer feel consistently uncomfortable. I run every day and that has gone from something that I worried about to something that I can enjoy again. My only remaining issues are some penile tip irritation and occasional dribbling of urine after I go.

    At this point I do have a question and because of the nature of it, have not been comfortable addressing it with my PT. She starts each session with checking my pelvic alignment and then working on my lower abdomen – this is great and relaxing – no issue at all, just background here. She then leaves and has me undress from the waist down and cover myself with a paper sheet and lay on my left side with my knees pulled up. She returns and sits down behind me, lubes up her gloved hand and inserts a finger into my rectum.

    Here is where my “issue” begins. I get hard. Every time. Now with my knees pulled up and on my side, I have no idea if she knows or if this is “normal” but my urologist assured me some time ago that it was common with the DRE so I assume that my PT has some experience with it as well. Once I am hard, I leak and leave a little puddle on the sheet. She has not said anything about this and honestly I don’t know that is matters to anyone but makes me worry.

    But we still have not hit the core of it yet. She starts with a finger in me and works her way around the clock as it were releasing each of the points, some faster than others but I am intimately aware of her finger for obvious reasons. The first couple of sessions were limited to this experience and all was fine. On my third session, I had a slightly different experience. It was a Monday and I was returning from a weekend family trip where I drove a lot. She was working her way around the “front” and while I had my usual erection, it suddenly felt like she was stroking the tip of my penis. I moaned and she took it to mean that it hurt so asked if I was ok. I nodded yes so she kept her finger there, I assume to release a trigger point? About 15-20 seconds later, my muscles started to spasm in what I can only describe as a “backwards” orgasm. Rather than being centered in the penis and running back, this started in the back and rippled up. The referral from the urologist had told her that I was having pelvic spasms (as I was) and she assumed that was what was happening. She returned to that area again at the end of the session and the same thing happened again. I spent the rest of the day horny as hell at work but developed testicular soreness worse than anything I had had previously by the end of the day.

    I told her about everything except for correcting her assumptions regarding those spams. The following session she told me she would be very careful not to trigger the spasms again because it left me so sore and she didn’t. The following session she went back to that same area and once again I had that same orgasmic response and when she asked me about it after, she again asked if it was uncomfortable. I told her no, that it felt rather good, like a release. She asked about my previous assessment of not being able to feel it to much (my embarrassed response the first time) with a questioning tone.

    In the 3 sessions since, she has not gone any where near that part of me, skipping over it in favor of focusing on the muscles toward the rear of my rectum where there is a trigger point that I can feel so I know she is working on me, not just avoiding things.

    My understanding is that the work that is producing that result is the left levator ani (I ask where she is all the time as I like to understand) and that make sense in terms of urethra/penile referral that would need to be addressed. Is this something that should bring up with her and if so how? Is it likely that she is avoiding it on purpose or is it likely that she just feels that other areas need to be resolved first/more? Given that the only discomfort I have right now is tip of penis and dribbling after urination what should I expect going forward? I have two sessions left in this prescription and since much of the discomfort is resolved, worry that I am not likely to get another one for a while and want to get those last two items addressed but am embarrassed to bring it up.

    1. Author

      Hi Scott,

      It is not very common that men become aroused during treatment. I’m not sure why this consistently happens to you. The episode you described as a backwards orgasm is likely due to her inadvertently massaging your prostate. At least that would be my best guess. I always think it’s best to be honest with your PT. Whether it’s concerning something personal during treatment, or what she feels like are your major remaining impairments and her strategy to eradicate them during the remainder of your treatment program. That’s what I prefer with all of my patients. She’s a professional and should be able to handle it as such.

      Best of luck,


  22. I am a 38 year old male that has been experiencing pelvic/groin pain for nearly a year. It really started up last summer when I began running 2-3 times per week. I am currently being treated with neurontin (for nerve inflammation) and PT. The PT has been mostly focused on building core abdominal strength. PT is helped a little bit but not been life-changing. The pain started in my left testicle but I also feel it in my perineum and in my pubic area. Stretching helps somewhat. The most pain typically occurs after exercise. During exercise I am fine.

    I have experienced a little leakage over the years after urinating. I am wondering if a weak pelvic floor could be part of the problem. Do you have any particular therapist in the metro-Detroit area that you would recommend?

    1. Author

      Dear Dave,

      Core and ab strengthening is not what a qualified pelvic floor PT would be focusing on based on your symptom description. Take a look at the following blog posts, which explain what we consider to be appropriate PT for pelvic pain: As for your question about whether a weak pelvic floor could be part of your problem, it’s impossible for me to speculate as without examining you I can’t really guess as to what impairment/s are contributing to your symptoms. But, typically, it’s a tight pelvic floor that is most involved with symptoms of pain.


      We are not familiar with a pelvic floor PT in the metro-Detroit area, however, below are two PTs in Michigan who have taken our course:

      Miles Kristen PT Royal Oak MI (248) 655-3011 [email protected] Women’s Urology Center
      Veeser Catherine PT Ferndale MI (248) 655-3000 [email protected] William Beaumont Hospital

      Lastly, here is a blog post that gives advice on finding qualified PTs that might help you:

      All my best,


  23. I have been suffering from chronic pelvic pain since the summer of 2013. I am a triathlete and this condition is seriously debilitating, since cycling is now out of the question and even running means increased pain. I live in Sweden. Do you know of any PT in Sweden or Europe that is trained in pelvic myofacial trigger point release, or do I have to fly to the US to find help?

  24. I have had pain in the inner thigh area. Had a sona gram, ct scan, bone scan, and MRI of lower back. Diagnois is oeistis pubis degenerative disease. Went to chiropractor (still going), gyny, and PCP, They thought it was my groin. I went to physical therapy for groin and it didn’t help (made it worse). Now I’m going to pt for pubic bone. The messages in the inner thigh are very painful and I have at least 20 black and blue marks from them. Brought me to tears. Now she wants to do an internal examine of muscles to see if they are stressed. I would like to have exercises to do since the messages are painful. What do you think? I have had this problem now for 2 years. Sometimes the pain is so bad that I limp. I don’t have pain anymore in the middle of my pubic bone and the pressure has gone away. No incontinence either. Not an athlete. Don’t know what happened. I am 64 years old. The PT said my muscles and tissues are all tight that are connected to my pelvic bone. This is so horrible and I am so tired of not performing daily duties as I used to. Do you think that I am on the right track?

    1. Author

      Hello Marlene,

      If your therapist has stated that your muscles and tissues are tight, then strengthening exercises will only make your situation worse. Is your current therapist a pelvic floor specialist? An internal evaluation of your pelvic floor is essential when determining the source of your pain. I wish you the best of luck in your recovery.

      All my best,


  25. I am a 67 year old male and have been experiencing pain in the lower abdomen for 8 months. The first five months I was told by urologists (14 visits) that I had prostatitis. I has ct scan, cyst scope, colonoscopy etc. and at least three different antibiotics. My psa is 1.1. Finally made it to different urologist in Indiana who immediately said CPPS. I have been seeing a PT for 6 weeks but because of her schedule (vacation) and mine (out of town for two weeks) it has not been consistent and not much relief. We now have scheduled 6 visits in a 3 week period. She seems very knowledgable and I am hopeful, but wonder what happens it this is unsuccessful. How long would you recommend this protocol and are there any trained PTs in the Daytona to Jacksonville area , as I will return there in November? This condition feels like the “golf ball” . It is relieved by floating in a hot tub but obviously one can not do that all day.

    1. Author

      Hi Steve,

      Since every patient is different, it is difficult to answer your questions about the expected treatment duration for your particular situation. I would however, recommend that you create a consistent treatment plan and maintain it for a minimum of 8 weeks in order for your body to adjust to therapy. I suggest that you discuss alternative treatment options with your therapist in case you fail therapy, but with a qualified PT, this may be unlikely. Below are therapist recommendations near Daytona. I wish you the best of luck in your recovery.



      Tracy Sher, PT
      Florida Hospital
      Altamonte Springs, FL

      Ashely Arango, PT and Katherine Marsh, PT
      Florida Hospital Pelvic Health Rehab
      Orlando, FL
      (407) 303-8280

      1. Thanks for the info. I’ve been working with pt here for about 12 weeks and seem to be making progress but it is slow. Sort of like 3 steps forward and then two back. She says the pelvic muscles are much softer that when we began. We are just now trying to strengthen. I will look for your recommended pt is Florida.

        Thanks again.

  26. It has been 13 months since my most recent bout with pelvic pain. When I last wrote on this site, I was a very unhappy camper. Without the support of a wonderful PT, I don’t know how I would have coped. She was able to work with my family physician, urologist, and exercise therapist to pinpoint treatments which would alleviate my pain while we worked to find the underlying cause. Through many ups and downs, we seem to have identified what caused my pelvic pain to begin with and what I need to do to bring it under control. Patience, life style changes, and a few medications have paid very big dividends. I may never be completely free from periodic symptoms, but I am MUCH better today than I was 13 months ago. For those traveling this road, I can only say that your medical team can be a very big reason for success or a very big hurdle in your search for relief. I am lucky to have the PT and supporting team that I have.

  27. I used to do aero pilates and gave it up months ago. I have R groin tightness and when receiving chiro. adjust. chiropractor pushed on L3 area and felt in groin each time he compressed. there is no herniation and no herniated disc. now i have muscle guarding with R adductor.. I was wondering is it the psoas TP’s. and how do you get to those if buried deep. tough to get from anterior too.


    1. Author

      Hello Pete,

      I would recommend that you see a local pelvic floor therapist in order to determine the exact cause of your symptoms. Pain in the groin can indicate tightness in your pelvic floor and may not necessarily involve your psoas. However, without an evaluation, I am unable to know for certain. I can recommend a few therapists, depending on your location.



  28. Can you recommend anyone in New Jersey? I was recently diagnosed with obturator internus problems.

    1. Author

      Hello Kate,

      Below is the list of therapists we recommend in the New Jersey area.



      Niva Herzig MS,PT
      Englewood, NJ
      Core Dynamics PT

      Jamie Besante, PT
      Beachwood, NJ
      Southern Ocean Medical Center
      (609) 978-3110

      Michelle Dela Rosa, PT
      Columbus, NJ
      (609) 379-0900

      Nancy Ely-Maskal, PTA
      Physical Medicine and Rehabilitation Center
      Englewood, NJ

    1. Author

      Hello Beth,

      I’m sorry, but we do not have recommendations for Ohio at this time. Would you like a recommendation for another location?



  29. I am thrilled i came upon your website, some of the stories I can relate to. I suffer from myofacial trigger points for over 2 years now. I also was just told I have a tight levator ani muscle, pelvis floor dysfunction. I was wondering if you know any qualified PT’s in RI? I have to go see one and don’t really know where to begin.
    Thank you~

    1. Author

      Hello Sharon,

      Michelle Clark is located in West Kingston, RI. Her information is located below.

      Michell Clark, PT
      Westerly Hospital
      (401) 788-5065
      [email protected]



  30. Thanks for the great article! I am suffering from CPPS as well and was wondering if you know of a PT trained in this field in Vancouver, Canada. Thanks

    1. Author

      Hello AJ,

      We don’t have a therapist recommendation located in Vancouver, but I can recommend a couple therapists in the surrounding area. Hope this helps!



      Johanne Sabourin, PT
      Coquitlam, British Columbia,Canada
      [email protected]

      Tamarah Nerreter, PT
      South Surrey, British Columbia Canada
      [email protected]

        1. Hi
          I am 35 yrs male.i ve burning pain in my penis and rectal area .
          Could u plz where r my trigger points located.thnks

  31. Is is possible that one trigger point release can heal something? i have had one rectal internal session so far. When the therapist hit this spot i stopped breathing, it was so painful. it was probably the left obturator just inside the anal sphincter area (does that make sense?). i hit the wall, went blind with pain. She continued the exam after staying there two minutes.

    When i left i used ice and also later that evening to calm down a flare.

    Today everything feels really different. i am not even using the rectal valium which i have been using 3x a day for months.

    i am wondering, is this possible? of course i am terrified to do this on my own. I am seeing her in a week again. The pain was like an 8 or 9 out of 10 but most of it went away in like 15-30 minutes.

    somehow i feel like i have been rearranged. i hope i don’t go back. i really don’t know what happened or if it’s even possible that one release could do that much. I mean, i am still tender and use some ice and cushions while sitting… but this is so unexpected.

    really puzzled.

    1. Author

      Hello Patricia,

      It is possible to experience improvement after just one session, but continuing with therapy once per week will help ensure that your gains become permanent. Like with any tight muscle, just stretching once may help, but can become tight again if the stretching stops. It is important that you communicate your concerns with your therapist. That’s what we are here for! He or she will be able to explain why consistency is so important, and will help calm any fears you may have. Also, it is normal to experience more discomfort in the beginning of your treatment, but it does get better! Hang in there.

      All my best,


  32. Hello,

    I’m a 41 year old male that had a radical prostatectomy (LRP) in 07/12 because of ongoing testicular/abdominal pain (directly behind navel) for years. A few months after the LRP, I had some scar tissue form at my bladder neck & had to have a bladder neck incision. Since the BNI, I’ve had urgency, frequency, burning urination, perineum pain, tightness, anal pain & really bad anxiety. Kegel exercises actually hurt now & everything just feels different in that area. It’s like something is missing or maybe just a general weakness/tightness of the muscles in that area. Something happened after the BNI but I’m dumbfounded as to what it might be. I’ve had a cystoscopy (5 different times) urodynamic testing, urinalysis tests but everything always turns out normal when I know for a fact that it is not. I’ve tried the internal therapy from a PT but it didn’t really help. It just seemed to aggravate everything whenever I had it done, which was about 6 or 7 times last year. I also had tibial nerve stimulation for about 8 treatments. There actually did seem to be some slight relief after the very first treatment but nothing after that. I’m about 90% sure that my problem is neuromuscular in nature & I have pretty much narrowed it down to pudendal neuralgia by process of elimination. I have a nerve block (ultrasound guided) with pulsed radio frequency set up at Andrews Clinic in Gulf Breeze, Fl on 01/06/15. I’m praying that I will get some relief from this awful nightmare. Please let me know you thoughts on all of this. I always welcome a professionals advice that’s well versed in pelvic pain.

    1. Author

      Hello Hunter,

      Please feel free to contact our San Francisco office after the holidays for a complimentary 15 minute consultation.



  33. Hello, I was a surrogate for my daughter and delivered a healthy beautiful grandson in December of 2012. 6 week check up revealed 3 organ prolapsed. Started a few weeks later with a pt for pop. My kegel strength was not progressing like pt wanted. She got me an internal estim which I was to use twice a day for 15 each. I was instructed to kegel during the estim contraction. After 2 weeks I deleoped terrible pain in my vagina and also my gluts. I had a few pain blog injections which did help but I still have terrible deep glut pain. It really flares up if I try to exercise and I also have abdominal trigger points, myofacial issues from the knees up to belly. My question is do you think that dry needling might be effective as hands on work doesn’t seeme to be getting to the heart of the pain. At hanks you so much for your work in this field and thie info you put out there for all of us suffering and looking for answers. P.s. I am in northern Illinois if you could recommend a pt. Thanks so much, Vickie

    1. Author

      Hello Vickie,

      I would recommend that you receive a second opinion from a pelvic floor specialist in order to determine whether altnerative treatment options may be appropriate for you. Below are our referrals for Illinois.



      Jamie Justice, PT
      Creative Therapeutics
      Dekalb IL
      (815) 785-5508

      Kristen Markett, PT
      Flexeon Rehab
      Orland Park IL
      (708) 671-1971

  34. I have been in pain for 18 months. It stareted in third trimester of my pregnancy. I delivered via c-section.
    I have a constant base pain level of a 2-3. The pain in relentless and does not go away.  It does get elevated to a 7-8 depending on certain movements/exercises. These are my symptoms:

    pain in my sacrum area (1/2 way down the crack of my butt at the bottom on my spine but mostly on the right side)
    It feels as though I am constantly sitting on a tennis ball even when standing
    pain and soreness after intercourse that elevates my pain level for at least 24 hours
    pressure during intercourse 
    sharp pain in the crack of butt during urination (especially in the morning) mild pain in bladder when urinating in the morning (no incontinence issues)
    shooting pain in coccyx area when standing from sitting and vice versa
    cannot sit more than 15 minutes without having to shift  or stand up because of pain
    i cannot “roll” flat on my back from a sitting position on the floor, or go from a laying position to sitting without extreme pain
    lots of pain when moving my pelvic floor muscles (pushing out or squeezing in)

    I am starting to believe this may be a muscular issue with my pelvic floor? Thoughts?

    1. Author

      Hello Sherri,

      That “sitting on a tennis ball” feeling is something that many of our patients describe. You may have hypertonic pelvic muscles which are could be the cause your symptoms. I suggest that you consult with a local pelvic floor therapist for an evaluation. I am also more than happy to offer a recommendation.

      All my best,


      1. I am having the same problems. I have been doing PT for this for the last 2 months with no relief. Does anyone have any suggestions? I think if I could have the trigger point injections it might help. Do you know anyone that does that for pelvic floor problems in Dalton, Ga?

        1. Hello Brenda,

          We do not have a therapist recommendation for Dalton, GA but we can recommend two therapists in the greater area. Here is their information

          Lone Howell, PT
          Physiotherapy Associates Lawrenceville
          Auburn GA
          (770) 995-5242

          Jenny Hunt, PT
          Provenance Rehabilitation of the Greater Atlanta Area
          Alphretta GA



  35. Hello, my husband has been suffering from chronic pelvic pain for years now, and the doctors have not been much of any help at all. Do you know of a physical therapist in the Raleigh North Carolina area?

    Thank you so much,

    1. Author

      Hello Grace,

      I’m sorry to hear about your husband’s situation. Here are the therapists we recommend in your area:

      Emily Wegmann, PT
      (919) 571-9912
      [email protected]
      Carolina Pelvic Health Center

      Jennifer Briggs, PT
      (919) 571-9912
      Carolina Pelvic Health Center



  36. Dear Stephanie
    Can you help me please? For many many years I have had problems with pain in my rectum and over the years have had many operations and procedures including heamorroidectomy {2} etc etc. Approx. 6 years ago I was diagnosed eventually with having Levator Ani syndrome. I am English, age 65, but live on an island called Gozo which is part of Malta. I have absolute chronic pain after every BM. Sitting is a no no and I spend most time laying. I have no life at all. Unfortunately I have to travel 2.5 hrs to Malta and long wait time {all sitting} to see a colorectal surgeon. They have not dealt with a case of this there.
    Take Valium and dihydrocodeine which dont help pain.
    Eventually sent to womens specialist PT. She was great – did trigger point therapy and a little biofeedback,and I felt good when she had finished treatment in early evening but pain back next day after BM. Recently the surgeon said I should go back to see her, but not convenient to go every week and I was speaking to him about having botox, but now he has said I would get faecal incontinence for 3 to 4 months – have you heard of this and what would you recommend please. Linda

    1. Hello Linda,

      I am sorry to hear about your situation. Jacoline Van Der Merwe, PT is located in Saudi Arabia and would be a good resource for you. Unfortunately, an evaluation is essential to determine the cause of your symptoms, but from your description, pelvic physical therapy seems to be beneficial for you. I understand it may not be convenient to see your therapist weekly, but physical therapy requires commitment, and consistency until symptoms can be managed, and a patient can become independant with treatment. Jacoline’s information is below:

      Jacoline Van Der Merwe, PT
      [email protected]



    2. Dear Linda

      I am living in sister island Malta and also suffering from pelvic tension and pain. Have been despairing of finding anyone who has ever heard of it and would be most grateful if you can let me know where I can find the womens PT specialist you mention. Best regards, Anne

    3. Dear Linda

      I have just found a PT on pelvic issues who works at Mater Dei Hospital and St Anne’s Clinic – Carolyn Sultana. I was just wondering if she is the same one you mentioned and who treated your pain successfully although short term. For years I have suffered the same and was in desperation, not finding anyone to treat me locally – until now. Just want to make sure I am making the best available choices. Is there another PT you can advise me of in Malta? ~ Anne

      1. Dear Anne.Sorry for delay in replying but ended up with back problem and laptop probs. Anyway YES Carolyn is the person I saw.Doc at Mater Dei recommended I see her, spoke to her briefly at hosp, and saw her at ST Annes. Unfortunately she cannot do this work at hosp. so have to see at St annes in the evenings, privately.She is a lovely young lady, knows what she is doing and very easy to talk to. I last saw her a year ago and she was soon stopping work to have her second child, but is now back at work.
        You are very lucky you live in Malta as it is so painful for me to go see her from here on public transport and it is better if you can see her regularly. I need to see her myself, but in this heat it is impossible.I have now been told I can be given Botox injections for my prob, but it has repercussions and I would like to discuss it with her first. Unfortunately I have at present until 23rd Aug to decide so……..
        If you see her before I do, please give her my regards and I will contact her as soon as I can.Good luck and I dearly hope she helps you. Linda

        1. Thanks so much Linda. In 2012 my doctor sent me for a gynae check after hearing my complaint. When I came back with an “all clear” he sent me to a colo-rectal surgeon. (I didn’t go thank goodness, sensing that was the wrong path). I’ve just been to him for a referral to Carolyn and he hardly knew how to spell “Pelvic Floor Dysfunction” let alone what it’s all about. More awareness needed, definitely and I thank my lucky stars that your comment here prompted me to run a PT search as had given up all hope of finding someone in Malta on pelvic issues. I believe she has completed a further degree at Bradford Univerisity last year.That’s encouraging to hear the Botox can help you if you decide but agree it’s terrible travelling in this heat and traffic! Will certainly pass on your regards to Carolyn. Her down-to-earth manner and confidence are so reassuring. Wishing you relief and roll on 23rd Aug. Anne

        2. Dear Linda. I am also having to consider Botox, on the physiotherapist’s advice. Did you decide to do the injections? If so how did it go? Anne

    1. Hello Sarah,

      Marcy Crouch,DPT is located in Oregon at OHSU. Below is her information:

      Marcy Crouch, DPT
      503 418-4500 or 855-230-4500



  37. This is amazing to me to find that I am not alone in my pain! I am 34 and have been in terrible pain since I was 10. It has increased over the years. For my 33 birthday I got a really cute cane to help during my bad days. Anyhow, I was wondering if there were good PT’s in Virginia? I have read a lot from the “Headache in the Pelvis.” It really fits the bill. I am desperate for somethingm i am tired of pain pills and hobbling around like a 90 year old woman.

    1. Hello Misty,

      Below are the therapists we recommend in Virginia:

      Pierce Kristen Warrenton VA (540) 316-2680 [email protected]
      Rich Jennifer Roanoke VA (540) 982-2273 [email protected]
      Gryski Joanne PT Herndon VA (703) 222-5973 [email protected]
      Miller Amanda DPT Richmond VA (804) 270-7754 [email protected]
      Pagliano Carrie PT Arlington VA 2024444180 [email protected]
      Brown Carolyn PT Virginia Beach VA 7573742373 [email protected]
      Simmons Camille PT Alexandria VA (703) 849-8142 [email protected]
      Oxford Kathy DPT Richmond VA (804)330-9105 [email protected]
      Morris Lydia PT Richmond VA (804)285-0148 [email protected]
      Pesavento Kathy PT Vienna VA (703)963-3466 [email protected]
      Silvers Janet PT Burke VA (703)531-2410 [email protected]
      Kalina Clare PT Fairfax VA (703)591-9088



  38. I need to know of pelvic floor specialists in Texas or New Mexico.
    I have suffered from vaginal pain and burning for 6 or eight months . No bacteria or yeast infections. Finally said I suffered from Vulvardynia. .Doctors put me on Prozax and gabepentin and has helped the nerve
    related pain so what.
    However recently I have experienced spasms in my pelvic floor making me feel like I have to urinate frequently. At night when I get up and have to urinate, I have terrible spasms until finally I go. This does not happen during the day. I see a massage therapist who works on my tight upper thigh. It helps but does not continue very long. I feel the spasms are coming from my pelvic floor. Can you suggest any pelvic floor specialists in Texas or New Mexico to help me. We live in New Mexico in summers and Texas in winters. However , I will go anywhere!

    1. Hello Rachel,

      Can you give me more specific information? Where in NM and TX are you located?



  39. Hi,
    I live in Odessa, Texas! Are there any PT’s in my area? Thank you so much!

    1. Hello Kelly,

      We do not have a therapist recommendation for your area, but the APTA website may be a great research tool for you.

      Kind Regards,


  40. Hi! Can you recommend a therapist in the South Florida area that specializes in the pelvic trigger points? (Fort Lauderdale, Boca area) thank you!

  41. Hi Anne.So far I have decided no,but have still not discussed with Carolyn. Complicated story so far regarding doctors comments, but if you would like I could explain on phone. If you are happy to let me have your number I could call you.If you dont want to put it on here you could put on my facebook page. Regards Linda

  42. Hi! Can you recommend a therapist in the Edina ,Mn 55439 area that specializes in the pelvic trigger points?

    Kind regards,

    1. Hello Kelly,

      Beth Stidham, PT is located in St. Paul, MN and is a great resource for you. Below is her information:

      Metro Urology
      (651) 999-2734 [email protected]



  43. Thanks Linda, it’s 21337135. Mostly I am in mornings and evenings. Would be interested to know how things are going. I’ve decided against Botox for now too, until I can learn more.

  44. Dear Anne. You will not believe this, but I have just found this message with your number. I had not seen this and assumed you did not want to give it to me, so I was going into site to apologise for asking for number, and to ask you a few questions. My answer was complicated and did not want to type it all as I am not at all good. Your Botox answer is also very interesting – so I think we have a lot to discuss.
    I will ring you next week and thanks so much for number.

  45. Your article has helped calm me down, but I am still really scared. I had a bad UTI- confirmed by culture- in August. The bacteria was treated by antibiotics, but the pain has remained. I feel an aching/burning/raw feeling in my urethra, constantly. I feel like I am going to lose my mind with the pain.

    My urogynecologist said it was myofascial pain resulting from the pain of the UTI, and I’ve been going to pelvic floor therapy once a week for a month now. Apart from a few days in the beginning of October, I haven’t had any relief. In fact, it feels like it’s getting worse.

    Can anyone please tell me a best estimate for how long until I see results? The urogynecologist and my PT say my levator ani and obterator internus are the problem. I’m so scared that I’m going to feel this forever, or that I have IC/urethral syndrome or something that won’t go away, even though I know this happened after a regular UTI.

    Please, any feedback would be greatly appreciated. This is all I can think about.

  46. Hi
    I just visited a therapist who has been doing myofascial release and trigger point therapy for my overactive bladder. The first few sessions were ok.
    Then, all of a sudden, I started getting muscle ache/soreness on my upper right thigh. A few days later the pain subsided and now I have upper back soreness which seems to be moving away from my upper back to my neck. Does this sound strange?
    I have even noticed soreness a few says on my foot and palm of my hand.
    Hope Im not causing myself more harm than good. ANy advise would be more than appreicated!

    1. Author

      Hi Randi,

      As people get treated they may notice pain symptoms traveling around their bodies. We suggest talking to your provider about this.

  47. I’ve had pelvic floor dysfunction for 9 years as a result of the pain/straining from interstitial cystitis. I’ve seen several therapist for help with it. I can’t find someone in Utah that is able to help me. I have several tight trigger points in my pelvic floor. I would love to try trigger point injections and dry needling, but I’m having no luck finding someone in Utah. I saw one therapist that was really good at internal vaginal work but didn’t work on any of the external trigger points or the anal trigger points. So I never felt better. I’m stuck using valium suppositories several times a day for relief. Can you refer me to anyone here? Is it possible for me to find relief from these trigger points in my lifetime? It feels like something I have to life with forever and it’s so painful.

  48. Hi I have seen two different Physio for vulval/anal/rectal/vaginal pain post vaginal childbirth. I have two questions. Can trigger points move? Each physio says I have trigger points in different muscles. Secondly the second physio I saw says trigger points are only when the pain radiates from where she presses (the first physio never said this). Is this correct? I made some progress with the first physio but then it just stopped working and my pain worsened and spread. I now have bilateral sciatica and pain from pubic symphysis dysfunction. I never seem to get any relief from the second physio’s internal work so I am a bit lost as to whether physio is my answer. I have had nerve blocks also but pulsed radiofrequency just worsened my pain so I am anxious to go down that route again. Many thanks, Ali X

    1. Author Stephanie Prendergast says:

      “It is more likely that the two PTs have different styles of evaluating/treating then the trigger points ‘moving’. Internal work may not have an impact on sciatic symptoms, many things outside of the pelvic floor can contribute to that symptom. I suggest seeking a third opinion if both of your physical therapists are unable to answer the questions that you have.”

  49. I have bee experiencing pelvic discomfort and muscle spasm in the last few months. Just like you said in the article i thought, and so did the doctor, that it was a UTI. I was treated but the discomfort, although reduced in one way, is still active in other areas of my pelvic muscles. I read an article on pelvic muscle floor tension by a woman named Jeannette Tries which helped answer some questions and your article also helped and made some things clear. I am still a little at a loss as to what to do about my symptoms. Are pelvic muscle floor tension and trigger points related or the same thing? If they are different, how can i tell which i have? They seem to carry and cause the same symptoms but have different treatments. How would you recommend i proceed

  50. How long did you have to go and how often before it started to help?

  51. I’ve been previously diagnosed with PNE, went through a cortisone treatment of shots with limited results. I’ve since noticed multiple, extremely painful trigger points in my pelvis area that duplicate and intensify the pain I experience.

    Can you recommend some PT’s dealing with trigger points, and pelvic pain in the Western New York area.

    Thank you.

  52. Hi,
    can over masturbation leads to pelvic floor tension and then erectile dysfunction problems without having any pain?
    I suffer of constipation / urinary hesitancy and erectile dysfunction.
    I don’t have any particular pain, but my bulbocavernous is flat, while before was like a baloon from my anus till the base of the penis; now is flat so my penis look like hanged, linked to nothing and it has shrunk and desensitised.

    1. It sounds like you may have a pelvic floor disorder. Unfortunately we cannot make specific recommendations without evaluating you. We would be happy to evaluate you in one of our locations or you can use our website to find a pelvic floor physical therapist in your area that can help.

  53. Hi! I was diagnosed with Pelvic Floor and SI Joint Dysfunction in my early 30′.
    The pain has flared up many times throughout the years. I have seen my physical therapists throughout the years. I’m now 55 and have extreme anal pain (my first time to experience it). To be absolutely blunt, it feels like a searing hot corncob is being shoved up my anus. This pain started Feb 2016. It’s almost unbaearable at times. I am seeing a physical therapists, who has done dry needling. Dry needling has helped a bit but I still have pain. Lesson learned, I should not have been doing squats, while holding heavy weights at my age. Are you able to recommend any therapists who specialize in PFD in women? I am in the Shreveport, LA area and willing to travel out of state if needed. Sitting is also miserable. Thanks in advance for your help.

  54. This post help us to know everything about pelvic pain trigger points.Not only this it help in exploring the part they play in pelvic pain syndromes.Must say very informative and help post especially for those suffering from such problem.
    Thank you for sharing this post with us.
    Great stuff!

    1. We are so happy to hear you enjoyed this post! We do our best to put out information that can help others in their pelvic health journey.

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