Pelvic Floor Tension Myalgia (for Patients)
Understanding a Common but Overlooked Cause of Pelvic Pain
If you’ve been dealing with chronic pelvic pain—pain that keeps coming back or never really goes away—you’re not alone. Many people with this kind of pain go through multiple medical visits, tests, and even surgeries, only to find that nothing seems to help. But what if the pain isn’t coming from your organs at all?
For many people, the source of pelvic pain isn’t endometriosis, infection, or something visible on imaging—it’s the muscles and fascia of the pelvic floor. This condition is called pelvic floor tension myalgia, and the good news is: it’s treatable.
What Is Pelvic Floor Tension Myalgia?
Pelvic floor tension myalgia (or PFTM) happens when the muscles at the base of your pelvis become overly tight and irritated. These muscles normally support your bladder, bowel, and reproductive organs—and help with things like urination, sexual activity, and posture. But like any muscle, they can hold tension, develop painful trigger points, and even spasm over time.
This kind of chronic tension can cause pain in areas far beyond the pelvic floor, including your:
Lower abdomen or belly
Tailbone or lower back
Hips or inner thighs
Genitals or perineum
During or after sex
While urinating or sitting
You may also notice symptoms like:
Pain with tampon use or pelvic exams
Feeling like you can’t fully empty your bladder
Frequent urges to urinate
Pressure or heaviness in your pelvis
Why Does It Happen?
There are many reasons why someone might develop pelvic floor tension myalgia, including:
Posture problems or misalignment in the spine, hips, or legs
Injuries to the tailbone, pelvis, or surrounding muscles
Scar tissue from surgery, childbirth, or abdominal trauma
Chronic holding patterns from stress, anxiety, or past trauma
Digestive issues like constipation or IBS
Other pelvic conditions such as endometriosis or interstitial cystitis
Sometimes, this tension starts as a protective response to pain or injury—but then becomes its own source of pain over time.
Why Standard Tests Don’t Show It
This is one of the most frustrating parts for patients: many people with pelvic floor tension myalgia are told that “everything looks normal.” That’s because this condition doesn’t show up on imaging (like MRIs or ultrasounds), and it won’t be seen during a laparoscopy unless there’s another issue too.
But here’s the key: muscle and fascia dysfunction can still cause real, physical pain—even when tests are negative.
How Physical Therapy Can Help
The most effective treatment for PFTM is pelvic floor physical therapy. This is a specialized form of therapy focused on improving the health, coordination, and tone of the pelvic floor and surrounding structures.
A trained pelvic floor physical therapist can:
Identify which muscles are tight or overactive
Release myofascial trigger points internally and externally
Improve blood flow and nerve mobility
Re-train your muscles to relax and fire correctly
Address posture, alignment, and core support
Guide you through calming, restorative exercises
Your therapist may also help with scar tissue, breathing patterns, and even digestive mobility, all of which can contribute to pelvic floor tension.
What About Fascial Counterstrain?
Another powerful hands-on therapy that can support pelvic floor healing is Fascial Counterstrain. This technique addresses not just the muscles, but the fascia (connective tissue), nerves, blood vessels, and even the lining of the bones (periosteum) that can contribute to chronic pelvic pain.
Fascial Counterstrain can:
Release deeply held tension in the fascia and muscles
Improve circulation and nerve flow
Help restore balance to structures influencing the pelvic floor
Gently downregulate the nervous system’s pain response
It’s especially helpful in complex or long-standing cases where traditional therapy alone hasn’t resolved the problem.
A Real-Life Example
One patient, a 48-year-old woman, had been experiencing pain with sex, constant urinary urgency, and pressure in her lower belly for three years. She had multiple surgeries, including a hysterectomy, but nothing helped. Eventually, she was told she might need her bladder removed.
Instead, she started pelvic floor physical therapy. Her therapist found tight muscles, scar tension, and pelvic misalignment. After several months of weekly sessions, her pain went away—and she was able to return to normal bladder function and activities. No surgery needed.
When to Consider This Approach
You might benefit from pelvic floor PT or Fascial Counterstrain if:
You’ve had pelvic pain for more than a few months
Tests and procedures haven’t found a clear answer
You feel worse after sitting, sex, or bowel movements
You’ve had surgery, injury, or trauma in the pelvic area
You’re dealing with bladder, bowel, or sexual symptoms without a known cause
You Deserve Real Relief
Living with chronic pelvic pain is exhausting—physically, emotionally, and mentally. If you’ve been told your tests are “normal” but you still know something’s wrong, don’t give up. Pelvic floor tension myalgia is real, treatable, and more common than most people think.
With the right care, including hands-on therapies and skilled guidance, relief is absolutely possible.
How to Find a Qualified Therapist:
Search the International Pelvic Pain Society
Ask if the therapist does both internal and external pelvic floor work
Look for experience with pelvic pain (not just incontinence)
Consider fascial therapy as an additional layer of support