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If you’re living with pelvic pain symptoms, you’ve probably had moments where you felt stuck between two frustrating extremes: “Everything looks normal” — yet you still feel pelvic pain or pressure, burning, aching, tightness, or that constant sense that something is “off.” You might even catch yourself googling late at night: why does my pelvis hurts, where pelvic pain located, or can pelvic pain be caused by gas.
As clinicians, we see how isolating this can feel. Pelvic pain can disrupt sleep, work, intimacy, exercise, and confidence. And because symptoms can shift location (or flare “for no reason”), many people start doubting their own body.
This post explains why pelvic pain often persists, what higher-quality research suggests may help, and how Unpain Clinic approaches Edmonton patients with a whole-body, root-cause mindset—without promising a guaranteed outcome. (Results may vary; always consult a healthcare provider.)
“Pelvic pain” is an umbrella term. Research reviews describe chronic/persistent pelvic pain as pain perceived in structures related to the pelvis, often accompanied by urinary, sexual, bowel, pelvic floor, or gynecologic-related symptoms.
Many patients are surprised by how wide the map can be. Where pelvic pain is located may include:
Lower abdomen (below the belly button) or deep “central” pelvic discomfort
Groin, inner thigh, or pubic region (sometimes mistaken for a hip injury)
Perineum (“between” the genitals and anus), rectal ache/pressure, or tailbone sensitivity
Bladder-area pain, urinary urgency/frequency alongside pelvic pain
Pain during/after sex, arousal discomfort, or pelvic floor “guarding” sensations
In men: symptoms labeled “chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)” may involve pelvic/perineal pain plus urinary symptoms and quality-of-life impact.
Patients also describe pelvic pain pressure (a heavy/full sensation), nerve-like burning, deep ache, or symptoms that spike with sitting, stress, bowel changes, or certain movements.
Important note: Pelvic pain can have many causes. If you have severe or worsening symptoms, fever, unexplained weight loss, blood in urine/stool, new bladder/bowel control changes, or concerns about cancer (for example, searches related to pelvic pain prostate cancer), seek medical evaluation promptly.
Persistent pelvic pain is rarely “just one thing.” High-quality reviews repeatedly point to overlapping drivers—muscle tone changes, nervous system sensitization, comorbid conditions, and psychosocial factors.
Many people assume pelvic floor problems mean the muscles are “weak,” so they do endless Kegels—only to get worse. Research suggests this isn’t surprising: a large systematic review found few studies with “convincing” measurement, but among those that did, increased pelvic floor muscle tone/overactivity was shown primarily in pelvic pain conditions (and the overall literature is limited by methods and design).
Another systematic review focused on pelvic floor physical therapy (PFPT) for pelvic floor hypertonicity (high tone/overactivity). It concluded PFPT can be beneficial, while also noting many studies have risk-of-bias limitations and that better RCTs are still needed.
A systematic literature review on central sensitization in urogynecological chronic pelvic pain highlights that chronic pelvic pain is often associated with signs of altered central pain processing (for example, generalized hyperalgesia and altered brain-related pain processing measures), though cause-and-effect is complex and many included studies were observational.
In bladder pain syndrome (a condition often overlapping the pelvic pain world), a newer systematic review reported evidence of central sensitization across included studies and noted associations between more sensitization and more severe presentations/comorbid pain conditions.
In plain language: sometimes pain persists because the “alarm system” is stuck on high sensitivity—even when tissue injury is not the whole story.
If you’ve ever wondered can pelvic pain be caused by gas, the honest answer is: gas itself can create pressure and discomfort, but persistent pelvic pain often involves more than just occasional bloating.
A 2025 systematic review and meta-analysis examining irritable bowel syndrome (IBS) and chronic pelvic pain reported that IBS prevalence among people with chronic pelvic pain was around the high 20% range in pooled analysis, and GI symptoms (including abdominal distension and gas) were among the associated symptom categories described in included studies.
This overlap matters clinically: if bowel symptoms drive flares, addressing only pelvic muscles may miss part of the loop (and vice versa).
Some pelvic pain is actually referred/overlapped pain from the hip, low back, or pelvic girdle. A systematic review of physical tests for femoroacetabular impingement (FAI) and labral pathology reported that many physical tests have limited diagnostic accuracy and that study quality issues make “quick certainty” difficult—supporting a careful, full-body assessment when groin/pelvic symptoms overlap hip function.
This is one reason people experience “sudden hip pain without injury” that feels like groin/pelvic pain: the location can be deceptive.
This is not “it’s all in your head.” It’s that pain is shaped by threat perception, stress physiology, and learned protection patterns.
A meta-analysis on catastrophizing and chronic cyclical pelvic pain found a small-to-moderate positive association between catastrophizing and pain ratings.
In men with CP/CPPS, a meta-analysis found notable prevalence of psychosocial symptoms and pain catastrophizing, supporting the view that pelvic pain is often biopsychosocial—not purely local tissue damage.
Because pelvic pain is multi-factorial, “single-modality” care often underperforms. The strongest signals in research tend to support multimodal approaches, and in some subgroups, targeted modalities can help.
A 2024 systematic review and meta-analysis of nonpharmacological conservative therapies reported that multimodal physical therapy reduced pain intensity compared with inert/nonconservative approaches in the short term (high certainty evidence) and intermediate term (moderate certainty evidence).
What this means practically: programs that combine education, movement/exercise, and targeted physical therapy skills tend to outperform “one technique only.”
The 2022 systematic review of PFPT for pelvic floor hypertonicity found that most included studies were not perfect, but 3 of 4 RCTs reported positive effects of PFPT compared with controls across multiple outcomes, and overall findings suggest PFPT can be beneficial for hypertonicity-related pelvic pain presentations (including CP/CPPS and dyspareunia contexts).
A randomized multicenter feasibility trial in urological chronic pelvic pain syndromes compared myofascial physical therapy vs global therapeutic massage. The myofascial PT group had a higher response rate on a global response assessment (reported as 57% vs 21%).
At the same time, not all “manual therapy” evidence is strong. A 2022 systematic review and meta-analysis on myofascial manual therapies in chronic pelvic pain syndrome found no statistically significant superiority over standard care for pain reduction and rated the evidence as very low quality—highlighting that technique choice, patient selection, and treatment integration matter.
For men—especially those labeled CP/CPPS—evidence for shockwave has grown.
A 2021 systematic review and meta-analysis of low-intensity extracorporeal shock wave therapy (LI‑ESWT) in male CPPS found that LI‑ESWT showed significant improvements at around 12 weeks (including NIH‑CPSI, pain/VAS, QoL, urinary symptoms), with less consistent effects at very short-term (1 week) and longer-term (24 weeks) points in the included studies.
A 2024 randomized, double-blind, placebo-controlled study in CP/CPPS reported a significantly greater improvement in NIH‑CPSI total score in the ESWT group vs control at follow-up, along with improvements in pain/QoL measures and no severe side effects reported during the study period.
A separate systematic review/meta-analysis (randomized trials through early 2022) also reported improvements in NIH‑CPSI domains and suggested benefits both with and without medication combinations, while describing LI‑ESWT as non-invasive and generally safe in the analyzed studies.
If your symptoms feel nerve-driven (burning, urgency-driven pain, “on/off” flares), it may be relevant that a systematic review of neuromodulation for chronic pelvic pain found that some modalities (including percutaneous tibial nerve stimulation and transcutaneous electrical nerve stimulation—TENS) showed pain improvement in meta-analysis where pooling was possible, while also emphasizing that study quality and bias risks vary and more high-quality trials are needed.
A separate systematic review/meta-analysis focusing on TENS in women with chronic pelvic pain reported mild pain reduction in some contexts (notably primary dysmenorrhea in pooled analysis), with heterogeneity in protocols and moderate methodological quality across many trials.
When people Google “pelvic pain specialists near me accepting new patients”, what they usually want is:
a clinician who believes them, and a plan that finally makes sense.
At Unpain Clinic, pelvic pain care starts by acknowledging what research keeps showing: pelvic pain is often a system problem—muscle tone, nerves, hip/back mechanics, stress physiology, and sometimes gut/bladder overlap.
For certain presentations (especially men with CP/CPPS patterns, and for musculoskeletal contributors around the pelvis/hips), research supports that ESWT/LI‑ESWT can improve pain and symptom scores in controlled trials and meta-analyses.
In Unpain Clinic’s Episode #18, host Uran Berisha discusses pelvic pain in the men’s health context with urologist Dr. Stefan Buntrock, including pelvic floor dysfunction and misconceptions around strengthening-only approaches.
EMTT has less direct pelvic-pain-specific evidence, so we position it carefully: as an adjunct that may help when pelvic pain overlaps degenerative back/hip conditions or stubborn soft-tissue irritation—without claiming it “fixes pelvic pain” on its own.
EMTT has been studied in randomized trials for non-specific low back pain (as an add-on to conventional therapy) and in combination with ESWT for rotator cuff tendinopathy . A newer double-blind, placebo-controlled randomized trial across degenerative musculoskeletal conditions reported improved physical function and reduced pain vs sham at follow-ups.
When symptoms suggest an “irritable” nervous system component, research supports that some neuromodulation approaches (including TENS and tibial nerve stimulation) may reduce pain in chronic pelvic pain phenotypes—though evidence quality varies by modality and study.
Hands-on care can be valuable—especially when integrated into a broader plan. Evidence includes a beneficial signal from myofascial physical therapy compared with general massage in urological chronic pelvic pain syndromes, while other reviews caution that evidence quality for manual therapies alone can be limited.
This is why Unpain Clinic emphasizes manual therapy as one piece—often paired with education and movement retraining.
The strongest evidence direction for many chronic pelvic pain presentations supports multimodal physical therapy approaches.
That typically means gradually restoring capacity: hips, trunk, breath mechanics, pelvic floor coordination (often down-training/relaxation first when tone is high), and confidence in movement.
“I came in thinking it was a ‘pelvic problem’—full stop. I had pelvic pain pressure after sitting, random groin aches, and I kept wondering if it was my bladder, my hip, or something scary. Tests weren’t giving me clarity.
What surprised me was that the first visit wasn’t a quick ‘do Kegels’ appointment. We mapped my symptoms, checked hip movement, trunk control, breathing patterns, and pelvic floor coordination. My plan wasn’t only about the pelvis—it was about reducing the threat signals that kept the whole area guarded.”
These are general, low-risk strategies many people find helpful between appointments. Stop if symptoms worsen, and consult a qualified provider for individualized guidance.
Try building a simple “calm + move” routine:
Downshift breathing (2–3 minutes): slow nasal inhale, longer exhale. This supports a relaxation bias, which matters when pelvic floor tone is elevated or when central sensitization is part of the picture.
Gentle hip mobility: controlled range (not aggressive stretching) can be useful when pelvic pain overlaps hip/groin mechanics.
Walk for circulation (as tolerated): short, frequent walks often beat “all-or-nothing” workouts for sensitized pain systems.
Symptom tracking: note patterns with bowel changes, stress, sleep, and sitting time—because IBS overlap and psychosocial factors are common in chronic pelvic pain populations.
If you’re doing Kegels and feeling worse, that can be a clue—some pelvic pain presentations involve overactivity/hypertonicity rather than weakness, and research reviews emphasize the complexity and the need for individualized assessment.
Pelvic pain can be felt in the lower abdomen, groin, perineum, bladder area, rectum/tailbone region, or deep within the pelvis—and it may overlap urinary, bowel, or sexual symptoms.
Gas and bloating can create pelvic pressure or discomfort, but persistent pelvic pain often involves broader drivers. A systematic review/meta-analysis found IBS is relatively common among people with chronic pelvic pain, and GI symptoms (including distension and gas) were among associated symptom categories described in included studies.
One common label is CP/CPPS (chronic prostatitis/chronic pelvic pain syndrome), which involves pelvic pain plus urinary symptoms and quality-of-life impact. Research also supports that pelvic floor hypertonicity/guarding and psychosocial contributors may be relevant in subsets of men.
Evidence is strongest for male CP/CPPS populations, where meta-analyses and randomized controlled trials report improvements in symptom scores and pain measures, with generally favorable safety reporting in the trials.
For other pelvic pain presentations, a clinician should determine whether shockwave targets a relevant musculoskeletal driver (and it should be part of an overall plan).
If you’re trying to find a highly-rated pelvic floor physiotherapist in Edmonton, look for someone who can (1) assess pelvic floor tone/coordination (not just prescribe strengthening), (2) screen hip/back contributions, and (3) integrate education + movement retraining—because evidence favors multimodal physical therapy for many chronic pelvic pain presentations.
Often, no—but rules vary by insurer and situation. If you have red-flag symptoms or complex medical conditions, coordinating with your physician is wise.
Pelvic pain plans vary widely depending on drivers (muscle tone, sensitization, gut/bladder overlap, hip/back contribution). Evidence supports multimodal approaches, but the right pace and duration should be individualized.
Wear something comfortable you can move in. Your assessment may include movement and strength testing.
If you’re dealing with pelvic pain symptoms, it’s not “just in your head,” and it’s not always “just your pelvis.” Research supports that persistent pelvic pain often involves a combination of pelvic floor tone changes, nervous system sensitization, comorbid gut/bladder factors, and movement contributions from hips/spine—with the best outcomes typically coming from integrated, multimodal care.
Book Your Initial Assessment NowAt Unpain Clinic, we don’t just ask “Where does it hurt?” — we uncover “Why does it hurt?” If you’ve been frustrated by the cycle of “try everything, feel nothing,” this assessment is for you. We take a whole-body approach so you leave with clarity, not more questions.
✅ What’s Included
Comprehensive history & goal setting
Orthopedic & muscle testing (head-to-toe)
Motion analysis
Imaging decisions (if needed)
Pain pattern mapping
Personalized treatment roadmap
Benefit guidance
🕑 Important Details
60 minutes · Assessment only · No treatment during this visit
👩⚕️ Who You’ll See
A licensed Registered Physiotherapist or Chiropractor
🔜 What Happens Next
If you’re a fit for our program, we schedule your first treatment and begin your plan.
🌟 Why Choose Unpain Clinic
Whole-body assessment, not symptom-chasing
Root-cause focus, not temporary relief
Non-invasive methods whenever possible
No long-term upsells—just honest, effective care
🎯 Outcome
You’ll walk out knowing:
What’s wrong
Why it hurts
The fastest path to fix it
Author: Uran Berisha, BSc PT, RMT, Shockwave Expert
Peer-reviewed research (RCTs, systematic reviews, meta-analyses)
Starzec‑Proserpio M, et al. (2024). Effectiveness of nonpharmacological conservative therapies for chronic pelvic pain in women: a systematic review and meta-analysis.
van Reijn‑Baggen DA, et al. (2022). Pelvic Floor Physical Therapy for Pelvic Floor Hypertonicity: A Systematic Review of Treatment Efficacy.
Worman RS, et al. (2023). Evidence for increased tone or overactivity of pelvic floor muscles in pelvic health conditions: a systematic review.
FitzGerald MP, et al. (2009). Randomized multicenter feasibility trial of myofascial physical therapy for urological chronic pelvic pain syndromes.
Li G, Man L. (2021). Low-intensity extracorporeal shock wave therapy for male chronic pelvic pain syndrome: a systematic review and meta-analysis.
Hur KJ, et al. (2024). ESWT for CP/CPPS: prospective randomized double-blind placebo-controlled study.
Kong X, et al. (Published 2022; journal issue 2023). Li‑ESWT for CP/CPPS: systematic review and meta-analysis.
van Balken M, et al. (2019). Benefits and harms of electrical neuromodulation for chronic pelvic pain: systematic review.
Babazadeh‑Zavieh SS, et al. (2022/2023). TENS for chronic pelvic pain in women: systematic review and meta-analysis.
Kaya S, et al. (2013). Central sensitization in urogynecological chronic pelvic pain: systematic literature review.
Neto JN, et al. (2025). IBS and chronic pelvic pain: systematic review and meta-analysis.
Hollander K, et al. (2025). EMTT for degenerative musculoskeletal disorders: double-blind, placebo-controlled randomized trial.
Krath A, et al. (2017). EMTT in non-specific low back pain: randomized controlled trial.
Notarnicola A, et al. (2018). EMTT + ESWT vs ESWT + sham for rotator cuff tendinopathy: randomized trial.
Unpain Clinic podcasts and YouTube (clinic sources)
Unpain Clinic Podcast Episode #18 (Oct 25, 2024): The No‑B.S. Guide to Beating Erectile Dysfunction, Peyronie’s Disease, Pelvic Pain and Reclaiming Your Manhood.
Unpain Clinic Podcast Episode #7 (Nov 18, 2021): How to Relieve Back Pain When Nothing Else Works.
