May Is Pelvic Pain Awareness Month: Understanding the Link Between Chronic Pelvic Pain and IBS

Every May, we take time to recognize Pelvic Pain Awareness Month: a dedicated opportunity to bring visibility to conditions that affect millions of people yet remain widely under-diagnosed and misunderstood. At Empower PT, we work every day with patients who have been living with chronic pelvic pain, bowel symptoms, or both for years, often having seen provider after provider without ever getting a clear picture of what is happening in their bodies or why.

If that sounds like your experience, this post is for you.

What Is Chronic Pelvic Pain?

Chronic pelvic pain (CPP) is persistent pain in the lower abdomen or pelvis that lasts six months or longer. It affects an estimated 15-20% of women in the United States, though it also occurs in men and is underreported across all populations. CPP is not a single diagnosis. It is a symptom complex that can involve the reproductive, urological, musculoskeletal, and gastrointestinal systems, often at the same time.

Conditions commonly associated with CPP include:

• Endometriosis

• Interstitial cystitis / bladder pain syndrome

• Pelvic floor dysfunction

• Irritable bowel syndrome (IBS)

• Vulvodynia

• Pelvic inflammatory disease

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Because so many body systems can be involved, patients often spend years seeing different specialists before anyone connects the pieces.

The IBS Connection: More Than a Coincidence

Irritable bowel syndrome is a functional gastrointestinal disorder characterized by recurrent abdominal pain alongside changes in stool frequency or consistency, without any structural abnormality to explain it. IBS affects approximately 10-15% of the global population and is diagnosed roughly twice as often in women as in men.

The overlap between IBS and CPP is striking and, for many patients, validating to learn about. Studies suggest that 50-79% of women with CPP also meet diagnostic criteria for IBS. If you have been managing both pelvic pain and bowel symptoms and wondering whether they are connected, they very likely are. And understanding that connection is often the first step toward more effective care.

Why Do CPP and IBS Co-Occur?

There are several well-documented reasons these two conditions tend to show up together, and understanding them can help make sense of what you have been experiencing.

Central Sensitization

Both CPP and IBS are associated with central sensitization, which a state in which the nervous system becomes highly attuned to pain signals, lowering the threshold at which ordinary sensations feel painful. Think of it as the body's alarm system getting stuck in a heightened state. This is not imagined, and it is not a personality trait. It is a real, measurable shift in how the nervous system processes information, and it is something that responds well to targeted treatment.

Viscero-Visceral Cross-Sensitization

The gut and pelvic organs share overlapping nerve pathways. When one area is persistently inflamed or painful, it can sensitize the nerves in neighboring structures as well. This is part of why an endometriosis flare can trigger bowel symptoms, and why an IBS episode often brings worsening pelvic pain alongside it. These systems are in constant communication with each other.

Pelvic Floor Dysfunction

The pelvic floor is a group of muscles at the base of the pelvis that coordinates bowel, bladder, and sexual function. In people with CPP and IBS, the pelvic floor is frequently hypertonic, meaning it is held in a state of chronic tension and guarding. This can contribute to:

• Constipation and difficulty with complete evacuation

• Straining during bowel movements

• Abdominal bloating and cramping

• Pain with sitting, intercourse, or pelvic exams

• Urinary urgency or frequency

  
  

This cycle of tension and pain is real and treatable, and addressing the pelvic floor directly is often what allows other treatments to finally take hold.

The Gut-Brain Axis

The gut and the brain are in constant two-way communication through what is called the gut-brain axis. When the nervous system is dysregulated as it is in people living with chronic pain, this communication gets disrupted. Stress, anxiety, and trauma can all affect gut motility, visceral sensitivity, and pelvic floor tension. This is why treatment that only targets one system rarely gets people all the way better.

The Endometriosis Factor: A Pattern Worth Knowing About

One pattern we see regularly at Empower PT is patients presenting with both CPP and IBS who have never been evaluated for endometriosis. This matters because endometriosis is one of the most common underlying drivers of both conditions at once. When endometriosis affects tissue near the bowel, it can cause symptoms that look almost identical to IBS including bloating, cramping, pain with bowel movements, and constipation, which means it is frequently missed or attributed solely to a gut issue.

If you are dealing with both CPP and IBS and endometriosis has never been raised as a possibility, it may be worth bringing up with your doctor. As we work with patients at Empower PT, we will often gently flag this if the clinical picture points in that direction. You can read more about our approach to endometriosis on our recent Endometriosis Blog Post.

How We Approach CPP and IBS at Empower PT

When a patient comes to us with both chronic pelvic pain and IBS symptoms, we do not treat them as two separate problems to be managed in parallel. We look at the whole picture: the nervous system, the pelvic floor, the breath, the bowel habits, the history, and build a treatment plan that addresses the underlying drivers rather than just the symptoms.

We Start by Really Listening

Before anything else, we take time to understand your full history: when symptoms started, what makes them better or worse, your bowel and bladder patterns, your menstrual history, any surgeries, and what you have already tried. Many of our patients arrive having been told their symptoms are stress-related, or that their test results look normal so there is nothing wrong. We want you to know that normal test results do not mean your pain is not real. We will work to understand what is driving it.

We Assess the Whole System

A thorough evaluation looks at both the external musculature like the hips, low back, abdomen, and inner thighs, and, where appropriate and consented to, the internal pelvic floor muscles. In patients with IBS, we pay particular attention to the muscles that coordinate defecation and their ability to relax, not just contract.

Breath and Movement Are at the Heart of What We Do

The foundation of our approach at Empower PT is breath and movement. The diaphragm and pelvic floor function as a coordinated pressure system. When breathing patterns are dysregulated, as they often are in people with chronic pain, the pelvic floor loses its opportunity to cycle through tension and release.

We work with patients on:

• Diaphragmatic breathing to restore the natural relationship between the diaphragm and pelvic floor

• Learning to consciously release pelvic floor tension using movement and loading

• Breathing strategies specifically for bowel movements to reduce straining

• Functional movement patterns that reduce chronic guarding and help the pelvic floor work the way it is designed to

• Mobility work targeting the hips, low back, and abdomen

  
  

The movement work is also nervous system work. Slow, diaphragmatic breathing is one of the most evidence-supported tools we have for calming an overactivated autonomic nervous system which, as we described above, is often at the root of both IBS and CPP.

Bowel Retraining and Habit Education

A lot of patients with IBS have developed bowel habits over time that, understandably, make things worse, such as straining, holding their breath, and spending a long time on the toilet hoping things will resolve. We provide practical, non-judgmental guidance around positioning, timing, breathing during bowel movements, and how to work with your body rather than against it.

Manual Therapy When Appropriate

Hands-on manual therapy can be a helpful part of care for some patients, particularly when there is significant soft tissue restriction or limited mobility in the abdominal or pelvic organs. Manual therapy can also be used to affect the nervous system. We use these techniques thoughtfully and always in combination with the active breathing and movement work that forms the core of treatment.

Pain Education and Nervous System Support

Understanding what is happening in your body is genuinely therapeutic. When patients learn about central sensitization and the gut-brain axis and understand that their nervous system has been working overtime to protect them, it often shifts something. Movement feels safer. The body starts to feel less like the enemy. We weave this kind of education throughout our work together, because we believe that informed patients heal better.

You Deserve Care That Takes the Whole Picture Seriously

Living with chronic pelvic pain and IBS is exhausting, not just physically, but emotionally. Being dismissed, misdiagnosed, or handed partial answers takes a real toll. Pelvic floor physical therapy is not a last resort, and it is not just for people with one clearly defined condition. It is often the missing piece for patients whose symptoms have been treated in silos without ever getting better.

If any of what you have read here resonates, we would love to hear from you. You can reach out to Empower PT to schedule an evaluation, and we will take it from there together.