Jan 20, 2021
Pain & Injury

Pelvic Pain Causes: from Appendicitis to Muscle Tightness

Pelvic Pain Causes: from Appendicitis to Muscle Tightness

Pelvic pain can manifest itself in many ways. It comes on very suddenly for some and can cause a range of other symptoms beyond just discomfort.

Pinpointing what causes pelvic pain can be tricky, though, because several medical conditions could be the culprit. What's more, if your pain is chronic, multiple conditions could be pelvic pain causes.

With so many different systems interacting with the body's pelvic region, it can be difficult to pinpoint the exact pelvic pain causes right away. This is especially true since when one area of the body begins to malfunction, others tend to follow suit.

Recognizing that you have pelvic pain is usually relatively easy, but figuring out the pelvic pain causes is far more complicated. However, issues related to your pelvic floor and muscle tightness in your iliopsoas often appear together.

While pelvic pain causes can range from digestive issues to the reproductive and urinary systems, the iliopsoas muscles are intimately connected to the other functioning parts of the pelvic floor.

If something is amiss in your pelvic area, the iliopsoas muscles attempt to rebalance and assist the pelvic bone. Unfortunately, this usually causes more harm than good.

What defines pelvic pain?

Pelvic pain is most often defined or described as pain below the belly button (in the anterior lower abdomen). While pelvic pain causes vary, it remains an increasingly common problem among both men and women. However, it tends to be an issue more widespread amongst women.

The origin and intensity of pelvic pain tends to fluctuate from person to person, and no specific disease has been pinpointed to cause it. Depending on the pelvic pain causes, the pain can be categorized as either being acute or chronic.

Acute pelvic pain means that the pain is felt very suddenly and is often very severe or debilitating. Whereas chronic pelvic pain means the pain may come and go, but it could also be constant - lasting for six months or longer.

Common pelvic pain symptoms

The most common symptom of pelvic pain is, of course, pain in your lower abdomen below your belly button. However, how many doctors end up diagnosing pelvic pain causes by looking at other symptoms associated with when the pain began to occur.

When monitoring the severity of your pelvic pain and how long it is present, look for these specific symptoms as well:

  • Cramping
  • Localized pelvic pain
  • Sudden onset of pain
  • Pain aggravated by movement
  • Pain involving your entire abdomen
  • Pain that slowly develops

If you start to develop some of these symptoms, then it is a good idea to start asking, answering, and recording the answers to the following questions. When you visit the doctor for a diagnosis of your pain, you will have a better foundation for them to work from.

  • Is the pain dull or sharp?
  • How long does the pain last?
  • Is anything triggering the pain, or under what circumstances does the pain happen?
  • Is the pain occurring during a menstrual cycle, sex, or urination?
  • Does the pain begin suddenly or gradually?
  • Does the pain come and go?
  • How long have you been experiencing any amount of pelvic pain?

When describing your pelvic pain and other symptoms, being as thorough as possible can help your medical provider understand more about your condition and the possible pelvic pain causes.

Pelvic pain causes

As mentioned before, there are two different types of pelvic pain: acute and chronic. Their differences are primarily in how the pain presents - and how long the pain lasts - but the pelvic pain causes can differ.

There can be an overlap between the two types of pain and the underlying causes, so it is essential to weigh all possible options.

Common acute pelvic pain causes

Ovarian cyst

When a fluid-filled sac develops on the ovary, this is called an ovarian cyst. Ovarian cysts are relatively common, and in most cases, will subside without any symptoms. While many go away naturally within a few months without treatment, it can cause pain in the pelvis when the cyst or fluid-filled sac bursts. Pain can also occur in the pelvis if the cyst twists in any way.

Urinary tract infection

A urinary tract infection (UTI) often comes with some form of acute pelvic pain, but it should subside once the infection has gone away. The UTI can present anywhere within the urinary system, including the bladder, urethra, or kidneys.

The severity of the pelvic pain associated with the infection depends on the person and where the infection is located in the urinary tract. However, most pelvic pain will be present when urinating.


Appendicitis is a painful swelling, usually originating in the middle of your abdomen, that is coming from your appendix. At first, pain may come and go but will increase in intensity as the swelling worsens.

The appendix is connected to the large intestine, and when appendicitis occurs it can put pressure on the pelvis, causing pain. Most pain will present in the lower right-hand portion of the abdomen, and some acute pelvic pain may be present.


Constipation, a bowel obstruction, or a bowel spasm can also cause pelvic pain. Common symptoms associated with constipation or bowel obstruction are abdominal pain and abdominal swelling.

Swelling in this lower section of the abdomen puts immense pressure on all surrounding organs and body parts, including the pelvic region. With the increased pressure and abdominal pain, some pelvic pain is possible with severe constipation or an occasional bowel spasm.

Acute pelvic inflammatory disease

Pelvic inflammatory disease can be both acute or chronic. It is usually a bacterial infection of the womb, ovaries, or fallopian tubes when it is acute. In most cases, the infection occurs after an additional infection of chlamydia or gonorrhea, which should be treated with antibiotics. Most localized infections like this cause inflammation, which then causes localized pelvic pain.


The peritoneum is a thin layer of tissue that lines the abdomen's interior, liver, kidney, bowel, and other organs in the abdomen. When this tissue becomes inflamed, it is known as peritonitis.

Peritonitis causes sudden and severe abdominal pain that requires immediate medical attention because inflammation of the peritoneum usually means the tissue is infected. Depending on the area, this infection may cause pelvic pain that subsides after the infection has been treated.

Pelvic abscess

An abscess is a collection of pus that can develop anywhere in the body. Abscesses are usually quite painful and are caused by a bacterial infection. A pelvic abscess is the collection of painful pus between the womb and vagina. These abscesses require immediate medical attention.  


Pelvic pain can occur during pregnancy for some women. This type of pelvic pain can be considered acute because it is associated with a temporary condition. However, it does have its own medical term: pregnancy-related pelvic girdle pain (PGP). There can be a more specific diagnosis of symphysis pubis dysfunction (SPD), but that is less common.

PGP is caused by your pelvic joints' stiffness, or sometimes the joints moving unevenly at the back or front of the pelvis. Both cause pelvic pain.

Common chronic pelvic pain causes


Endometriosis can also cause acute pelvic pain, but it is far more commonly associated with chronic pelvic pain because it is a long term condition. Endometriosis is a condition that occurs when small parts of the womb lining exist on the outside of the womb. This could be on the ovaries, and when that is the case, it causes extremely painful periods and pelvic pain.

Chronic pelvic inflammatory disease

As mentioned before, pelvic inflammatory disease can be either acute or chronic. The origins of both are the same, and it is a bacterial infection in the womb, ovaries, or fallopian tubes. The main difference is that when you have chronic pelvic inflammatory disease, you will also likely have chronic pelvic pain associated with it.

Irritable bowel syndrome

Irritable Bowel Syndrome (IBS) is a condition that affects the digestive system, causing bloating, cramps, diarrhea, and constipation. Symptoms associated with IBS will come and go with time and vary in severity.

For some people, symptoms could last for weeks or even months at a time. IBS's exact cause is not yet determined, but for most people, it is a lifelong condition. Due to the intense abdominal pain and associated swelling, chronic pelvic pain is possible, especially during IBS flare-ups.

Inflammatory bowel disease

Similar to IBS, inflammatory bowel disease (IBD) groups two chronic conditions into one umbrella term: ulcerative colitis and Crohn's disease. Both of these conditions affect the gut in several ways but also can cause inflammation and pelvic pain.


One of the less common chronic pelvic pain causes is developing fibroids or non-cancerous tumors that grow in and around the womb. Most women that have fibroids are unaware entirely, as the fibroids do not cause any symptoms. However, the tumors made up of muscle and fibrous tissue can twist or deteriorate with time. These complications have been known to cause pain, especially pelvic pain.

Trapped or damaged nerves

Many nerves surround the pelvic floor, and if they become trapped or damaged in any way, specific movements or activities can cause pelvic pain. Depending on the type of nerve damage, it could cause a sharp, stabbing, or aching pain that is usually localized to one area of the pelvis. Nerve damages or trappings are also often associated with tight hip flexor muscles due to the additional stress on the pelvis caused by the muscle pull.

Pelvic pain and muscle tightness

Pelvic pain and pelvic pain causes are different for everyone, but when one portion of the pelvic region is unstable, your hip flexor muscles will attempt to correct the issue.

In fact, in some cases, the iliacus muscle could actually be causing the pelvic pain.

Since the iliacus muscles lie on the pelvic bone's inside surface, they are intimately involved in all pelvic movements and the general well-being of muscles and nerves associated with the pelvic floor.

The primary job of the iliacus muscle is to stabilize the hip and pelvic bones. When pelvic issues arise, the iliacus muscle tightens to protect and stabilize the pelvic area. While the iliacus muscle tightness could simply be a symptom, tight hip flexor muscles can also be one of the pelvic pain causes.

Many medical practitioners that look at the tightness of the iliopsoas in relation to pelvic pain often ask if the muscle tightening is the cause or a side effect of a different condition. In either case, tight iliopsoas muscles could be contributing to your pelvic pain.

Relieve pelvic pain with muscle release

Since muscle tightness seems to be associated with most types of chronic pelvic pain, whether it be a cause or a side effect, finding relief takes a bit of work. You may start to see a physical therapist to understand the root of the pain or find ways to stretch, relax, and release muscle tension.

Although stretching and relaxing your iliopsoas muscles can help, the most effective treatment for tight iliopsoas muscles is to use prolonged pressure to release the tension. To do this, use a targeted tool like the Hip Hook for a few minutes each day.

The Hip Hook is the only tool specially designed to target iliacus muscle tension at the source. Its unique angles design allows the tool to first release the psoas, then pivot to access the iliacus, reaching the inside of the hip bone and allowing the user to relax their body into the Hip Hook while releasing these key muscles.

Depending on the pelvic pain cause you are experiencing, a Hip Hook can be the ideal tool to help get you back on track to recovery quickly. Whatever your pelvic pain causes, releasing tight iliopsoas muscles can help relieve pelvic pain, whether acute to chronic.

FAQs on pelvic pain

Why are my pelvic muscles so tight?

The iliopsoas muscle is involved in everything from sitting to standing, bending to running. They are constantly active. They also tend to tighten to guard other injuries and issues in the pelvic area. Once the iliopsoas muscles accumulate tension, they often don’t release without manual pressure.

How do you release pelvic muscle tension?

Prolonged pressure is the most effective way to release these deeper muscles. It is difficult to access both the psoas and iliacus muscles, because the iliacus is attached to the pelvic bone and it takes a specific angle and depth to reach it. Skilled therapists use their hands to manually release these muscles for their clients, or you can use a tool specific to the job, like the Hip Hook

How do tight hip flexors affect pelvic pain?

The psoas muscle, and more specifically the iliacus muscle, are primary hip stabilizers. When there is dysfunction in the pelvic area, these muscles will tighten to protect the area. When these muscles are holding tension, they bring the entire region out of alignment, creating inefficient movement, twisting, and pain.

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