Bladder issues can be linked with pelvic floor problems. When suffering from repeated and chronic UTI symptoms the pelvic floor muscles can go into spasm causing more tension and pain.

Pudendal nerve entrapment is also an issue for some, that is compression of the pudendal nerve in the pelvic floor which can cause a constant sensation of needing to urinate. For men and women, nerve dysfunction (either through damage such as a fall or nerve compression) can also cause UTIs by altering voiding signals and causing urinary retention.

For women, childbirth or vaginal prolapse can add to issues with pelvic floors.

All of the above are noted to increase bladder pain and inflammatory responses throughout the pelvic floor either through nerve guarding or neural cross talk.

What can help pelvic floor problems?

If you are struggling with ongoing pain in the pelvic floor and lower back, your GP may refer you to see a specialist such as a uro-gynaecologist, neurologist or pelvic pain doctor who can organise for a scan allowing visualisation of the nerves in the lower spine and pelvic floor as well as the condition of the organs of the pelvic floor. Because of these scans look inside the nerves, they provide information about the internal state of the nerves such as the presence of irritation, nerve swelling, compression, pinch or injury. Following scans they will then discuss any outcomes found and routes of treatment which may include behavioural changes, surgery (where necessary), medication and physical therapy and biofeedback.

More information about managing pelvic pain and pelvic pain centres in the UK

If you decide to see or are referred to a therapist, they will work to relax muscle tension by identifying trigger points in these muscles alongside any other issues diagnosed by your clinician and providing guided a gentle pelvic exercise programmes for you to continue at home.

Women are often told, particularly after childbirth, that Kegel exercises are the answer but sadly these can overtighten things if a pelvic floor is already too tense, damaged and in spasm. Where appropriate, after diagnosis, work with a therapist on reverse Kegels to loosen the pelvic floor.

Others have pelvic floor muscles which are too weak and again guided, gentle pelvic floor exercise can help to strengthen these.

When you see a pelvic floor therapist

The therapist should take a full history and carry out a gentle body assessment so they can build a picture of possible causes and existing issues such as pelvic misalignment. Trigger points are not only located vaginally or rectally, they are often external and found in the thighs, abdomen and back. By loosening these first, you will know if you are ready to move to internal work.

Initially symptom relief can be felt but be warned, it may cause discomfort to start with. These are long standing tensions in the pelvic floor that may not release easily.

There may be an increase in frequency and pain in the bladder and/or pelvic floor for a day or so after treatment because of the complex nerve structure in the pelvis. A softly, softly approach is best and if during the exam things start to hurt, tell the therapist immediately.

More information

Amy Stein’s website and book Heal Pelvic Pain has lots of information

Pelvic have a searchable online list of UK and Ireland pelvic floor therapists

The Pelvic Obstetric and Gynaecological Physiotherapy Network affiliated to the Chartered Society of Physiotherapy have a searchable list of pelvic floor therapists in the UK.

The Pelvic Pain Network is a UK-wide expert team of pelvic pain physiotherapists, psychologists and pain specialists collaborating with doctors across specialities throughout the UK.