The Overlooked Connection Between Lower Back Pain and Pelvic Pain in Females
A few months ago, a woman came into my office frustrated. She had been dealing with lower back pain for over a year. She had done stretching. She had strengthened her “core.” She had tried massage. She had even changed her mattress. Nothing fully resolved it. Then she quietly added: “Oh… and I also leak a little when I sneeze. And sometimes intercourse is uncomfortable. But I don’t think that’s related.” It was related. And this is something I see all the time.
The Missing Link Most Women Aren’t Told About
When we think about lower back pain, we usually think:
Bad posture
Weak abs
Tight hamstrings
Sitting too much
What almost never gets mentioned? - The pelvic floor.
Your pelvic floor is a group of muscles that sit at the base of your pelvis. They support your bladder, bowel, and uterus. But they also play a major role in spinal stability. They are part of your “core system,” working together with:
Your diaphragm (breathing muscle)
Your deep abdominals
The small stabilizing muscles in your lower back
When this system is coordinated, your body feels supported and efficient. When it’s not? Pain often shows up.
How Pelvic Floor Issues Can Show Up as Back Pain
1. A Pelvic Floor That’s Too Tight
Many women assume pelvic floor problems mean weakness. But I frequently see the opposite. A pelvic floor that is constantly gripping or bracing can:
Pull on the sacrum (tailbone area)
Alter how the pelvis moves
Create tension that refers into the lower back
Make sitting uncomfortable
This is especially common in women who hold stress in their bodies, have a history of trauma, are always “on” and pushing through discomfort. The muscles never truly relax and the back pays the price.
2. A Pelvic Floor That’s Not Supporting Well
If the pelvic floor isn’t generating enough support or isn’t timing correctly, the lower back can take on extra load. One reason why your pelvic floor might not be able to do its job is because outside of the pelvis there may be a biomechanical issue such as impaired function of the ribcage, hip, and/or foot and ankle. When the pelvic floor isn’t supportive enough, you might notice:
Back pain with lifting
Ache after long periods of standing
Feeling unstable during workouts
The body will always find a way to compensate. The lumbar spine often becomes the overworker.
3. A Coordination Problem (This Is More Common Than You Think)
Sometimes it’s not about tight or weak. Sometimes it’s about timing.
If you:
Hold your breath when lifting
Deal with chronic constipation
Constantly brace your abs
Feel like you can’t fully relax your belly
Your pressure system inside your abdomen changes. That pressure gets transmitted down to the pelvic floor and back to the spine. Over time, pain develops.
Signs Your Back Pain Might Have a Pelvic Floor Component
If you have lower back pain and any of the following, it’s worth looking deeper:
Urinary leakage (even “just a little”)
Urinary urgency or frequency
Pain with intercourse or that feeling as if something is “hitting a wall”
Tailbone pain
Pelvic pressure or heaviness
Constipation
Pain that worsens with sitting
When back pain and pelvic symptoms coexist, that’s rarely a coincidence.
Why Traditional Treatment Sometimes Doesn’t Fully Work
Many women I see have already tried traditional orthopedic physical therapy. And sometimes it helps - but not completely. Why? Because if the pelvic floor isn’t assessed, a key stabilizing muscle group is left out of the equation.
What Pelvic Floor Therapy Actually Looks Like
If the idea of pelvic floor therapy feels intimidating, let me demystify it. It starts with conversation.
We look at:
Your symptoms
Your stress levels
Your breathing patterns
Your movement habits
Your goals
There area always different options for way to assess what’s going on and you get to choose what feels most comfortable. Treatment may include:
Learning how to truly relax your pelvic floor
Improving breath mechanics
Rebalancing core coordination
Gradual strengthening
Re-learning movement patterns
Optimizing biomechanics outside of the pelvis
Strategies you can use at home
The goal isn’t just to reduce pain. It’s to help your body feel safe, supported, and capable again.
You Don’t Have to Just “Live With It”
Lower back pain that lingers is often a signal - not a life sentence. If you’ve been dealing with back pain along with bladder, bowel, or pelvic symptoms… or if you’ve tried everything and still feel like something is missing…The pelvic floor may be the piece no one has evaluated yet. You deserve a body that feels stable, strong, and comfortable. If this sounds like your story, consider scheduling a pelvic floor evaluation. Getting a comprehensive assessment can uncover what other approaches may have overlooked and give you a plan that actually fits your body. And if you’re not quite ready for an appointment, start by becoming curious. Notice your breath. Notice when you grip. Notice what your body might be holding. Sometimes awareness is the first step toward relief.
✨If you’ve been struggling with any symptoms of pelvic floor dysfunction, I’d love for you to consider working with us and getting you relief. We have both in-person and virtual options available, for your convenience.
