Fibromyalgia and Pelvic Pain: What’s the Connection?
When you’re living with fibromyalgia, another uncomfortable symptom can feel like one more thing you’re expected to manage. Bladder urgency? Pelvic pain? Pain with sex? It’s easy to wonder, “Is this just part of having fibromyalgia?”
There is an overlap between fibromyalgia and pelvic floor symptoms. But that doesn’t mean you have to shrug off those symptoms—or assume there’s nothing that could help.
Fibromyalgia and pelvic symptoms can show up together
Research suggests that women with fibromyalgia report more pelvic floor symptoms than women without it. These can include bladder and bowel leakage, pelvic discomfort, and symptoms that interfere with daily life.
These studies show an association. They don’t prove that fibromyalgia causes pelvic floor dysfunction, and they don’t mean everyone with fibromyalgia will develop it.
Still, the overlap gives us a good reason to ask about pelvic health instead of leaving it out of the conversation.
Your nervous system may be part of the picture
Fibromyalgia involves changes in how the nervous system processes pain. Some people with chronic pelvic pain also experience increased sensitivity in their pain-processing systems.
Think of it like a volume dial: the nervous system can become more responsive, making sensations feel more painful or harder to settle.
That pain is real. Nervous system involvement doesn’t mean you’re imagining symptoms or that you should be able to think your way out of them.
Pelvic muscles, connective tissues, and conditions affecting the bladder, bowel, or reproductive organs may also contribute. More than one factor can be present at the same time.
Where does the pelvic floor fit in?
Your pelvic floor is a group of muscles that helps support your pelvic organs and contributes to bladder control, bowel function, and sexual function.
Like other muscles, these muscles can become tender, have difficulty relaxing, or struggle with strength and coordination.
And “tight” doesn’t automatically mean “strong.” A muscle can have trouble relaxing and still have difficulty doing its job.
That’s why a pelvic floor assessment looks beyond whether you can squeeze.
Can pelvic floor physical therapy help?
Pelvic floor physical therapy helps when pelvic muscle tenderness, difficulty relaxing, or other muscle-function problems are contributing to symptoms.
Research supports its use in certain pelvic pain conditions. However, the evidence is stronger for those conditions than for fibromyalgia specifically. We can’t assume that results from pelvic pain studies apply equally to everyone with fibromyalgia.
The practical takeaway? Having fibromyalgia doesn’t rule out a treatable pelvic floor contribution to your symptoms. An evaluation can help determine whether pelvic floor PT belongs in your care plan.
Treatment should fit your body
Depending on your symptoms and assessment, pelvic floor PT may include:
Learning how your pelvic muscles contract and relax.
Gentle movement and breathing strategies.
Hands-on treatment when appropriate and comfortable.
Bladder and bowel habit education.
Gradually building strength, coordination, and activity tolerance.
Understanding pain and finding ways to pace activity during flares.
You don’t need every treatment on that list. Your plan should reflect your goals, comfort, and response.
And no, the answer isn’t automatically Kegels. If your muscles already have difficulty relaxing, adding more squeezing may aggravate symptoms. Strengthening can be useful when it’s indicated—but it should follow an assessment.
Pelvic symptoms deserve attention
If you’re experiencing persistent pelvic pain, pain with sex, bladder urgency, or bladder or bowel leakage, bring it up with your healthcare team. These symptoms deserve evaluation rather than being automatically attributed to fibromyalgia.
At Bonneville Pelvic Health in Ogden, Utah, we take time to understand your symptoms and assess how your pelvic floor may be contributing. When physical therapy is appropriate, we work with you to build a manageable plan that supports the activities that matter to you.
You don’t need to know exactly what’s wrong before asking for help. That’s what the evaluation is for.
Most research on this overlap has studied women. Findings may not apply equally to people of all genders. This article is educational and does not replace individualized medical care.
Written By:
Dual Board-Certified Pelvic Floor Therapist and Owner of Bonneville Pelvic Health
As an expert in pelvic floor rehabilitation, Dr. Bailee Burningham brings extensive experience in treating complex pelvic floor disorders. She is dedicated to providing compassionate, patient-centered care
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