One of the questions I always ask patients in my office with pelvic floor dysfunction is if they feel any pelvic heaviness. I will be the first to say that the term “pelvic heaviness” is pretty vague and likely interpreted differently from one patient to the next. BUT, I actually love that this is a vague term because if the answer is “yes” or “sometimes”, we can jump into further discussion about what exactly they feel and when. (If the answer is “no”, I still ask some follow up questions just to make sure we are on the same page).

One quick disclaimer before I go further - in this blog post I am going to be specifically talking about pelvic heaviness in women who are not pregnant. Pregnant women often feel pelvic heaviness and pelvic floor therapy can also be helpful for them, but for the sake of this blog we are going to focus on non-pregnant women!

So what do I mean by “pelvic heaviness”?

Pelvic heaviness can mean anything from feeling bloating or pressure in the lower abdomen/top of pelvis, a bulging sensation into the vaginal canal (a similar sensation as if a tampon is falling out of the vagina), heaviness around the pubic bone or lower pelvis, or even varicose veins in the pelvic region. These symptoms may change throughout the day, throughout your menstrual cycle, or even with changing positions (lying down vs sitting vs standing).

What could be causing pelvic heaviness?

Depending on the type of symptoms you are experiencing, when you experience them, and what makes them better or worse, there could be a few different things causing pelvic heaviness.

1) Pelvic Organ Prolapse. Pelvic organ prolapse is the descent of one or more of the anterior vaginal wall (bladder or urethra), posterior vaginal wall (rectum or small intestine), the uterus, or the apex of the vagina (vaginal vault or cuff scar after hysterectomy). Some patients may also experience a rectal prolapse. I know it can sound scary, but many cases of POP are asymptomatic and many of the cases that are symptomatic can be well managed with pelvic floor therapy. Check out this blog post to learn more about pelvic organ prolapse.

2) Constipation. The rectum is supported by the pelvic floor muscles, so if you are constipated and unable to fully empty your bowels, the pelvis can feel heaviness and pressure. Constipation and gas can also cause bloating and discomfort in the abdomen, which some patients will describe as feeling heavy as well. Check out this blog post to learn more about how constipation affects your pelvic health.

3) Pelvic floor muscle dysfunction. Pelvic floor muscle dysfunction, particularly pelvic floor muscle fatigue or tension, can cause a sensation of heaviness. I have had postpartum patients (and have also experienced this myself) who return to exercise and although they are managing their pressure well, they are starting to push themselves in the gym. Sometimes after a work out they will feel some heaviness, but it subsides after some rest. In this situation I think it is more that their pelvic floor muscles are simply fatigued from needing to work harder as they are challenging themselves in the gym (pelvic floor muscles can experience DOMS, too!).

Pelvic floor muscle tension can occur for a lot of reasons, including stress, tailbone injuries, after childbirth, because of POP, and more. Sometimes this tension and guarding can cause a sensation of heaviness, especially in those who also have pelvic organ prolapse. By addressing the muscle tension with breathing, relaxation techniques, and manual therapy, the heaviness can significantly improve or resolve.

4) Pelvic congestion syndrome. Pelvic congestion syndrome occurs when there is a problem with blood flow in the veins in your pelvis. There can be different causes of pelvic congestion syndrome, so it is important to work with your physician to determine the cause and best course of treatment.

5) Conditions that cause inflammation and irritation in the pelvic region such as UTIs, STIs, endometriosis, ovarian cysts, fibroids, or appendicitis. This is another situation where it is important to work with your physician to determine the underlying cause of heaviness and how to best treat it!

How can pelvic floor therapy help?

Depending on the cause of pelvic heaviness, pelvic floor therapy can play a very important role in helping to reduce or resolve the pelvic heaviness you are experiencing. All of these causes of heaviness in the pelvis are likely affecting your pelvic floor muscles, so a thorough muscle assessment can be play an important role in addressing the heaviness. Techniques such as visceral manipulation can also help with pelvic organ prolapse, constipation, and pelvic floor muscle function.

If you’re experiencing heaviness in your pelvis, we can help! Set up your free 15 minute phone consult with one of our pelvic health specialists here.

Blog post written by Dr. Alexis Hutchison, PT, DPT, OCS

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