Pelvic Pain and Yoga: What the Research Says

Understanding Chronic Pelvic Pain
Chronic pelvic pain (CPP) is a challenging and often debilitating condition that affects up to 20% of women in the United States. The American College of Obstetricians and Gynecologists defines CPP as noncyclical pain (not linked to the menstrual cycle) that lasts for six months or more and affects areas like the pelvis, lower back, and buttocks.

Living with CPP can significantly impact daily life, often leading to emotional distress, including sadness, depression, and anxiety. There isn’t a single cause of CPP – it can result from a wide range of factors, including but not limited to endometriosis, bladder pain, irritable bowel syndrome, vulvodynia, or even stress.

Pain can also be influenced by overall health and how the brain processes pain. Psychological responses, such as catastrophizing (excessive worry about pain), can sometimes intensify the experience. Because CPP can stem from many different causes, treatment often requires a multifaceted approach, which may include medication, pelvic floor physical therapy, counseling, lifestyle modifications, and, in some cases, medical procedures. The most effective treatment plan will depend on the underlying causes and individual needs.

Treating the Cause, But Still in Pain?

For many people with CPP, the journey to relief can feel frustrating. You may have identified the source of your pain – such as endometriosis, vulvodynia, or musculoskeletal dysfunction- and undergone various treatment, yet you still experience discomfort.

This can be confusing and disheartening, leading to the question: “Why am I still in pain if the underlying issue has been treated?”

First and foremost, it is important to discuss your specific condition with a healthcare provider to ensure that all possible causes of pain are properly assessed and treated. There may still be underlying tissue damage, inflammation, or other contributing factors that require medical attention.  

However, if you’ve addressed all known causes and are still experiencing pain, the answer may lie in how the nervous system processes and remembers pain. In some cases, the nervous system can continue to send pain signals even after the initial cause has been resolved, leading to persistent discomfort even when no active injury is present.

When the Nervous System Stays on High Alert

Pain typically acts like a fire alarm, alerting the body to injury or dysfunction. However, in conditions like CPP, the nervous system can become overactive or hypersensitive, causing pain signals to persist even after the initial cause of injury has healed.

This does not mean the pain isn’t real—it is very real. It simply means that the nervous system has learned to stay on high alert, and treatment often involves strategies that help calm and retrain the body’s pain response.

The Limits of Conventional Treatments
Medications like pain relievers, antidepressants, and nerve pain blockers can offer relief but often come with side effects. While they can help manage symptoms, they don’t always address how the nervous system processes pain.

This may explain why many women with CPP turn to alternative approaches, like yoga, to help manage their pain.

What the Research Says About Yoga for Chronic Pelvic Pain
Recent studies suggest that yoga can lead to clinically meaningful improvements in both pain levels and quality of life for women with chronic pelvic pain.

Women who practiced yoga for 6 to 8 weeks reported a 50% improvement in emotional well-being and a 33% reduction in pain on average. The yoga sessions included physical postures, breathing exercises, and relaxation techniques.

Importantly, no serious side effects were reported, making yoga a promising and safe option for managing chronic pelvic pain.

How Yoga Can Help with Chronic Pelvic Pain
The mind-body connection is a key reason why yoga can be effective for managing chronic pain. If you are experiencing amplified pain signals from CPP, yoga can help break this cycle by encouraging mindfulness—allowing you to be present with your body’s sensations in a relaxed and attentive way.

Meditation and mindful breathing can train your mind to respond to pain signals with calmness instead of fear, helping to gradually lower the nervous system’s sensitivity.

By consistently training your nervous system to quiet these amplified pain signals, they begin to lose their intensity and have less power to dominate your experience – allowing them to gradually fade over time.

Stretching and Breathing: Easing the Pain Alarm
Another way yoga can help is through gentle stretching. Yoga poses can release tension in the pelvic floor muscles and improve blood flow, which can help if you have tight or painful areas.

Repeating these gentle, pain-free movements sends a signal to your nervous system that these sensations are safe, which can help retrain it to stop overreacting to pain—almost like gradually turning down the volume on a loudspeaker.

Breathing exercises are another powerful tool in yoga’s approach to managing pain. Deep belly breathing, also known as diaphragmatic breathing, helps the pelvic floor muscles work in sync with the diaphragm (the main muscle used in breathing).

This type of breathing also stimulates the vagus nerve, which activates the parasympathetic nervous system—your body’s “rest and digest” mode.

By switching off the body’s stress response (the “fight or flight” mode) and turning on the relaxation response, deep breathing helps lower stress hormones like cortisol, slow your heart rate, and release muscle tension.

Over time, by focusing on nonpainful sensations and calming techniques, you can help build new, nonpainful pathways in the nervous system.

As these pathways become stronger and more frequently used, the painful pathways can gradually weaken and become less dominant, making it easier to manage pain.

Why Seeing a Physical Therapist Matters
Because CPP is such a complex condition, it’s important to see a pelvic floor physical therapist. They can assess your symptoms and recommend yoga poses that are helpful for your specific condition.

They can also suggest modifications—like using props or adjusting how deep you go into a stretch—to make sure you’re getting the most benefit without making your pain worse.

Knowing which poses to do, and how to do them correctly, can give you the confidence to practice yoga safely and effectively.

Conclusion

Yoga’s combination of mindful movement, stretching, and focused breathing offers a unique way to manage CPP without relying solely on medication. 

By calming the nervous system and helping it relearn how to process pain signals, yoga can help women with CPP regain a sense of control over their bodies and improve their quality of life.

If you are struggling with chronic pelvic pain, know that your pain is real, and you deserve to be heard, supported, and given effective treatment options.

There is no one-size-fits-all approach to healing, and it’s okay to explore different treatment options to find what works best for you.

Yoga can be one tool among many that may help some people find relief.

Research & Evidence

It is important to note that the current evidence offers moderate confidence in yoga’s effectiveness for managing chronic pelvic pain. The studies reviewed showed promising results, but they had small sample sizes, a moderate risk of bias, and variability in yoga styles.

More high-quality research is needed to confirm these findings. For now, yoga seems like a safe and helpful option to try alongside other treatments recommended by your healthcare provider.

Resources

Russell, Natalie DPT1; Daniels, Bevin PT, DPT2; Smoot, Betty PT, DPTSc1; Allen, Diane D. PT, PhD1. Effects of Yoga on Quality of Life and Pain in Women With Chronic Pelvic Pain: Systematic Review and Meta-Analysis. Journal of Women's Health Physical Therapy 43(3):p 144-154, July/September 2019. | DOI: 10.1097/JWH.0000000000000135

Note:
This blog post is for informational purposes only and does not provide medical advice. It is not intended to diagnose or treat any medical condition. Please consult your healthcare provider before making decisions about your health or treatment options