The pelvis consists of three bones, the two hip bones and the sacrum, joined at three joints: the SI joints on each side of the sacrum at the back, which normally move only a few millimetres but transfer the whole weight of the upper body to the legs, and the pubic symphysis at the front. At the bottom the pelvis is covered by the pelvic floor, a hammock of muscles that supports the organs and controls continence and sexual function, and on the outside attach the gluteal muscles, hip flexors, adductors and hamstrings. Pelvic pain is therefore a collective name for rather different things that are told apart by where it sits and what triggers it. The most common cause in adults in general is the SI joint and the muscles around it: one-sided ache just below the belt line beside the sacrum, worse with standing up, turning in bed and standing on one leg, often after long sitting, uneven loading, pregnancy or a period of weak glutes. In pregnant women the same thing is called pelvic girdle pain and affects one in five. In athletes who kick, sprint and turn quickly it is the pubic attachment and the groin, in runners the SI joint and gluteal muscles, in people who sit a lot the tailbone and a chronically tight pelvic floor, and after childbirth the pubic symphysis and a weakened pelvic floor. Hip osteoarthritis often feels like pelvic and groin pain, and pain from the lower back radiates into the pelvis. Inside the pelvis are bowel, bladder, prostate, uterus and ovaries, and pain from them requires a different investigation, which is why the warning signs below matter. Here is the pelvis part by part, when to seek care, and what helps.
Where in the pelvis does it hurt, and what it usually means
| Location | Most common | How it feels | Read more |
|---|---|---|---|
| At the back, just below the belt line, beside the sacrum, usually one side | SI joint problems (pelvic joint pain) | Deep, dull or stabbing ache over the small dimple, worse with standing up, turning in bed, standing on one leg, stairs, long sitting; sometimes radiates to the buttock and back of the thigh but not below the knee; feeling of instability or locking | Lower back pain, buttock pain |
| At the front, over the pubic bone, sometimes out into the groins | The pubic symphysis and adductor attachments | In pregnancy and after childbirth: pain and a "click" in the pubic bone when walking, on stairs, turning over; in athletes: dull pain at the edge of the pubic bone increasing with kicking, sprinting, sideways movements, painful to sneeze | Pelvic girdle pain, groin pain |
| Deep in the buttock | Piriformis, gluteal muscles, hamstring attachment | Ache in the middle of the buttock, worse with sitting, stairs, running; sometimes radiation into the thigh | Piriformis syndrome |
| At the very bottom, between the buttocks | The tailbone | Pain when you sit, especially leaning back, and when you stand up; after a fall, childbirth, long sitting | Tailbone pain |
| In the groin, deep, with stiffness | Hip osteoarthritis, hip impingement, hip flexor, inguinal hernia | Ache in the groin radiating towards the front of the thigh, stiff in the morning, difficulty putting on socks; hernia: a bulge that increases with coughing | Hip pain |
| In the genital area, pelvic floor, perineum, pressure, heaviness, burning | Tight pelvic floor (overactive), weakened pelvic floor, prolapse, after childbirth | Tight: pressure and ache in the genital area, pain during sex, difficulty urinating or emptying the bowel, worse with stress and long sitting, often with back pain. Weak: heaviness, leakage, a feeling that something bulges | Pelvic floor training |
| The whole pelvis, diffuse, with other symptoms | Organs: urinary infection, prostate, uterus, ovaries, endometriosis, bowel | Pain that follows the menstrual cycle, comes with fever, burning, bleeding, changed toilet habits or nausea | Your doctor or gynaecologist; see below |
| The pelvis after a fall or in older people | Fracture, stress fracture (sacrum, pubic bone) | Pain on weight-bearing that doesn't pass, difficulty walking; in older people with osteoporosis even without a clear fall; in runners after a rapid increase | Care: X-ray or MRI |
When to seek care
- Emergency: pelvic pain after a fall or trauma in an older person or with osteoporosis, especially if you can't bear weight; pelvic pain with numbness in the genital area or inner thighs, difficulty urinating or holding urine, or weakness in the legs; sudden severe pain in the lower abdomen or pelvis with fever, vomiting or feeling faint; in pregnancy: regular pains in waves, bleeding or reduced fetal movements.
- Your doctor or gynaecologist within a few days: pelvic pain with fever, burning when urinating, blood in the urine, discharge or bleeding outside periods; pain that follows the menstrual cycle and limits daily life (endometriosis); pain during sex; pain with changed bowel habits, blood in the stool or weight loss; new pelvic pain in men with urinary symptoms.
- Your doctor or physiotherapist within a few weeks: SI joint, pubic bone or tailbone pain not improved in four to six weeks with self-care; pelvic pain that prevents sleep, work or walking; recurrent problems; pain in runners increasing with load (stress fracture); pelvic floor problems (leakage, heaviness, pain during sex, difficulty emptying) which are very treatable with a pelvic floor physiotherapist; pelvic pain after childbirth not improved in three months.
What helps pelvic pain
1. Stability before stretching
The most common mistake with SI joint and pubic bone pain is stretching what hurts: a joint that already moves too much only gets more irritated. The first step is instead to stabilise with deep core strength and glutes, to avoid asymmetric loads for a while (standing on one leg, crossing the legs, sitting with the legs drawn up, carrying on one hip, a wide stance) and to let the joints settle. Stretching comes later, aimed at what is actually short (hip flexors, piriformis), never at the joint.
2. Exercises for pelvic stability, ten minutes a day
- Pelvic floor squeeze and deep abdominal activation: squeeze as if holding urine and wind and at the same time draw the navel lightly inwards, hold 5–10 seconds with calm breathing, relax fully; 10 times. The pelvis's innermost stability. With a tight pelvic floor: skip the squeeze and do the relaxation below instead.
- Glute bridges with a ball or cushion between the knees that you press lightly, 3 × 12; activates adductors and pelvic floor and stabilises the pubic bone.
- Clamshells and side-lying leg raises with a small range, 3 × 15; gluteus medius holds the SI joint.
- Bird dog, 5 per side, 5-second holds; core and glutes without loading the joints.
- Dead bug on your back: lower opposite arm and leg slowly with the lower back on the floor, 10 per side.
- Isometric adduction (press a ball between the knees, 10 × 10 seconds) and abduction (band around the knees, press apart): the pelvis's "corset" from both directions; especially for pubic bone pain in athletes.
- Kneeling hip flexor stretch, 30 seconds per side; a short hip flexor tips the pelvis forward and irritates the SI joint.
- Progression after four to six weeks: single-leg stance with a level pelvis, step-ups, reverse lunges, Romanian deadlifts with light weight, side steps with a band.
Programmes are in core exercises at home, pelvic floor training and hip and hip flexor stretches; for pregnant women in back pain in pregnancy.
3. If the pelvic floor is too tight
An overactive pelvic floor gives pressure, ache and burning in the genital area, pain during sex, difficulty urinating or emptying the bowel, and often lower back and hip pain, and is worsened by stress, long sitting, hard core training and too much squeeze training. Then the treatment is the opposite: teaching the muscles to relax. Deep belly breathing lying with knees bent and a hand on the lower belly, five minutes; "release" exercises where you imagine the pelvic floor sinking towards the floor on the exhale; happy baby and a deep squat with support; a warm bath; and a pelvic floor physiotherapist, who can treat the muscles directly. See relaxation exercises and the diaphragm.
4. Daily life and sitting
Sit on both sitting bones with feet on the floor and support in the lower back, stand up every half hour, with tailbone pain a wedge cushion with a cut-out, with SI joint pain no crossed legs; sleep on your side with a pillow between the knees and turn with the knees together; lift close to the body with both sides equally; a pelvic belt with clear instability, fitted by a physiotherapist; flat shoes. See cupping for people who sit a lot.
5. Heat and treatment
Heat on glutes and lower back for 15–20 minutes loosens the muscles before exercises. A physiotherapist is the right place for all pelvic problems that haven't responded to four to six weeks of self-care: manual treatment of SI joint and muscles, pelvic floor treatment, and an individual programme. Cortisone injection into the SI joint is used for severe, long-standing problems; surgery very rarely.
6. Cupping around the pelvis
Cupping isn't used on the pelvic joints themselves, the pubic bone or the genital area, but the muscles that pull on the pelvis, the gluteal muscles, piriformis, the lower back muscles, the visible part of the hip flexors on the front of the thigh and the adductors on the inside of the thigh, respond well to cupping, and when they relax the uneven pull on SI joint and pubic bone and the ache in the buttock decrease. How to: lie on your side or front, oil the skin, glide the dynamic cup with light to moderate pressure from the sitting bone diagonally up towards the iliac crest over the glutes, 3 minutes per side, along the lower back muscles on each side of the spine from a hand's width above the sacrum up towards the ribs, 2 minutes per side, and along the front and inside of the thigh towards the groin (not into the groin crease), 2 minutes per side. Place static cups in the middle of the buttock and over gluteus medius for 5 minutes while you belly-breathe. Finish with the hip flexor stretch and the stabilising exercises. Two to three times a week. Don't cup directly over the SI joint or sacrum with strong suction, never over the pubic bone, lower abdomen or genital area, not during pregnancy without the midwife's OK and never over the lowest lower back and sacrum then, not with fever, suspected infection or fracture, and not if you take blood thinners without having asked; see when to avoid cupping and cupping during pregnancy. Routines in cupping on the back and the cupping programme for runners.
Deeper guides
Pelvic girdle pain in pregnancy, back pain in pregnancy, pelvic floor training, buttock pain, tailbone pain, groin pain, hip pain, period pain and diastasis recti and training after childbirth.
Frequently asked questions
Why does my pelvis hurt?
Most common are the SI joint and the muscles around it (one-sided ache just below the belt line by the sacrum, worse with standing up and turning over), the pubic symphysis (at the front, in pregnancy and athletes), tight or weak gluteal muscles, the tailbone (when you sit), the hip joint (the groin) and a pelvic floor that is too tight or too weak (pressure and ache in the genital area). Pain with fever, burning, bleeding, changed toilet habits or that follows the menstrual cycle comes from the organs and should be investigated.
How does SI joint pain feel?
Like a deep, dull or stabbing ache on one side just below the belt line, over the small dimple beside the sacrum, worse with standing up from sitting, turning in bed, standing on one leg, climbing stairs and sitting for long, sometimes with radiation to the buttock and back of the thigh but not below the knee, and often with a feeling of instability. Treated with stability (core, glutes, adductors), symmetric loading and cupping of the gluteal muscles, not with stretching of the joint.
When is pelvic pain dangerous?
Seek emergency care after a fall in an older person or with osteoporosis, with numbness in the genital area or difficulty urinating, with sudden severe pain with fever or vomiting, and in pregnancy with regular pains in waves or bleeding. Seek care within a few days for pain with fever, burning, blood in urine or stool, discharge, bleeding outside periods, pain during sex or pain that follows the menstrual cycle. Mechanical pelvic pain not improved in four to six weeks: physiotherapist.
Which exercises help pelvic pain?
Stability first: pelvic floor squeeze with deep abdominal activation, glute bridges with a ball between the knees, clamshells, bird dog, dead bug, isometric press with a ball between the knees and a band around the knees, and a hip flexor stretch; ten minutes a day, progression after four to six weeks. Avoid stretching the joint itself and asymmetric loading. If the pelvic floor is too tight the opposite applies: breathing and relaxation instead of squeezing, ideally with a physiotherapist.
Can you cup for pelvic pain?
Around the pelvis, not on it: cupping of the gluteal muscles, piriformis, lower back and the front and inside of the thigh releases the muscles that pull unevenly on SI joint and pubic bone and reduces the ache, followed by stabilising exercises. Never over the pubic bone, lower abdomen or genital area, not with strong suction directly on the SI joint or sacrum, not during pregnancy without the midwife's OK, and not with fever, infection or suspected fracture.
Written by Curam. Last updated 17 October 2026. This is general self-care information and does not replace medical care. For sudden, severe or unusual symptoms, contact your doctor. Talk to your doctor before cupping if you are pregnant, take blood thinners or have a condition affecting skin, blood vessels or blood.
