A woman in her 20s complains of unrelenting pain around her lower back, hips or pelvis. Her scans are normal. There’s no visible injury. She spends eight to ten hours sitting at a desk, works from her laptop, exercises rarely and says she’s always stressed.
This is a clinical picture I am more and more careful not to dismiss. Pelvic pain is not only a gynaecological problem.
What you need to know about the pelvic floor
The pelvis is a complex musculoskeletal region that involves the spine, hip joints, abdominal muscles, pelvic floor and surrounding connective tissues. Issues in one area can affect the other areas.
One factor that causes issues to the pelvic floor may be our increasingly sedentary lifestyles. In 2024, a study of 2400 Indian women found a prevalence of 70.4 per cent for chronic lumbopelvic pain. Crucially, the researchers identified several associated factors, including low physical activity, hamstring tightness, reduced hip flexibility, altered foot posture, increased lumbar lordosis, reduced core muscle performance and higher perceived psychological stress.
That does not mean that sitting causes pelvic pain. Thus, a combination of reduced movement, musculoskeletal imbalance and psychological stress may contribute to the development or persistence of pelvic and lower back pain.
We hear a lot about a weak pelvic floor. But a pelvic floor that is too tight can cause trouble as well. Increased pelvic-floor muscle tone can be related to ongoing pain, stress and protective muscle guarding. A systematic review and meta-analysis concluded that women with persistent non-cancer pelvic pain were more likely to have an increased pelvic-floor muscle tone on digital examination. However, the authors also noted that the relationship is complex and influenced by several biopsychosocial factors.
Not all women with pelvic pain need extra strengthening exercises. If the pelvic floor is already overactive or tight, repeatedly contracting it without proper assessment may not solve the underlying problem.
Stress is not just a mental issue
There is also increasing evidence of a strong link between psychological well-being and chronic pelvic pain. In 2024, a systematic review and meta-analysis of more than 632,000 women found significantly high levels of anxiety and depression in women with different pelvic-floor disorders. Pooled estimates for anxiety and depression in women with chronic pelvic pain were around 29.5 per cent and 26.8 per cent, respectively.
That doesn't mean the pain is just in the mind. There is pain. But the nervous system, muscles, sleep, stress and movement patterns can all affect the experience and maintenance of pain.
What to do for young women?
Start with the basics. Exercise regularly. Break up long periods of sitting with walks, strength training and mobility work suited to your fitness level. Regular movement helps maintain muscle strength, joint mobility and core function.
Pay attention to posture, but don’t obsess over 'perfect' posture. It is better to have a varied movement routine than to stay in one rigid position all day.
Eat for musculoskeletal health. A balanced diet rich in protein, calcium, vitamin D and other micronutrients provides the building blocks needed to maintain healthy bones, muscles and connective tissues. Dairy or fortified alternatives, pulses, eggs, fish, nuts, seeds, fruits and vegetables can all contribute to a varied diet. Nutritional needs, of course, vary from person to person.
Stay adequately hydrated. This becomes particularly important with India’s changing temperatures and humidity. Dehydration can contribute to fatigue, headaches and reduced exercise tolerance, making it harder to stay physically active. Water needs vary with weather, activity levels and individual factors, so regular fluid intake through the day is important.
Don’t automatically strengthen. If pelvic pain persists, it may be necessary to evaluate the hip, spine, core and pelvic-floor muscles to determine whether they are weak, tight or poorly coordinated.
Don’t accept continuing pain as normal. Chronic pelvic pain is defined as pain in the pelvic region lasting six months or more. It can have gynaecological, urinary, gastrointestinal, neurological or musculoskeletal causes.
Consider multidisciplinary care when needed. Depending on the symptoms, the next step might involve an orthopaedic specialist, gynaecologist, pelvic-floor physiotherapist, pain specialist or another clinician.
Perhaps the larger message for Gen Z women is simply this: your body wasn't designed to be sedentary all day, and chronic pelvic pain isn't something you just have to accept. Understanding the movement, muscular and psychological factors around pain can be an important first step to treat it properly.
(The author is a consultant orthopaedic surgeon at HOSMAT Hospital)
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK
