Fibromyalgia and Pelvic Symptoms: Understanding the Hidden Connection

Fibromyalgia (FM) is a chronic pain syndrome characterized by widespread symptoms including musculoskeletal pain, fatigue, sleep disturbance, and cognitive changes. Increasingly, research is showing a strong overlap between fibromyalgia and pelvic pain symptoms, including bladder, bowel, and sexual symptoms. Pelvic floor physical therapy (PFPT) is an important component of treatment for people with fibromyalgia who also have pelvic symptoms.  

Several studies have documented that women with fibromyalgia have a much higher prevalence of pelvic floor disorders (PFD), bladder symptoms, bowel issues, and sexual dysfunction, compared to healthy peers. 

There is a high prevalence of urinary incontinence, overactive bladder symptoms, bowel symptoms including incontinence and constipation, pelvic organ prolapse symptoms, sexual dysfunction (pain with sex, decreased sexual satisfaction), and pelvic pain among people with fibromyalgia. FM appears to increase risk by roughly a factor of 2‑3 for certain PFD symptoms. 

The overlapping symptoms of fibromyalgia and pelvic/pelvic floor disorders likely arise from several mechanisms: 

1. Central sensitization: Fibromyalgia is considered a central sensitivity syndrome, meaning that pain processing in the central nervous system is amplified. Sensory inputs from peripheral structures (bladder, gut, pelvic floor) that might be normal or mildly irritating can be perceived as painful. This can also heighten perception of bladder or rectum fullness or urgency. Several studies suggest FM patients’ have increased pain response to visceral stimuli. 

2. Pelvic floor muscle hypertonicity: The pelvic floor muscles may be overactive, have trigger points, or have altered resting tone in many FM patients. This can contribute to pelvic pain, painful intercourse (dyspareunia), and bladder and bowel dysfunction.  

3. Visceral comorbidity with other pain syndromes: Irritable bowel syndrome, painful bladder syndrome, interstitial cystitis, chronic pelvic pain, and vulvodynia often occur along with FM. These disorders share features of pain with variable inflammatory markers and increased sensitivity to stressors, psychological factors.  

4. Psychological, mood, sleep, and stress influences: Depression, anxiety, and poor sleep all worsen fibromyalgia and pain eption, and are known to affect bladder and bowel control, sexual function. Some studies have shown that blurring of physical and psychological distress is common.  

5. Musculoskeletal contributions: Changes in posture, muscle spasms, myofascial taut bands, and trigger points in pelvic floor or adjacent muscles may cause mechanical strain, decrease muscle relaxation, and contribute to pain referral patterns.  

Let’s look at what the research says specifically about bladder, bowel, and sexual symptoms in FM. 

• Bladder Symptoms: 

• Overactive bladder symptoms (urgency, frequency, nocturia) are reported at significantly higher rates in FM. In the study of 481 women, 24% had mild OAB, ~17% moderate, ~7% severe. (PubMed) 

• Painful bladder syndrome/interstitial cystitis has an increased prevalence among FM patients.  

• Urinary incontinence is common; 60% of FM patients in one study reported UI vs 25% in controls. (SAGE Journals) 

• Bowel Symptoms: 

• Fecal incontinence and gas incontinence are significantly more common in FM vs controls.  

• Bowel symptoms (constipation, diarrhea, urgency) are frequently present in CPP and IBS, which often co‑exist in FM. (PubMed) 

• Sexual Symptoms: 

• Sexual dysfunction (painful intercourse, decreased sexual satisfaction, decreased desire) is more frequent in FM. 

Bladder, bowel, pelvic floor, and sexual symptoms are not just extra discomforts — they relate strongly to disease severity, quality of life, psychological state, sleep, mood. 

• In FM patients, greater pelvic floor distress is correlated with worse overall pain, decreased daily functioning, worse mood, and worse sleep quality. (PMC) 

• The Pelvic floor awareness study, higher depression and anxiety scores related to worse PFD symptoms. (SAGE Journals) 

• In the study of Overactive Bladder & Sexual Dysfunction, OAB and sexual dysfunction severity both correlated with disease severity, more widespread pain, and neuropathic pain features. (PubMed) 

Given the overlap, what does the evidence show about treating pelvic floor dysfunction in FM or in pelvic pain syndromes more broadly? Pelvic floor physical therapy (PFPT) is one of the front‑line therapies for FM and pelvic floor dysfunction. 

Because FM is a complex, multisystem condition (central sensitization, altered pain thresholds, sleep disturbance, psychological comorbidities), treatments can take more time and be challenging due to potential pain during therapy, flare‑ups, and difficulty sustaining progress. 

Based on what is known, here are some recommendations for clinicians and patients when dealing with fibromyalgia and pelvic pain symptoms: 

1. Screen for pelvic floor/bladder/bowel/sexual symptoms in patients with fibromyalgia. Because the prevalence is high (urinary incontinence, urgency, bowel incontinence or symptoms, sexual dysfunction), explicitly asking can uncover treatable issues. 

2. Add pelvic floor physical therapy early in treatment for FM patients reporting pelvic pain, dyspareunia, urinary and bowel dysfunction. The modality may need to be adjusted for FM (more gentle treatments, gradual changes in exercise, pain pacing, careful of triggering flares). 

3. Integrate PFPT with broader FM management, including: 

1. Pain medicine (analgesics, medication for neuropathic pain if present), 

2. Sleep therapy, 

3. Psychological treatments (CBT, mindfulness), 

4. Lifestyle (exercise, nutrition, stress management). 

4. Set realistic expectations for progress. Because FM involves central pain modulation, change may be slower; therapy may need more sessions; pain flare ups may occur. 

5. Tailor PFPT with a focus on relaxation and muscle release and adjust therapy for bladder training, bowel regularity, and sexual comfort. 

6. Monitor outcomes: Use patient‐reported outcomes (pain, function, sexual satisfaction, bladder and bowel symptom scores), quality of life, mood and sleep. 

Fibromyalgia frequently coexists with pelvic pain, urinary and bowel symptoms, and sexual dysfunction. The prevalence is high, and there is a clear association between worse pelvic floor distress symptoms and more severe fibromyalgia disease burden. Pelvic floor dysfunction and hypertonicity are important mediators of these symptoms in many FM patients. 

Pelvic floor physical therapy is an effective treatment for symptoms of pelvic floor hypertonicity, urinary and bowel dysfunction, and sexual pain. The evidence supports incorporating PFPT into a multimodal therapeutic plan. 

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Disclaimer: This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you.