When Hip Tightness Creates Bladder Symptoms: The Surprising Role of the Obturator Internus

Most of us never think about the tiny muscles hidden deep inside our hips and pelvis. But sometimes, one of these muscles can cause surprising problems. One of the most important of these deep muscles is called the obturator internus. Even though most people have never heard of it, this muscle can create both hip pain and bladder symptoms when it becomes tight, irritated, or injured. 

The obturator internus is a deep muscle located on the inside of your pelvis. It sits behind your hip joint and helps you turn your leg outward, like when you step out to the side or cross one ankle over the other. Because this muscle is deep and surrounded by bones, nerves, and other muscles, most people never realize how important it is—until it becomes irritated. 

Even though you can’t feel it from the outside, the obturator internus plays a big role in: 

• Stabilizing the hip 

• Helping you walk, twist, and balance 

• Supporting the pelvic floor muscles 

• Protecting important nerves that run through the pelvis 

The obturator internus is one of the main external rotators of the hip. This means it helps turn the hip outward. When this muscle becomes strained, inflamed, or tight, it can cause pain in several places, such as: 

• Deep in the buttock 

• Along the outside of the hip 

• Near the tailbone 

• Down the back of the leg (sometimes feeling like sciatica) 

Doctors sometimes call this deep gluteal pain. Because the obturator internus sits so close to other hip muscles, problems with it can mimic other hip issues. People may think they have a hamstring injury, piriformis syndrome, or even lower-back pain, when the real issue is actually this deep muscle. 

Research and case reports show that irritation of the obturator internus can happen from things like: 

• Sports injuries 

• Overuse 

• Prolonged sitting 

• Falling on the hip 

• Infection or, rarely, a hematoma (a collection of blood in the muscle) 

When this muscle gets irritated, it can press on nerves nearby or limit hip movement, which leads to pain. 

This is the part that surprises many people: a hip muscle can actually affect the bladder. 

The obturator internus sits right next to the pelvic floor muscles, including a group of muscles called the levator ani. These muscles help support the bladder, bowels, and reproductive organs. 

Here’s the important part: 

 The obturator internus and the pelvic floor share a special tissue covering called the obturator fascia. This means the two areas are connected like a team. When one area becomes tight, weak, or irritated, it can affect the other. 

Because of these connections, problems in the obturator internus can cause: 

• Bladder urgency 

• Bladder frequency 

• A feeling of pressure 

• Trouble holding in urine 

• Pelvic floor tension or weakness 

Another reason bladder symptoms can happen is that an important nerve called the pudendal nerve travels very close to the obturator internus. This nerve helps control the bladder and pelvic floor. If the muscle becomes tight or swollen, it can irritate the pudendal nerve, causing bladder problems or pelvic pain. 

Pelvic floor physical therapy (PFPT) is a special type of physical therapy that focuses on the muscles of the pelvis, hips, and lower abdomen. It is considered a first-line treatment for many bladder and pelvic floor problems because it is safe, effective, and does not require surgery or medication. 

A pelvic floor physical therapist is trained to find tightness or trigger points in deep muscles like the obturator internus. Treatment may include: 

• Manual therapy:  Gentle pressure or stretching to relax tight muscles 

• Trigger point release:  Targeting painful “knots” inside the muscle 

• Myofascial release: Improving the way connective tissue moves between muscles 

• Hip and pelvic exercises: Strengthening muscles that support your hips and bladder 

• Relaxation and breathing training:  Helping the pelvic floor relax so it can work normally again 

Because the obturator internus connects to the pelvic floor, improving this muscle often improves bladder symptoms too. Studies show that PFPT can help people who struggle with: 

• Urgency (“I need to pee right now!”) 

• Frequency (going to the bathroom too often) 

• Stress incontinence (leaking with coughing or laughing) 

• Pelvic pain related to muscle tension 

If the obturator internus is tight, the pelvic floor must work harder to keep things stable. This can make the pelvic floor tired, tense, or uncoordinated—which leads to bladder problems. PFPT retrains these muscles so they work better together. 

A visit with a pelvic floor physical therapist may include: 

1. A gentle physical exam:  The therapist checks how your hips, abdomen, and pelvic floor move. 

2. Education:  You learn how your muscles work and what may be causing your symptoms. 

3. Hands-on treatment:  The therapist gently treats tight or painful muscle areas, including the obturator internus. 

4. Exercises to do at home:  These may include stretching, strengthening, posture work, and breathing exercises. 

Most people begin noticing improvements within a few weeks. Because the pelvic floor and hip muscles are closely connected, treating both areas often brings better results. 

While strengthening is important, research shows that strengthening the hip muscles alone does not always fix bladder problems. Many people need a mix of: 

• Relaxation 

• Mobility work 

• Gentle strengthening 

• Better coordination of the hip and pelvic floor muscles 

This is why a customized plan from a pelvic floor therapist works better than general exercises you might find online. 

The obturator internus is a small but powerful muscle with big responsibilities. Because it is connected to the pelvic floor and close to important nerves, problems with this muscle can lead to both hip pain and bladder symptoms. 

The good news is that pelvic floor physical therapy offers a safe, effective, and research-supported way to treat these problems. By improving the health of both the hip muscles and the pelvic floor, PFPT can reduce pain, improve bladder control, and restore comfortable movement. 

If you have deep hip pain, bladder symptoms, or pelvic discomfort, the obturator internus might be playing a role—and a trained pelvic floor physical therapist can help you find relief. 

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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.