What Causes Lower Back Pain in Females? The Overlooked Role of the Pelvis and Core.
Lower back pain in females can have many overlapping causes, including hormonal changes, pelvic floor dysfunction, pregnancy and postpartum recovery, menstrual cycles, bowel and bladder issues, and certain gynecologic conditions like endometriosis and fibroids. These factors influence how the spine, core, and pelvis work together and can make lower back pain more complex.
Because there is rarely a single cause, a complete evaluation should consider pelvic floor function, core strength, posture, hip mobility, breathing mechanics, and hormonal stage. Pelvic floor physical therapy offers a whole-body approach that addresses these female-specific contributors and can help improve pain, strength, and stability in daily life, exercise, and motherhood.
Female Anatomy Affects the Back and Core
Females are not just “smaller males.” There are important anatomical differences that affect how forces travel through the pelvis, core, and spine.
Wider pelvis and hips
A wider pelvis changes the angle of the thigh bones and how the legs and glutes support the back.SI joint sensitivity
The sacroiliac joints (often called SI joints) connect the pelvis to the spine. They can become irritated more easily during pregnancy or hormonal shifts.Different center of balance
The body’s balance point changes throughout life, especially during pregnancy and postpartum.
Hormones Can Change Pain and Stability
Hormones shift throughout a female’s life. These changes can affect flexibility, joint stability, strength, and how much pain the body feels.
Menstrual Cycle and Period Symptoms
During periods, the uterus contracts. These contractions are caused by chemicals called prostaglandins. They can send pain signals to the lower back, hips, or pelvic area. This pain may be dull, crampy, or sharp and often follows a monthly pattern.
Pregnancy
During pregnancy, hormones such as relaxin make ligaments looser so the body can prepare for birth. At the same time, the growing belly changes posture, rib position, and breathing patterns. This can lead to:
lower back pain
hip pain
SI joint pain
pelvic pain
core weakness or instability
Postpartum and Breastfeeding
After birth, hormone levels shift again and may stay different for months, especially while breastfeeding. Postpartum back pain can come from:
diastasis recti (ab separation)
C-section scars
pelvic floor dysfunction
feeding or holding posture
decreased core strength
Many people are surprised that back pain can continue long after birth. It often improves with proper rehab.
Perimenopause and Menopause
During perimenopause and menopause, estrogen levels drop. Estrogen helps support bone, discs, and connective tissues. Lower levels may lead to:
joint stiffness
disc discomfort
reduced bone density
pelvic floor changes
These shifts can make back pain more noticeable or new.
Pelvic Floor Dysfunction Is Often Missed
The pelvic floor is a group of muscles at the base of the pelvis. It works with the abdominal muscles, diaphragm, and deep spinal muscles to stabilize the body. Together, these structures form the core.
Back pain can happen when the pelvic floor is:
too tight
too weak
uncoordinated
recovering from childbirth or surgery
restricted by scars
A tight pelvic floor can send pain into the lower back, tailbone, hips, or pelvis. A weaker pelvic floor may cause instability and force the back to compensate.
Females experience pelvic floor changes more often due to pregnancy, childbirth, periods, and hormonal shifts. Many evaluations skip this part completely.
Gynecologic Conditions Can Cause or Refer Pain
Some reproductive health conditions can create or refer pain into the back.
Endometriosis
Endometriosis is when tissue similar to the lining of the uterus grows outside of the uterus. It often causes:
painful periods
deep pelvic pain
pain with bowel movements
pain with sex
lower back or hip pain
Pain may follow a monthly pattern.
Fibroids
Fibroids are noncancerous growths in the uterus. They can create:
heaviness
cramping
pressure
lower back discomfort
Pelvic Inflammatory Disease (PID)
PID is an infection that affects the reproductive organs. It may cause pelvic pain, fever, and lower back pain.
These conditions show why back pain is not always “just muscular.”
Bowel and Bladder Issues Can Also Impact the Back
The bowel, bladder, and pelvic floor share nerves and muscles. Because of this, bowel or bladder problems can contribute to lower back pain.
Common examples include:
constipation
straining during bowel movements
urinary urgency or frequency
bladder irritation
Straining increases abdominal pressure, which can stress the pelvic floor and the spine.
Orthopedic and Postural Causes Still Matter
More familiar orthopedic causes also play a role, including:
muscle strains
disc irritation
arthritis
scoliosis
weak glutes or hips
sitting for long periods
lifting or exercising without core support
Motherhood adds unique challenges such as carrying babies, car seats, strollers, and diaper bags. These tasks often happen while tired or breastfeeding.
When Lower Back Pain Needs Medical Attention
Seek medical care if pain is paired with:
fever
unexplained weight loss
numbness or tingling
night pain that does not change with position
sudden changes in bowel or bladder control
numbness in the inner thighs or groin
How to Treat Lower Back Pain in Females
Because lower back pain in females has many possible causes, a good evaluation should look beyond basic spine movements. An effective evaluation often includes:
pelvic floor function
abdominal strength
breathing patterns
hip strength
hip mobility
posture
hormone stage
bowel and bladder habits
surgical history and scar tissue
Generic stretches or “just strengthen your core” rarely solve complex pain patterns.
How Pelvic Floor Physical Therapy Helps
Pelvic floor physical therapists are trained to assess both the back and the pelvic floor. Treatment may address:
core strength
pelvic floor tension or weakness
hip strength and mobility
breathing patterns
scar tissue
SI joint alignment
rib cage position
This whole-body approach helps many females who have not improved with standard orthopedic PT alone.
When to Seek Help
Reach out if you notice:
pain lasting more than two weeks
pain linked to your menstrual cycle
pain with sex, peeing, or pooping
heaviness in the pelvis
leaking urine or gas
postpartum pain that does not improve
difficulty returning to exercise
Pain is common, but living with it long-term is not normal.
Final Takeaways on Lower Back Pain in Females
Lower back pain in females is common, but it is rarely caused by one single factor. Hormones, pelvic floor function, pregnancy and postpartum changes, gynecologic conditions, bowel and bladder patterns, and orthopedic factors can overlap. This is why many females do not get relief from a simple stretch routine or a generic core program. Their pain deserves a complete evaluation that understands the female body.
When the pelvic floor, core, hips, and spine work well together, most people feel stronger, more stable, and more confident moving through daily life, exercise, work, and motherhood without pain holding them back.
We’re Here to Help
If you are experiencing lower back pain and want answers, support, and a plan, you do not have to navigate it alone. We are here to help.
Envision Pelvic Health & Wellness is located in the Norwood Park neighborhood of Chicago, close to Park Ridge, with convenient access and free parking.
At Envision Pelvic Health & Wellness, we specialize in treating lower back pain through a female-focused lens, taking into account hormones, pregnancy, postpartum, pelvic floor function, and your individual goals.
Book a discovery call or submit a contact form today.
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