Chronic pelvic pain often involves multiple intersecting systems - gynecologic, urologic, gastrointestinal, musculoskeletal, and neurological. An increasing body of research suggests diet may be an important, modifiable factor in many of these conditions.

Self-reported food sensitivities and dietary patterns are being explored in relation to symptoms like bladder pain, pelvic floor-related pain, vulvar pain, and bowel-related pelvic pain.

What the Research Shows
Recent studies and reviews are beginning to clarify how diet and food sensitivities relate to chronic pelvic pain. An umbrella review in 202 by Neri et al 5 found that a higher intake of vegetables and dairy products might reduce the risk and symptom severity of endometriosis.

Research on chronic primary pelvic pain syndromes (CPPPS), which includes interstitial cystitis/bladder pain syndrome (IC/BPS) and vulvodynia among others, emphasizes the multifactorial nature of these syndromes and suggests that diet may play a role, but the data are still inconclusive in many areas.

For IC/BPS, there are surveys and qualitative studies in which many patients report that certain foods or beverages (such as caffeine, acidic foods, alcohol, spicy foods) act as triggers. However, rigorous intervention trials (e.g., randomized controlled dietary interventions) are limited. The American Urological Association’s 2022 Guidelines do acknowledge dietary triggers in patient reports but do not prescribe specific elimination diets due to limited high-quality evidence.

In endometriosis, the umbrella review and some cohort studies suggest anti-inflammatory dietary patterns, increased fruit and vegetable intake, and possibly dairy consumption may correlate with lower pain or symptom burden. Yet the causal evidence (especially from randomized trials) remains sparse.

Regarding vulvodynia and vulvar pain, the research and literature is less developed. There are observational reports and case series that suggest some patients may benefit from dietary modifications, but strong clinical trials are nearly absent. Proteomics and biomarker studies in vulvar pain disorders are uncovering potential mechanisms, but do not yet conclusively link specific dietary interventions to symptom improvement.

Overlap with gastrointestinal disorders like IBS is well-documented among pelvic pain populations. When GI symptoms are prominent, interventions such as low-FODMAP diets have been shown in some studies (mostly observational or small trials) to reduce GI symptoms, which in turn may reduce pelvic floor complaints or pelvic pain by reducing visceral hypersensitivity or bowel dysfunction. However, even in this area, high-powered randomized controlled trials with pelvic pain outcomes as primary endpoints are limited.

From what is currently known, patient-reported dietary triggers are common across pelvic pain conditions, and many individuals report subjective improvement with dietary adjustments. The existing studies lend support to low-risk modifications, like avoiding known bladder irritants and adjusting diet when GI symptoms coexist. However, limitations include a lack of large randomized controlled trials with robust design comparing specific diets head-to-head for pelvic pain and heterogeneity in how pelvic pain conditions are defined & diagnosed. Some studies mix patients with different etiologies (bladder, bowel, muscular, nerve). Other issues are that comorbid conditions (IBS, fibromyalgia, psychological stress) are frequent and often not controlled for, and mechanistic data (microbiome changes, immune signaling, visceral cross-sensitization) are promising but mostly preliminary.

Mechanisms by Which Diet May Be Relevant
Several plausible biological and physiological pathways support the link between diet and chronic pelvic pain. Certain foods or substances may act as direct irritants to sensitive tissues like the bladder mucosa or vulvar skin/mucosa, which can cause burning, urgency, or pain flares.

Diet can influence the gut microbiota and the substances they produce, such as short-chain fatty acids and gases. These byproducts can affect intestinal permeability and alter systemic inflammatory or immune signaling, which in turn may modulate pain perception and contribute to sensitization. In some patients, non-IgE–mediated food intolerances or delayed hypersensitivity reactions to fermentable carbohydrates, additives, or specific food components may further drive these processes.

In addition, Viscerosomatic crosstalk provides another lens to understand diet’s impact on the pelvic floor. Dysfunction in organs such as the gut or bladder can send altered sensory signals to the nervous system, which in turn influences pelvic floor muscle tone, coordination, and reflex activity. This interplay means that gastrointestinal irritation from certain foods may not only trigger digestive discomfort but can also lead to changes in pelvic floor function. Over time, these altered neuromuscular responses may amplify pain through musculoskeletal pathways, creating a feedback loop that perpetuates both visceral and pelvic floor symptoms.

Practical Clinical Approach
Dietary sensitivity likely plays a role for many individuals with chronic pelvic pain, but the pattern is highly individual. As pelvic rehab providers, pelvic rehabilitation practitioners can support patients by validating concerns, initiating low-risk dietary trials, monitoring outcomes, and collaborating with dietitians for those cases that are more complex. When combined with pelvic floor rehabilitation and multimodal care, dietary approaches offer a promising route toward reducing pain and improving quality of life.

Given the current evidence, practitioners can use a patient-centered, low-risk approach to exploring diet’s role in pelvic pain.

1. Screen systematically. Collect detailed histories: what foods seem to trigger symptoms, timing (after meals, specific foods), associated GI symptoms, and any prior dietary experiments. Use food diaries or symptom trackers.
2. Identify red flags. Be alert for signs of serious pathology (e.g., GI bleeding, weight loss, malabsorption, celiac disease, severe allergies) and refer appropriately for medical evaluation or nutritional consultation.
3. Begin with simple diet trials. For example, remove or reduce common irritants (caffeine, alcohol, acidic or spicy foods), track symptoms over 2-6 weeks. If GI symptoms are present, consider a trial of low-FODMAP style elimination (with reintroduction phases) under dietitian supervision.
4. Elimination/rechallenge when indicated. If a patient reports a specific suspect (gluten, dairy, additive), a structured elimination followed by reintroduction can help confirm or rule out the trigger while minimizing unnecessary dietary restriction.
5. Promote anti-inflammatory whole-diet patterns. Emphasize vegetables, fruits, fiber (if tolerated), lean proteins, healthy fats, and minimally processed foods. Dietary patterns rather than single nutrients may be more achievable and sustainable.
6. Integrate other contributors. Diet doesn’t act in isolation. Combine dietary strategies with pelvic floor therapy, behavioral/pain education, sleep hygiene, psychological supports, and addressing comorbid conditions like IBS or mood disorders.

Exploring diet in the context of pelvic pain is not about chasing a single “trigger food,” but about understanding patterns, empowering patients, and integrating nutrition into a whole-person approach. By combining careful screening, individualized trials, and collaboration with nutrition professionals, pelvic rehab practitioners can help patients discover meaningful connections between food and symptoms—ultimately enhancing both symptom control and quality of life.

Learn More in Our Upcoming Course
If you'd like to deepen your understanding of nutrition’s role in pelvic pain and gain clinically actionable strategies, then register for Nutrition Perspectives for the Pelvic Rehab Therapist on either October 11–12, 2025, or December 5-6, 2025. This course is instructed by Megan Pribyl, PT, CMPT, CMTPT/DN, PCES, and covers the latest research, digestion basics, nutritional interventions for bowel/bladder dysfunction, pain, and healing, and includes immersive labs to help you apply what you learn in real clinical settings.

Additional dates in 2026 are available on the website.

References:

1. Neri LCL, Quintiero F, Fiorini S, Guglielmetti M, Ferraro OE, Tagliabue A, Gardella B, Ferraris C. Diet and Endometriosis: An Umbrella Review. 2025 Jun 13;14(12):2087. doi: 10.3390/foods14122087. PMID: 40565701; PMCID: PMC12192176
2. Pinto L, Soutinho M, Coutinho Fernandes M, et al. (December 01, 2024) Chronic Primary Pelvic Pain Syndromes in Women: A Comprehensive Review. Cureus 16(12): e74918. doi:10.7759/cureus.74918
3. Varney, J. E., So, D., Gibson, P. R., Rhys-Jones, D., Lee, Y. S. J., Fisher, J., Moore, J. S., Ratner, R., Morrison, M., & Burgell, R. E. (2025). Effect of a 28-day low FODMAP diet on gastrointestinal symptoms associated with endometriosis (EndoFOD): A randomised, controlled crossover feeding study. Alimentary Pharmacology & Therapeutics, 61(12), 1889-1903. https://doi.org/10.1111/apt.70161
4. Fehring, R. J., Schneider, M., Raviele, K. M., & Isaa, M. (2025). Dietary interventions in endometriosis: prospective study comparing low FODMAP diet and an “endometriosis diet.” [Details from the study]. Journal name, volume(issue), pages. (Note: This is “The effect of dietary interventions on pain and quality of life in women diagnosed with endometriosis: a prospective study with control group.”)
5. Jankovich, E., & Watkins, S. (2017). The low FODMAP diet reduced symptoms in a patient with endometriosis and IBS. South African Journal of Clinical Nutrition, 30(4), 32-36.
6. Drummond J, Ford D, Daniel S, Meyerink T. Vulvodynia and Irritable Bowel Syndrome Treated With an Elimination Diet: A Case Report. Integr Med (Encinitas). 2016 Aug;15(4):42-7. PMID: 27574494; PMCID: PMC4991650.

Blog by Deanna Vaughn, PT, DPT who practices at Core and Pelvic Physical Therapy Clinic in Conway, Arkansas, this article was originally located at https://whatsupdownthere.info/colorectal-cancer-the-gut-and-the-butt/.

Colorectal cancer refers to cancerous cells within the colon or rectum. Need a quick anatomy review? Keep reading then!

The colon is another name for the large intestine, which is the long tube (nearly 5 FEET!) surrounding the small intestines (that snaky, jumbled tube in the middle of our bodies, which you can see below in the picture). It’s comprised of segments: the cecum (the little pouch that joins the small intestine to the large intestine) in the right lower abdomen, the ascending colon starting at the right lower part of your abdomen (coming off the cecum), and up to about the right side of your ribcage; the transverse colon that loops underneath the stomach and ribcage from right to left; the descending colon that extends down from the left side of your ribcage to the lower part of your left abdomen; and then the sigmoid colon that loops (in an s-shape) along the lower abdomen to the center of the body. At the end of the colon is the rectum, which pretty much connects the colon to the actual anus/anal opening for wastes to leave the body.

That being said, colorectal cancer can affect any part or segment of the colon and the rectum. If you have a family history of colorectal cancer, or if you have an inflammatory bowel disease (like Crohn’s disease or ulcerative colitis), then you may be at a higher risk for colorectal cancer. Other risk factors are the same for virtually any other health condition – genetics, no regular physical activity, poor diet, tobacco use, high alcohol consumption, etc.

So how would we know if it’s colorectal cancer – or precancerous cells, and how do we decrease our risk?

That’s where screening comes into play! Just like how someone may see their gynecologist annually and undergo the PAP smear every 1-3 years to check for any gynecological cancer (like cervical or labial cancer), someone may see their colorectal or gastrointestinal (GI) provider to check for colorectal cancer or disorders. Regular screening takes place around age 45 (although a person may be screened earlier if they are at higher risk or had a previous history of cancer).

What does screening look like?

There are a few tests that screen for colorectal cancer. These tests include stool tests, flexible sigmoidoscopy, and colonoscopy.

Stool tests – This pretty much involves you taking a sample of your stool via test kit provided to you, and returning it to your doctor/lab, where your stool is checked for any blood or other abnormal findings.

Flexible sigmoidoscopy – A thin, short tube with a light is inserted into the rectum. This allows your doctor to see any polyps or cancer within the rectum and lower part of the colon.

Colonoscopy – This is like the sigmoidoscopy, but with a longer tube. The longer tube allows your doctor to check for polyps/cancer inside the rectum and the entire length of the colon. Your doctor can also remove some polyps during this procedure if indicated.

Most people without any symptoms, abnormal findings or outstanding personal or family history of colorectal cancer will have these screening tests performed anywhere from 5-10 years.

What are the symptoms? 

This is not an exhaustive list, but some symptoms may include:

• Bleeding, pain, and/or discomfort within the rectum/anus
• Blood in stool
• Abdominal pain and bloating
• Nausea/vomiting
• Difficulty or incomplete bowel evacuation
• Hemorrhoids
• Altered bowel habits (such as sudden constipation, diarrhea, change in stool consistency)

Now what are our treatment options?

Besides preventative measures – such as getting regular physical activity, improving our diet, etc., treatment looks similar to any other cancer treatment. This may look like chemotherapy, radiation therapy, immunotherapy, and/or surgery. Surgery may be indicated to remove polyps/tumors, or parts of the colon or rectum to eliminate cancerous growths. Thankfully though, regular screening of the colorectal region can find precancerous/cancerous cells early. Oftentimes, such as during a colonoscopy, your colorectal provider may go ahead and remove polyps that are abnormal or deemed precancerous at that time!

Now what about pelvic physical therapy? Can it possibly help?

Well, this is another condition (like Pelvic Congestion Syndrome in the previous blog post), where pelvic physical therapy is not the initial go-to or main treatment option. Individuals with colorectal cancer vary in several ways depending on staging/severity and overall health. Once again, pelvic therapy is a nice resource to utilize if you’re needing or wanting ways to manage your bowel symptoms.

Ways that pelvic PT CAN help may include: Teaching appropriate toileting – positioning to straighten out the anorectal angle and allow stool to pass more easily from the rectum; mechanics, such as exhaling smoothly when pushing for a bowel movement to prevent straining; Improving pelvic floor muscle function (strength, endurance, coordination) so that your body can delay defecation as needed and calm down bowel urges; and overall promoting health bowel habits by supporting your nutrition and keeping bowel movements regular.

Whether or not you (or someone you know) have colorectal cancer, developing healthy and safe bowel habits is key to a better quality of life. Working with your doctor and/or your team of providers is important in making sure your needs are addressed, but feel free to reach out to your local pelvic PT if you want more resources or guidance – even things like, “So, how SHOULD I be pooping??”

References & Resources

Brenner H, Chen C. The colorectal cancer epidemic: challenges and opportunities for primary, secondary and tertiary prevention. Br J Cancer. 2018;119(7):785-792. doi:10.1038/s41416-018-0264-x

https://www.cancer.org/cancer/colon-rectal-cancer.html

https://my.clevelandclinic.org/health/diseases/14501-colorectal-colon-cancer

Kuipers EJ, Grady WM, Lieberman D, et al. Colorectal cancer. Nat Rev Dis Primers. 2015;1:15065. Published 2015 Nov 5. doi:10.1038/nrdp.2015.65

Leslie A, Steele RJC. Management of colorectal cancerPostgraduate Medical Journal 2002;78:473-478. http://dx.doi.org/10.1136/pmj.78.922.473

Mármol I, Sánchez-de-Diego C, Pradilla Dieste A, Cerrada E, Rodriguez Yoldi MJ. Colorectal Carcinoma: A General Overview and Future Perspectives in Colorectal Cancer. Int J Mol Sci. 2017;18(1):197. Published 2017 Jan 19. doi:10.3390/ijms18010197

You YN, Lee LD, Deschner BW, Shibata D. Colorectal Cancer in the Adolescent and Young Adult Population. JCO Oncol Pract. 2020;16(1):19-27. doi:10.1200/JOP.19.00153