Fibroids and Endometriosis Pain When Sitting: Why It Happens and What Helps

September 13, 2025

Fibroids and Endometriosis Pain When Sitting: Why It Happens and What Helps

If pelvic pain spikes the moment you sit down, you are not imagining it. For many people with uterine fibroids or endometriosis, the mechanics of sitting can intensify pressure, inflammation, and muscle tension in the pelvis. Understanding why this happens can help you choose practical changes and evidence-based treatments that make daily life—work, commuting, meals—more comfortable.

Why sitting can make fibroid or endometriosis pain worse

1) Direct pressure and “mass effect”

Uterine fibroids are benign growths that can enlarge or distort the uterus. Depending on their size and location, fibroids can press on the bladder, rectum, or pelvic nerves. When you sit, the pelvis flexes and the uterus can shift backward, increasing contact with the rectum and pelvic floor, which may worsen aching, rectal pressure, or tailbone pain. The National Institutes of Health notes that fibroids can cause pelvic pressure, urinary frequency, constipation, and back pain—symptoms often aggravated by prolonged sitting (NICHD).

2) Inflammation, adhesions, and tension

Endometriosis involves endometrial-like tissue growing outside the uterus, leading to inflammation, scarring, and adhesions that can tether pelvic organs together. Sitting can stretch or compress these sensitive areas, triggering cramping or sharp pain. The NIH highlights that endometriosis can cause chronic pelvic pain, pain with bowel movements, and pain during sex, often worse around menstruation (NICHD).

3) Pelvic floor muscle guarding

When pain persists, the pelvic floor muscles may tighten reflexively to protect the area—sometimes called “guarding.” A seated posture keeps these muscles under load, especially on firm surfaces, which can perpetuate a pain–tension cycle. Pelvic floor dysfunction can contribute to rectal, vaginal, or tailbone pain and a sensation of pressure.

4) Nerve irritation and referred pain

Both fibroids and endometriosis can irritate nearby nerves. Pressure on the sacral plexus, pudendal nerve, or sciatic nerve can cause pain that radiates to the low back, hips, buttocks, or legs. Sitting places weight on the ischial tuberosities (“sit bones”) and can compress soft tissues around these nerves, amplifying symptoms.

Fibroids vs. endometriosis: Clues in your symptom pattern

Fibroids: Heavy or prolonged periods, pelvic pressure or fullness, frequent urination, constipation, back pain, or anemia. Many people notice bulk-related symptoms that worsen with positions that compress the pelvis. Learn more from NICHD and ACOG.
Endometriosis: Pelvic pain often cyclical or worsening around periods, pain with bowel movements or urination (especially during menses), pain during sex, spotting, and sometimes infertility. See NICHD and ACOG.
Overlap is common: Some people have both conditions. A thorough evaluation helps tailor treatment.

What helps right now: Practical adjustments for sitting

Change positions often: Set a timer to stand, stretch, or walk for 2–3 minutes every 30–45 minutes. A sit–stand desk can reduce continuous pelvic pressure.
Open your hip angle: Keep hips slightly higher than knees to avoid deep flexion. Try a seat wedge or adjustable chair; ensure feet are supported.
Cushion smartly: A well-padded chair, coccyx cutout cushion, or gel cushion can reduce pressure on the tailbone and perineum. Avoid very firm or very soft surfaces that increase strain.
Support the low back: Use lumbar support to maintain a gentle curve, which can reduce pelvic floor load and referred pain to the back or hips.
Heat therapy: A heating pad or warm pack to the lower abdomen or low back can relax muscles and ease cramping. Use a protective layer and follow device instructions.
Gentle movement: Micro-movements—pelvic tilts, ankle pumps, glute squeezes—keep blood flowing. Between sitting bouts, try hip flexor and piriformis stretches or a short walk.
Bowel and bladder care: Fibroids and endometriosis can make constipation more uncomfortable. Aim for fiber, hydration, and regular toileting habits; discuss stool softeners if needed.
Over-the-counter pain relief: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen can help period-related pain; use the lowest effective dose and follow label directions. Ask your clinician if you have kidney disease, ulcers, are pregnant, or take blood thinners.

Evidence-based medical options to discuss with your clinician

For uterine fibroids

Hormonal options: Combined oral contraceptives or progestin-only methods (including the levonorgestrel intrauterine device) may reduce bleeding and cramping (ACOG). The FDA has also approved relugolix/estradiol/norethindrone acetate (brand: Myfembree) to manage heavy menstrual bleeding associated with fibroids and to treat moderate-to-severe endometriosis pain; it works by suppressing ovarian hormones while adding “add-back” therapy to protect bone (FDA).
Tranexamic acid: A non-hormonal option for heavy menstrual bleeding taken only during menses (MedlinePlus).
GnRH agonists: Short-term use (e.g., leuprolide) can shrink fibroids and reduce bleeding, often before surgery (ACOG).
Procedures: Uterine artery embolization (UAE) reduces blood flow to fibroids; MRI-guided focused ultrasound is a noninvasive option for select cases; surgery includes myomectomy (fibroid removal) or hysterectomy (uterus removal). See ACOG and MedlinePlus on UAE.

For endometriosis

Hormonal suppression: Combined oral contraceptives, progestins, or the levonorgestrel IUD can reduce pain (ACOG). FDA-approved elagolix (Orilissa) and relugolix/estradiol/norethindrone acetate (Myfembree) treat moderate-to-severe pain by suppressing ovarian hormones; clinicians monitor for side effects like bone mineral density loss (FDA).
NSAIDs: Can help period-related pain; effectiveness varies.
Surgery: Laparoscopic excision or ablation of endometriosis and lysis of adhesions can relieve pain and improve function for some patients (ACOG).

Because fibroids and endometriosis can coexist, treatment often blends approaches—managing bleeding and bulk symptoms while suppressing inflammation and pain.

When to seek medical care

Severe or sudden pelvic pain, fever, or vomiting
Heavy bleeding soaking a pad or tampon every hour for several hours, passing large clots, or symptoms of anemia (fatigue, dizziness, shortness of breath)
Urinary retention or new bowel changes that do not improve
Numbness, weakness, or pain radiating down the leg that is progressive
Pain that interferes with sleep, work, or daily life despite self-care

A simple, day-to-day sitting plan

Alternate sitting and standing; move at least every 30–45 minutes.
Use a supportive chair with a cushion and lumbar roll; keep hips slightly higher than knees.
Apply heat to the lower abdomen or back during flares.
Practice 2–3 gentle stretches (hip flexor, hamstring, piriformis) between meetings.
Prioritize regular bowel habits and hydration to reduce pelvic strain.
Ask your clinician for a referral to pelvic floor physical therapy; targeted relaxation and biofeedback can reduce pain related to muscle guarding.

Bottom line

Sitting concentrates pressure and tension in the pelvis, which can aggravate pain from fibroids and endometriosis. Small ergonomic changes, scheduled movement, bowel care, and heat can provide immediate relief. For longer-term control, talk with your clinician about hormonal options, non-hormonal treatments like tranexamic acid for heavy bleeding, pelvic floor physical therapy, and procedures when appropriate. An individualized plan, guided by a thorough evaluation, offers the best chance to work, commute, and rest with less pain.