Pelvic floor dysfunction can contribute to pelvic pain, constipation, urinary symptoms, sexual pain, hip pain, low back pain, SI joint pain, and tailbone-region pain.
Learn how Dr. Ahmed explains pelvic floor dysfunction, how it can contribute to chronic pelvic pain, and personalized treatment options to help improve function and quality of life.
Our team organizes conditions and treatments into related zones of expertise to make it easier to explore the care paths most relevant to your symptoms and goals.
Use the zone tags above to browse dedicated pages for each focus area, including services, providers, and what to expect during treatment.
Pelvic floor dysfunction is a condition that involves the muscles, nerves, and connective tissues that support the bladder, uterus, and bowel.
When this system isn’t working properly, it can lead to a wide range of symptoms, including pelvic pain, urinary issues, bowel changes, and pain with intimacy.
One of the most important things to understand is that the pelvic floor doesn’t just become “weak.” In many cases, the muscles can actually become overactive, tight, or uncoordinated, especially after injury, surgery, or long periods of pain.
Over time, this can also involve nerve sensitivity and even affect nearby areas like the hips, lower back, or abdomen.
Because of this, pelvic floor dysfunction is often more complex than it first appears.
At Manhattan Pain Medicine, we take a diagnosis-first approach. We start by really understanding your symptoms and mapping out where the pain is coming from.
From there, we look at how the pelvic floor, the nervous system, and surrounding areas are all contributing.
Treatment is usually a combination of approaches. This may include pelvic floor physical therapy, targeted treatments for muscle or nerve pain, and coordination with gynecology or urology when needed.
The goal is to create a plan that helps your body relax, function better, and reduce pain over time.
If you’ve been experiencing pelvic pain or symptoms that haven’t been fully explained, it may be helpful to look at whether the pelvic floor is playing a role.
Pelvic floor dysfunction occurs when the muscles of the pelvic floor do not relax, contract, coordinate, or support the pelvis normally. For some patients, the pelvic floor becomes overactive or hypertonic, creating muscle tightness, spasms, trigger points, pelvic pressure, burning, deep aching, bowel symptoms, bladder symptoms, sexual pain, hip pain, low back pain, sacroiliac joint pain, or tailbone-region pain.
Pelvic floor dysfunction can be primary, but it may also develop in response to endometriosis, fibroids, constipation, pelvic surgery, childbirth, injury, trauma, hip impingement, sacroiliac joint dysfunction, anterior pelvic tilt, pudendal neuralgia, sciatica-like pain, hypermobility, EDS, vascular compression syndromes, or chronic pain sensitization.
At Manhattan Pain Medicine (MPM), evaluation begins by identifying whether symptoms are driven by pelvic floor muscle overactivity, trigger points, nerve irritation, joint or spine mechanics, endometriosis, fibroids, bowel or bladder contributors, hypermobility, or overlapping chronic pain mechanisms.
For patients looking for pelvic floor dysfunction treatment in Manhattan or NYC, MPM provides a diagnosis-first evaluation of pelvic, rectal, vaginal, testicular, bladder, bowel, hip, low back, SI joint, and tailbone-region pain patterns.
MPM reviews the pain location, bowel and bladder symptoms, sexual pain, sitting tolerance, pelvic pressure, muscle spasm, prior pelvic floor therapy, endometriosis history, fibroid history, hip or SI joint symptoms, spine findings, nerve-type pain, hypermobility, EDS, vascular compression concerns, prior imaging, prior procedures, and response to treatment. Care may involve pelvic floor therapy coordination, medication management, biofeedback, pain psychology, acupuncture, Feldenkrais, diagnostic ultrasound when appropriate, ultrasound-guided injections, pelvic floor trigger point injections, pudendal nerve blocks, ganglion impar block, superior hypogastric plexus block, sympathetic blocks, neuromodulation, or coordination with gynecology, urology, GI, colorectal, vascular, orthopedic, or pelvic floor specialists when needed.
Pelvic floor dysfunction can be difficult to recognize because symptoms may appear in several systems at once. Patients may experience pelvic pain, constipation, painful bowel movements, urinary urgency, bladder pain, painful intercourse, rectal pain, vaginal pain, testicular pain, hip pain, low back pain, SI joint pain, or tailbone pain. Imaging may be normal, and symptoms may be attributed to stress, gynecologic conditions, urologic conditions, bowel problems, spine pain, or hip pain without fully evaluating the pelvic floor.
MPM’s diagnosis-first approach is designed to avoid assuming that every pelvic pain pattern is caused by the pelvic floor alone. The evaluation considers pelvic floor dysfunction, pudendal neuralgia, pelvic dystonia, hip impingement, sacroiliac joint dysfunction, anterior pelvic tilt, endometriosis, fibroids, constipation, May Thurner Syndrome, Nutcracker Syndrome, hypermobility, EDS, sciatica, disc herniations, nerve entrapment, and chronic pain sensitization.
Pelvic floor dysfunction fits within MPM’s Pelvic Pain and Musculoskeletal issues Zones of Expertise because pelvic floor symptoms often overlap with hip mechanics, sacroiliac joint dysfunction, anterior pelvic tilt, low back pain, sciatica-like symptoms, tailbone pain, and pelvic-region nerve irritation.
In selected patients, hypermobility spectrum disorder or Ehlers-Danlos syndrome may contribute to altered pelvic mechanics, joint instability, muscle guarding, pelvic floor overactivity, recurrent strain, or chronic pain sensitivity. MPM evaluates these relationships carefully without assuming that hypermobility is the only cause of pelvic floor dysfunction.
These guys are the best. I've been going here for over 6 years and their familiarity with my Schwannomatosis (most ppl have never even heard of it - its rather rare) and their ability to diagnose my CRPS quickly and accurately and then treat it like I was merely getting a flu shot is just incredible...
Highly recommended for those who need Pain Management. Everyone at Manhattan Pain Medicine is extremely nice and helpful. I have had very good interactions with both Dr. Siefferman and Dr. Louis. All of the staff is very responsive. 5 stars.
The providers at Manhattan Pain Medicine are exceptional. I wish I had found them 30 years ago!
I genuinely can’t say enough good things about the team at Manhattan Pain Medicine. I have MCAS, EDS, and an inflammatory autoimmune disease, and I’ve basically been searching for answers since I was a kid. I had years of unexplained inflammation markers, chronic pain, and allergic reactions despite...
I have a complex medical history and have seen a lot of doctors over the years. Dr. Mikaberidze and Dr. Siefferman each took the time to really listen and understand everything I had been dealing with. I also appreciated how they work together and communicated about my care. I left with a plan that...
Sharing my gratitude for the pleasant experience last week during my visit, the medical team provided great care and also treated my session as a learning experience, I left my session with a wealth of knowledge. A big thank you to the kind, and professional staff who welcomed me to the office as a...
I cannot say enough good things about Manhattan Pain Medicine. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional — knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
Dr Siefferman is the most thorough, patient doctor I have even been to. Currently I travel from miami to nyc to see him because his bed side manner and desire to help is incomparable.
ZocDoc
This practice is wonderful. I have been a patient of Dr. Siefferman’s since 2019 and he’s extremely helpful and kind. He has brought in a Rheumatologist who is also great. They handle very complex pain issues and always try to find new ways to help me.
Dr. Siefferman is an incredible doctor! He is extremely diligent and knowledgeable. It feels like you are his only patient. He invests a lot of time and effort into your injuries and concerns. I did not find these wonderful qualities with other pain specialists before, who were always rushed and som...
ZocDoc
Dr. Siefferman is a doctor who combines the old world bedside manner of doctors from my childhood (60 years ago) with a sta te of the art embrace of modern technology. It is always a pleasure to have an appointment with him...always has options and solutions to my medical issues. He is truly the doc...
ZocDoc
Dr. Siefferman is a genius. He is very informed and listens attentively.
ZocDoc
Dr. Siefferman and his entire team continue to be efficient, dedicated, and driven by precision and a genuine desire to give fantastic care. Will always recommend.
ZocDoc
Doctor Siefferman is fantastic. Have been seeing him for 5 years. Couldn’t recommend more.
ZocDoc
Dr. Siefferman is the ONLY doctor who has ever been able to diagnose my pain and treat it. He is hands down the best
ZocDoc
Pelvic floor dysfunction occurs when the muscles of the pelvic floor do not relax, contract, coordinate, or support the pelvis normally. Some patients have overactive or hypertonic pelvic floor muscles, while others have weakness, poor coordination, or mixed patterns. Symptoms may involve pelvic pain, pressure, constipation, urinary symptoms, sexual pain, hip pain, low back pain, SI joint pain, or tailbone-region pain.
Pelvic floor dysfunction may feel like pelvic pressure, tightness, burning, spasms, deep aching, rectal pain, vaginal pain, testicular pain, tailbone pain, bladder discomfort, painful intercourse, constipation, painful bowel movements, urinary urgency, or pain with sitting. Some patients also feel hip, groin, low back, or SI joint pain.
Yes. Pelvic floor dysfunction can contribute to pelvic pain when the muscles become tight, overactive, irritated, poorly coordinated, or painful. However, pelvic pain can also come from endometriosis, fibroids, pudendal neuralgia, hip impingement, sacroiliac joint dysfunction, constipation, vascular compression syndromes, nerve entrapment, or other causes. Careful evaluation is important.
Yes. Pelvic floor dysfunction can contribute to constipation when the pelvic floor muscles do not relax or coordinate properly during bowel movements. Patients may feel incomplete evacuation, straining, rectal pressure, painful bowel movements, or difficulty passing stool. Evaluation may involve GI, colorectal, pelvic floor therapy, and pain medicine coordination when symptoms are complex.
Pelvic floor dysfunction can contribute to urinary urgency, frequency, bladder pressure, difficulty starting urination, incomplete emptying sensations, or pain associated with urination. These symptoms can also come from urinary tract disease, bladder pain syndromes, infection, gynecologic conditions, nerve irritation, or other medical causes, so evaluation should not assume one source.
Yes. Pelvic floor muscle overactivity, trigger points, guarding, nerve irritation, endometriosis, pelvic surgery, trauma, or chronic pelvic pain can contribute to painful intercourse or sexual pain. These symptoms should be evaluated respectfully and carefully, with attention to muscle, nerve, gynecologic, urologic, psychological, and musculoskeletal contributors.
Yes. The pelvic floor works closely with the hips, low back, sacroiliac joints, tailbone, abdominal wall, and core muscles. Pelvic floor dysfunction can overlap with hip impingement, anterior pelvic tilt, SI joint dysfunction, low back pain, sciatica-like symptoms, tailbone pain, and pelvic mechanics. The goal is to identify which structures are actually contributing to the pain.
Pelvic floor dysfunction involves abnormal pelvic floor muscle function, such as tightness, spasm, trigger points, weakness, or poor coordination. Pudendal neuralgia involves irritation or pain related to the pudendal nerve. The two can overlap because pelvic floor muscle guarding may irritate nerves, and nerve pain may cause protective muscle tightening. Evaluation helps determine whether the main driver is muscular, nerve-related, or mixed.
Yes. Endometriosis and fibroids can coexist with pelvic floor dysfunction. Chronic pelvic pain may lead to pelvic floor guarding, trigger points, painful intercourse, bowel or bladder symptoms, and nerve sensitization. Persistent pain may continue even after gynecologic treatment if pelvic floor, nerve, hip, SI joint, abdominal wall, or central pain contributors remain active.
In selected patients, hypermobility spectrum disorder or Ehlers-Danlos syndrome may contribute to pelvic floor dysfunction through altered pelvic mechanics, joint instability, ligamentous laxity, muscle guarding, SI joint dysfunction, hip symptoms, or chronic pain sensitivity. Hypermobility does not automatically cause pelvic floor dysfunction, but it can make the clinical picture more complex.
Evaluation begins with a detailed review of symptoms, pain location, bowel and bladder patterns, sexual pain, sitting tolerance, pelvic floor therapy history, gynecologic history, hip and SI joint symptoms, spine findings, nerve-type symptoms, prior imaging, prior procedures, and treatment response. MPM also considers overlapping pain generators, including pudendal neuralgia, endometriosis, fibroids, hip impingement, SI joint dysfunction, vascular compression syndromes, hypermobility, and chronic pain mechanisms.
Treatment depends on the pain generator. Options may include pelvic floor physical therapy coordination, medication management, biofeedback, pain psychology, acupuncture, Feldenkrais, trigger point injections, pelvic floor trigger point injections, pudendal nerve blocks, ganglion impar block, superior hypogastric plexus block, sympathetic blocks, diagnostic ultrasound, ultrasound-guided injections, or neuromodulation in selected cases. Treatment should be individualized and coordinated.
Pelvic floor trigger point injections may be considered when the evaluation suggests that focal pelvic floor muscle trigger points are contributing to pain. They are not appropriate for every patient and should be selected based on the exam, diagnosis, anatomy, risk profile, and treatment goals. They may be used alongside pelvic floor therapy or other coordinated care when appropriate.
Biofeedback may help some patients learn how to better coordinate, relax, or retrain pelvic floor muscles. Pain psychology can help patients manage the nervous system response to chronic pain, fear, stress physiology, flare patterns, and functional limitations. These approaches do not mean the pain is psychological. They can be part of a coordinated plan for chronic pelvic pain.
Pelvic floor-like symptoms require urgent evaluation when there is fever, severe or sudden pelvic or abdominal pain, heavy bleeding, pregnancy-related pain, fainting, blood in urine or stool, inability to urinate, new bowel or bladder dysfunction, saddle anesthesia, new leg weakness, unexplained weight loss, severe testicular pain, signs of infection, chest pain, shortness of breath, or rapidly worsening symptoms.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
If pelvic pain, pressure, constipation, urinary symptoms, sexual pain, hip pain, SI joint pain, low back pain, tailbone pain, or sitting-related pain is affecting your life, MPM can help evaluate what may be contributing. Our diagnosis-first approach considers pelvic floor dysfunction, pudendal neuralgia, pelvic dystonia, endometriosis, fibroids, hip impingement, SI joint dysfunction, sciatica, vascular compression syndromes, hypermobility, EDS, and chronic pain mechanisms. Request an appointment to discuss your symptoms and care options.
Jason W. Siefferman, MD
Jason W. Siefferman, MD
MPM
Pelvic floor dysfunction occurs when the muscles that support the pelvis, bladder, bowel, and sexual function do not coordinate normally. Some patients have pelvic floor muscles that are too tight or overactive. Others have weakness, poor coordination, or a mixed pattern. When the pelvic floor cannot relax or function properly, pain and dysfunction can appear across several systems.
Symptoms may include pelvic pain, pelvic pressure, rectal pain, vaginal pain, testicular pain, tailbone pain, bladder discomfort, urinary urgency, constipation, painful bowel movements, painful intercourse, hip pain, low back pain, sacroiliac joint pain, or sciatica-like symptoms. Because these symptoms involve private and overlapping areas of the body, many patients feel dismissed or confused before receiving a clear explanation.
A hypertonic pelvic floor means the pelvic floor muscles are overactive, tight, or unable to relax fully. This can create muscle spasm, trigger points, pressure, deep aching, burning, pain with sitting, pain with sex, or pain with bowel and bladder activity.
Pelvic floor tightness may develop after injury, surgery, childbirth, endometriosis, constipation, trauma, hip pain, SI joint dysfunction, nerve irritation, or chronic pelvic pain. In some cases, the pelvic floor tightens protectively in response to pain elsewhere. Over time, that protective guarding can become a pain generator of its own.
Pelvic floor dysfunction can affect bowel function when the muscles do not relax or coordinate during bowel movements. Patients may experience constipation, straining, incomplete evacuation, rectal pressure, painful bowel movements, or worsening pelvic pain after bowel activity.
Chronic constipation can also make pelvic floor symptoms worse by increasing strain, pressure, and muscle guarding. For this reason, pelvic floor dysfunction and constipation often require coordinated evaluation with GI, colorectal, pelvic floor therapy, and pain medicine when symptoms are persistent or complex.
Pelvic floor dysfunction can contribute to urinary urgency, frequency, bladder pressure, difficulty starting urination, incomplete emptying sensations, or pain related to urination. It can also contribute to painful intercourse, genital pain, rectal pain, testicular pain, or pain after sexual activity.
These symptoms should be evaluated carefully because they may also overlap with urinary tract disease, bladder pain syndromes, gynecologic conditions, prostate or testicular conditions, endometriosis, pudendal neuralgia, pelvic floor trigger points, or nerve sensitization.
The pelvic floor is part of a larger musculoskeletal system that includes the hips, sacroiliac joints, low back, tailbone, abdominal wall, and deep core muscles. When hip mechanics, SI joint dysfunction, anterior pelvic tilt, or low back pain are present, the pelvic floor may become overactive or poorly coordinated.
Some patients have pelvic pain that is actually driven by hip impingement, sacroiliac joint dysfunction, lumbar spine irritation, or sciatica-like symptoms. Others have primary pelvic floor dysfunction that refers pain into the hip, groin, tailbone, low back, or thighs. MPM evaluates these relationships before treatment is selected.
Endometriosis and fibroids can coexist with pelvic floor dysfunction. Chronic gynecologic pain may cause pelvic floor guarding, trigger points, painful intercourse, bowel symptoms, bladder symptoms, or nerve sensitization. Some patients continue to have pain after gynecologic treatment because the pelvic floor, pudendal nerve, abdominal wall, SI joint, hip, or chronic pain mechanisms remain involved.
MPM does not replace gynecology or gynecologic treatment. Instead, MPM evaluates the pain generators that may persist alongside endometriosis, fibroids, pelvic floor dysfunction, or chronic pelvic pain.
Pelvic floor dysfunction can mimic or overlap with several conditions. Pudendal neuralgia may cause burning, electric, rectal, genital, perineal, or sitting-related pain. Sciatica or lumbar nerve irritation may cause low back, buttock, leg, or pelvic-region symptoms. Hip impingement may cause groin pain, hip pain, pelvic pain, or pain with movement.
These conditions can coexist. A patient may have pelvic floor trigger points and pudendal nerve irritation. Another may have hip impingement and pelvic floor guarding. Another may have SI joint dysfunction, sciatica-like pain, and pelvic floor overactivity. MPM’s role is to map the pattern and identify the most likely drivers.
In selected patients, hypermobility spectrum disorder or Ehlers-Danlos syndrome may contribute to pelvic floor dysfunction. Joint laxity, SI joint instability, hip mechanics, anterior pelvic tilt, ligamentous strain, recurrent injury, or connective tissue vulnerability may cause muscles to guard in an attempt to stabilize the pelvis.
This does not mean every pelvic floor dysfunction case is caused by hypermobility. It means that when a patient has hypermobility, EDS, recurrent sprains, pelvic instability, hip pain, SI joint pain, or multi-region pain, the evaluation should consider how pelvic mechanics and connective tissue may be influencing symptoms.
May Thurner Syndrome and Nutcracker Syndrome are vascular compression conditions that may overlap with pelvic pain in selected patients. They are not pelvic floor diagnoses, but they may be part of the broader pelvic pain differential when symptoms include pelvic heaviness, vascular findings, leg swelling, flank pain, blood in urine, pelvic congestion-type symptoms, or other vascular concerns.
MPM does not replace vascular, urology, nephrology, or surgical evaluation for these conditions. However, MPM may help evaluate whether persistent pain is vascular, pelvic floor-related, nerve-related, musculoskeletal, or mixed and coordinate referral when appropriate.
MPM begins with a detailed history and symptom map. This includes pain location, bowel and bladder symptoms, sexual pain, sitting tolerance, pelvic pressure, muscle spasm, prior pelvic floor therapy, prior gynecology, urology, GI, colorectal, orthopedic, or spine evaluation, prior imaging, prior procedures, and treatment response.
The evaluation also considers pelvic floor dysfunction, pelvic dystonia, pudendal neuralgia, hip impingement, SI joint dysfunction, anterior pelvic tilt, constipation, endometriosis, fibroids, vascular compression syndromes, hypermobility, EDS, sciatica, disc herniations, and chronic pain sensitization.
Treatment depends on the diagnosis. Some patients benefit most from pelvic floor physical therapy, biofeedback, medication management, pain psychology, movement retraining, acupuncture, or Feldenkrais. Others may need evaluation of hip, SI joint, spine, nerve, bowel, bladder, gynecologic, or vascular contributors.
Selected patients may be considered for trigger point injections, pelvic floor trigger point injections, pudendal nerve blocks, peripheral nerve blocks, ganglion impar block, superior hypogastric plexus block, sympathetic blocks, diagnostic ultrasound, ultrasound-guided injections, botulinum toxin, nerve hydrodissection, or neuromodulation. These options are not routine for every patient. They depend on the pain generator, anatomy, risks, prior response, and care goals.
Pelvic floor trigger point injections may be considered when focal pelvic floor muscle trigger points are contributing to pain. These injections may help reduce muscle-related pain in selected cases, but they should be part of a broader plan that may include pelvic floor therapy, movement retraining, medication management, pain psychology, or treatment of overlapping conditions.
The purpose is not to treat every pelvic pain condition with an injection. The purpose is to target a specific muscle-related pain generator when the clinical pattern supports it.
Pudendal nerve blocks may be considered when symptoms suggest pudendal nerve irritation or pudendal neuralgia. Ganglion impar block may be considered in selected tailbone, rectal, perineal, or pelvic pain patterns. Superior hypogastric plexus block may be considered in selected visceral pelvic pain patterns. Lumbar sympathetic blocks or other sympathetic blocks may be considered only when the pain pattern suggests a sympathetically mediated component.
Each of these procedures requires diagnosis-specific evaluation, risk discussion, and clinician supervision.
Neuromodulation, including peripheral nerve stimulation, spinal cord stimulation, or dorsal root ganglion stimulation, may be considered for selected chronic pelvic, nerve, or complex pain patterns when conservative care and less invasive options have not provided sufficient relief. These options are not first-line treatments for pelvic floor dysfunction and should only be considered after careful evaluation.
Pelvic floor-like symptoms should not be assumed to be benign. Patients should seek urgent evaluation for fever, severe or sudden pelvic or abdominal pain, heavy bleeding, pregnancy-related pain, fainting, blood in urine or stool, inability to urinate, new bowel or bladder dysfunction, saddle anesthesia, new leg weakness, unexplained weight loss, severe testicular pain, signs of infection, chest pain, shortness of breath, or rapidly worsening symptoms.
These symptoms may indicate conditions that require emergency, gynecologic, urologic, gastrointestinal, vascular, neurologic, or surgical evaluation.
MPM approaches pelvic floor dysfunction through a diagnosis-first, coordinated model. The goal is to identify whether pain is coming from pelvic floor muscle dysfunction, pelvic dystonia, pudendal neuralgia, hip impingement, SI joint dysfunction, anterior pelvic tilt, endometriosis, fibroids, constipation, vascular compression syndromes, hypermobility, EDS, spine-related nerve pain, or chronic pain sensitization.
For patients looking for pelvic floor dysfunction treatment in Manhattan or NYC, MPM offers a careful pain medicine perspective focused on symptom mapping, musculoskeletal evaluation, nerve pain differentiation, pelvic PT collaboration, image-guided options when appropriate, and coordination with the right specialists. Treatment is individualized and selected only after the likely pain generators are better understood.
