Pelvic Pain/Floor
Pelvic Floor Muscle Dysfunction (PFMD) is the most common name used among healthcare providers to cover a wide range of diagnoses and syndromes involving the pelvic floor muscles.
Examples of these diagnoses and syndromes are vaginismus, vulvodynia, non-bacterial prostatitis, levator ani syndrome, urinary incontinence, post-partum pelvic pain and chronic constipation.
The pelvic floor muscles comprise the base of the pelvic bowl and are critical for bowel and bladder continence. They also contribute to sexual climax as well as lumbo-pelvic stability along with the other core muscles. People with PFMD may have non-ideal bowel or bladder habits, constipation, leakage, pain with intercourse or ejaculation, low back or hip pain. It is important that a medical work-up rule out any issues that may not be related to the joints and muscles. If your physical therapist (PT) has any concerns s/he will ask that you consult your medical doctor, or if you need a referral, your PT can make a recommendation.
PFMD can present in many different ways. As specialists in motor control and movement, PT’s often categorize PFMD by whether the muscles are hypertonic (over-worked), hypotonic (under-used), or poorly coordinated in their timing or in relation to synergistic muscles. Your PT will evaluate the muscles to determine what your primary type of PFMD is.
Evaluation of the pelvic floor muscles (PFM) can be accomplished through manual palpation, Real Time Ultrasound imaging (sonogram picture of the muscle used as a biofeedback tool), and by surface electromyography (sEMG) which reads the electrical activity created by the muscle. Physical therapists are interested in the pelvic floor muscle resting tone, timing, magnitude and quality of contraction.
Treatment of PFMD by a qualified PT will address the joints of the spine, pelvis and hips as well as the PFM and their partner muscles. KNOSIS therapist Liudmila Lahonda specializes in treating PFMD.
Common Pelvic Floor Conditions treated at KNÓSIS include:
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Chronic pelvic pain is rarely caused by a single issue. It often reflects a combination of muscle imbalance, restricted joint or fascial mobility, nerve irritation, or even visceral contributions from surrounding organs.
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Bladder symptoms such as leakage, urgency, or irritation are often a result of more than just the bladder itself. They may reflect pelvic floor tension, postural changes, nerve sensitivity, or pressure management dysfunction.
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Bowel symptoms such as constipation, bloating, or loss of control are often linked to poor pelvic floor muscle coordination, altered pressure regulation, or stress-related holding patterns. These issues can interfere with normal abdominal and pelvic function, making bowel health unpredictable and uncomfortable.
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Sexual dysfunction often involves a complex interplay between pelvic floor tension, circulation, and nervous system regulation. These factors can create pain, restriction, or difficulty with arousal and orgasm, impacting both comfort and quality of life.
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Pregnancy and birth bring profound changes to the body, including shifts in posture, spinal alignment, pelvic floor load, and abdominal wall integrity. These changes can lead to pain, weakness, and conditions such as leakage, prolapse, or diastasis recti.
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Abdominal wall separation is more than a cosmetic concern—it can contribute to core weakness, spinal instability, and back pain. It reflects not only changes in the abdominal wall but also altered breathing mechanics and postural adaptations.
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Tailbone pain often develops from pelvic floor tension, postural dysfunction, or direct trauma. It can make simple tasks such as sitting, driving, or bending forward uncomfortable and limiting.
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Vaginismus, or involuntary tightening of the vaginal muscles, is often a protective response to pain or trauma. This reflexive tension can create difficulty with penetration, gynecological exams, or intimacy.
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Chronic vulvar pain can stem from sensitivity in the skin, pelvic floor muscles, and nerves. It may be persistent or episodic, creating challenges with daily activities, clothing, or intimacy.
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Lichen sclerosis is an inflammatory skin condition that can alter tissue health and impact how pelvic muscles and nerves respond. Beyond affecting the skin, it can create discomfort, mobility restrictions, and protective muscle tension.
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Pelvic organ prolapse occurs when the supportive structures of the pelvis weaken, leading to a sense of heaviness or bulging. It can interfere with daily activities, exercise, or confidence in movement.
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Endometriosis creates inflammation and pain that can affect not only the pelvis but also the spine, hips, and abdominal organs. This pain often limits activity, fertility, and overall quality of life.
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Pudendal neuralgia results from irritation of the pudendal nerve, often leading to burning, sharp, or aching pelvic pain. This can make sitting and daily activities significantly more difficult.
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Pelvic pain in men is often misattributed to infection when the underlying cause may be muscle tension, nerve hypersensitivity, or postural dysfunction. Symptoms may include urinary difficulty, discomfort with sitting, or pain during activity.
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Spasm of the levator ani muscles creates a deep aching pain, often worse with sitting or bowel movements. This chronic tension pattern disrupts pelvic coordination and perpetuates discomfort.
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Surgical procedures often leave behind scars, adhesions, and altered muscle activation patterns. These changes can restrict mobility, weaken support systems, and disrupt coordination between the core and pelvic floor.
Chronic Pelvic Pain
Chronic pelvic pain is rarely caused by a single issue. It often reflects a combination of muscle imbalance, restricted joint or fascial mobility, nerve irritation, or even visceral contributions from surrounding organs. Over time, these factors create a cycle of protective tension, altered posture, and inefficient movement strategies, which perpetuate pain and dysfunction.
At KNÓSIS, we take a whole-body view of pelvic pain, assessing how the spine, hips, pelvic floor, and visceral systems interact. Our treatment combines manual therapy to release restrictions, movement retraining to restore stabilizer function, and breathing or postural strategies to reduce strain. This integrated approach helps break the cycle of tension and supports long-term restoration of balance and ease.
Bladder Dysfunction (Urinary Incontinence, Interstitial Cystitis)
Bladder symptoms such as leakage, urgency, or irritation are often a result of more than just the bladder itself. They may reflect pelvic floor tension, postural changes, nerve sensitivity, or pressure management dysfunction. These imbalances can make it difficult for the bladder to function efficiently, leading to frustration and limitations in daily life.
At KNÓSIS, we assess both local and whole-body contributors to bladder dysfunction. Treatment focuses on restoring optimal pelvic floor coordination, improving alignment and breathing mechanics, and calming hypersensitive nerves. Our goal is to reduce strain on the bladder system and support more effective, comfortable bladder control.
Bowel Dysfunction (Constipation, Bloating, Fecal Incontinence)
Bowel symptoms such as constipation, bloating, or loss of control are often linked to poor pelvic floor muscle coordination, altered pressure regulation, or stress-related holding patterns. These issues can interfere with normal abdominal and pelvic function, making bowel health unpredictable and uncomfortable.
At KNÓSIS, we evaluate how breathing, posture, abdominal wall mechanics, and pelvic floor coordination contribute to these challenges. Treatment may include manual therapy to reduce restrictions, visceral manipulation to improve mobility and function of the abdominal organs, retraining of muscle timing and breathing patterns, use of a biofeedback device for improving pelvic floor awareness in cases of fecal incontinence or constipation, and progressive movement strategies to restore more normal and reliable bowel function.
Sexual Dysfunction (Dyspareunia, Erectile Dysfunction, Difficulty with Orgasm)
Sexual dysfunction often involves a complex interplay between pelvic floor tension, circulation, and nervous system regulation. These factors can create pain, restriction, or difficulty with arousal and orgasm, impacting both comfort and quality of life.
At KNÓSIS, we address these multiple layers with a combination of hands-on therapy, targeted exercise to restore coordination, and techniques to calm overactive nerves. Our approach focuses on improving pelvic floor health, circulation, and whole-body integration to reduce pain and restore more natural function.
Very often, an overactive sympathetic nervous system keeps the pelvic floor muscles in a state of tightness and upregulation, contributing to pain, tension, and impaired sexual response. For this reason, part of our treatment includes regulating the nervous system through guided breathing, vagus nerve techniques, and craniosacral therapy (CST). By down-training the sympathetic system and restoring balance with the parasympathetic system, we help reduce pelvic floor overactivity and support healthier, more coordinated muscle function.
Pregnancy and Postpartum Rehabilitation
Pregnancy and birth bring profound changes to the body, including shifts in posture, spinal alignment, pelvic floor load, and abdominal wall integrity. These changes can lead to pain, weakness, and conditions such as leakage, prolapse, or diastasis recti.
At KNÓSIS, we support mothers through both pregnancy and recovery by addressing pain, restoring pelvic floor and core coordination, and treating scar tissue or restrictions from delivery. We provide targeted strategies to rebuild strength, manage pressure systems, and support long-term pelvic and spinal health.
Diastasis Recti
Abdominal wall separation is more than a cosmetic concern—it can contribute to core weakness, spinal instability, and back pain. It reflects not only changes in the abdominal wall but also altered breathing mechanics and postural adaptations.
At KNÓSIS, we go beyond measuring the gap, assessing how the abdominal wall, diaphragm, and pelvic floor work together. Treatment involves progressive strategies to retrain deep abdominal muscles, restore breathing patterns, and integrate core function into daily movement and exercise.
Coccydynia
Tailbone pain often develops from pelvic floor tension, postural dysfunction, or direct trauma. It can make simple tasks such as sitting, driving, or bending forward uncomfortable and limiting.
At KNÓSIS, we evaluate how pelvic alignment, muscle tone, and surrounding joint mobility contribute to coccyx irritation. Through manual release, postural retraining, and pelvic floor coordination, we work to reduce sensitivity and restore comfortable sitting and movement tolerance.
Vaginismus
Vaginismus, or involuntary tightening of the vaginal muscles, is often a protective response to pain or trauma. This reflexive tension can create difficulty with penetration, gynecological exams, or intimacy.
At KNÓSIS, we approach vaginismus with gentle, graded strategies to release muscle guarding, calm the nervous system, and restore safe movement. Treatment may include manual therapy, relaxation techniques, and progressive retraining to support comfort and function. Because vaginismus is often linked to an overactive sympathetic nervous system that keeps the pelvic floor muscles tight and reactive, we also integrate guided breathing, vagus nerve techniques, and craniosacral therapy (CST). These approaches help down-train nervous system overactivity, reduce pelvic floor guarding, and re-establish a sense of safety and control for the patient.
Vulvodynia
Chronic vulvar pain can stem from sensitivity in the skin, pelvic floor muscles, and nerves. It may be persistent or episodic, creating challenges with daily activities, clothing, or intimacy.
At KNÓSIS, we provide a whole-body approach to managing vulvodynia. Treatment combines gentle manual therapy, pelvic floor retraining, and strategies to calm nerve sensitivity. The focus is on restoring tolerance for daily function and reducing chronic irritation.
Lichen Sclerosis
Lichen sclerosis is an inflammatory skin condition that can alter tissue health and impact how pelvic muscles and nerves respond. Beyond affecting the skin, it can create discomfort, mobility restrictions, and protective muscle tension.
At KNÓSIS, we complement medical care with therapy aimed at restoring mobility, releasing protective patterns, and supporting pelvic floor function. Our approach helps reduce discomfort and improve overall pelvic health.
Pelvic Organ Prolapse
Pelvic organ prolapse occurs when the supportive structures of the pelvis weaken, leading to a sense of heaviness or bulging. It can interfere with daily activities, exercise, or confidence in movement.
At KNÓSIS, we retrain the pelvic floor and core, while addressing posture, breathing, and load transfer strategies. Treatment is designed to improve support, reduce strain, and restore more effective pelvic function.
Endometriosis
Endometriosis creates inflammation and pain that can affect not only the pelvis but also the spine, hips, and abdominal organs. This pain often limits activity, fertility, and overall quality of life.
At KNÓSIS, we integrate manual therapy, mobility restoration, and nervous system downregulation with your medical care. Treatment reduces tension, improves mobility, and helps manage the chronic pain and movement limitations associated with endometriosis.
Pudendal Neuralgia
Pudendal neuralgia results from irritation of the pudendal nerve, often leading to burning, sharp, or aching pelvic pain. This can make sitting and daily activities significantly more difficult.
At KNÓSIS, we focus on reducing mechanical strain on the nerve through manual therapy, pelvic floor release, and postural retraining. Our goal is to restore mobility, improve tissue balance, and reduce nerve sensitivity for better functional tolerance.
Nonbacterial Prostatitis
Pelvic pain in men is often misattributed to infection when the underlying cause may be muscle tension, nerve hypersensitivity, or postural dysfunction. Symptoms may include urinary difficulty, discomfort with sitting, or pain during activity.
At KNÓSIS, we treat these musculoskeletal contributors through soft tissue release, pelvic floor retraining, and optimization of breathing and posture. Because an overactive sympathetic nervous system can upregulate pelvic floor muscles and worsen pain, we also incorporate guided breathing, vagus nerve techniques, and craniosacral therapy (CST) to calm the nervous system and restore balance.
Education is a central part of care: we use models and illustrations to help patients understand pelvic anatomy, pressure regulation, and muscle function so they feel empowered in their recovery. Sessions emphasize building body awareness and proprioception, helping patients reconnect with their pelvic floor, improve coordination, and restore healthy, pain-free function.
Levator Ani Syndrome
Spasm of the levator ani muscles creates a deep aching pain, often worse with sitting or bowel movements. This chronic tension pattern disrupts pelvic coordination and perpetuates discomfort.
At KNÓSIS, we use manual release techniques, mobility restoration, and pelvic floor retraining to reduce muscle spasm and improve alignment. Treatment focuses on restoring coordinated function to break the pain cycle.
Post-Surgical Treatments (C-section, Hysterectomy, Abdominoplasty, Laparoscopy, Hernia, Prostatectomy)
Surgical procedures often leave behind scars, adhesions, and altered muscle activation patterns. These changes can restrict mobility, weaken support systems, and disrupt coordination between the core and pelvic floor.
At KNÓSIS, we evaluate scars in the context of whole-body movement. Treatment includes scar mobilization, joint and tissue release, and retraining of core and pelvic function. Our goal is to support safe, complete recovery and help patients return to activity with strength and stability.