Pelvic pain can come from pelvic floor muscles, nerves, joints, ligaments, abdominal wall structures, hip mechanics, endometriosis, fibroids, hernias, hypermobility, inflammation, or chronic pain sensitization.
Learn how Dr. Ahmed evaluates pelvic pain, identifies potential underlying causes, and develops personalized treatment plans to help patients find lasting relief.
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 pain is very common, but it’s often misunderstood and overlooked. It refers to pain in the lower abdomen or pelvic area, and it can come from many different systems. It includes the reproductive organs, the bladder, the bowel, muscles, and or nerves. One of the biggest challenges with pelvic pain is that it rarely comes from just one place.
Over time, the body starts to adapt to pain. Muscles can tighten, nerves can become more sensitive, and the nervous system can stay in a constant alert state. And that’s why symptoms can expand beyond the pelvis and include things like low back pain, urinary symptoms, bowel changes, and pain with intimacy. At Manhattan Pain Medicine, we start with a detailed history and pain mapping to understand your specific pain pattern.
From there, we may use a combination of medications, targeted treatments, and coordinating care with physical therapy, gynecology, and other specialists. Our goal is not just short-term relief, but helping your body reset and function better over time.
Pelvic pain can feel sharp, aching, burning, cramping, pressure-like, deep, nerve-like, or difficult to localize. It may involve the lower abdomen, groin, hips, tailbone, pelvis, genitals, rectal area, bladder region, pelvic floor, or lower back. Some patients feel pain with sitting, sex, urination, bowel movements, walking, exercise, or certain positions.
Chronic pelvic pain is often defined as pain below the bellybutton and between the hips that lasts for several months, commonly six months or longer. It may have one clear cause, but many patients have more than one contributing driver.
At Manhattan Pain Medicine (MPM), pelvic pain evaluation begins with a diagnosis-first approach. The goal is to determine whether pain is coming from pelvic floor dysfunction, pudendal neuralgia, abdominal wall pain, hip impingement, labral tears, sacroiliac joint dysfunction, endometriosis, fibroids, hernia pain, hypermobility, autoimmune or inflammatory conditions, central pain sensitization, or a combination of factors.
At MPM, pelvic pain care begins by mapping the pain pattern, location, triggers, prior workup, prior treatment response, and related symptoms. For patients looking for pelvic pain treatment in Manhattan, MPM evaluates whether symptoms may involve pelvic floor muscles, pelvic nerves, hip mechanics, sacroiliac joint dysfunction, abdominal wall pain, hernia-related pain, endometriosis, fibroids, constipation, hypermobility, EDS, autoimmune or inflammatory conditions, or chronic pain sensitization.
Care may include medication management, pain psychology, biofeedback, acupuncture, Feldenkrais, trigger point injections, pelvic floor trigger point injections, pudendal nerve block, ganglion impar block, superior hypogastric plexus block, sacroiliac joint injection, sympathetic blocks, diagnostic ultrasound, ultrasound-guided injections, nerve hydrodissection, peripheral nerve stimulation, or other selected interventions when clinically appropriate. MPM also coordinates with gynecology, urology, gastroenterology, pelvic floor physical therapy, orthopedics, neurology, rheumatology, surgery, and behavioral health when pelvic pain requires a multidisciplinary plan.
Pelvic pain can be difficult to diagnose because several systems overlap in a small, highly sensitive region. Pain may begin in the pelvic organs, pelvic floor muscles, bladder, bowel, nerves, abdominal wall, hips, sacroiliac joints, spine, connective tissue, or central nervous system.
Some patients have normal imaging or inconclusive testing but continue to experience real and disruptive symptoms. Others have a known diagnosis, such as endometriosis, fibroids, EDS, hip impingement, pudendal neuralgia, or pelvic floor dysfunction, but still have pain because another driver is also present.
MPM’s diagnosis-first approach is designed to identify the dominant pain generator while recognizing that pelvic pain is often layered. The evaluation considers gynecologic, urologic, gastrointestinal, musculoskeletal, nerve-related, inflammatory, hypermobility-related, abdominal wall, and central pain contributors before recommending treatment.
Pelvic pain is a primary focus within MPM’s Pelvic Pain Zone of Expertise, but it often overlaps with Complex Chronic Pain, Hypermobility, Autoimmune and Inflammatory, Psychology of Pain, and Musculoskeletal issues.
A patient with hypermobility may develop pelvic instability, hip pain, sacroiliac joint dysfunction, or pelvic floor muscle guarding. A patient with endometriosis may also develop nerve sensitization, pelvic floor overactivity, or central pain mechanisms. A patient with autoimmune or inflammatory symptoms may have overlapping joint, tendon, nerve, or pelvic pain. A patient with longstanding pelvic pain may also experience fear, sleep disruption, medical trauma, and nervous system sensitization.
MPM evaluates these relationships carefully. The goal is to identify what is driving the pain, what systems are involved, and which treatments are most appropriate for the patient’s specific pattern.
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...
The best care I've received as a chronic pain patient. I traveled from out of state to visit Manhattan Pain Medicine because I could not find knowledgeable doctors in my hometown for my hypermobility, and Ehlers-Danlos syndrome symptoms and comorbidities. Let me tell you, it was worth every travel e...
I was injured in a bicycle accident over 8 years ago. I’ve suffered throughout the years since my accident with nothing seeming to work. PT, Yoga, lifestyle changes, NOTHNG! I finally made an appointment with Dr Kane and I’m feeling an improvement in my life. I no longer stay up all night in pain, a...
One of the best experiences, if not the best, I have ever had at the doctor’s office. From the front desk to the nurses to the PA assisting the doctor this was a great experience. Dr.Nino actually listened to me and came up with a game plan. Would recommend this practice to as many people as I could...
I have very unique & severe nerve pain from CRPS which has no known specific cure. Dr. Siefferman has a huge tool box, far greater than the other 23 Drs. I have seen. He saved me from jumping off a bridge and continues to help me with both treatments and advice. Dr. S. is in a different league!
After two years of searching and feeling lost and let down, I finally found real help at Manhattan Pain Medicine. With Dr. Siefferman, Adam Rosenberg, Dr. Mikaberidze, and the whole team, I feel heard, supported and understood. Every symptom is being considered and I’m finally getting answers with m...
Why is Dr Dr. Tayyaba Ahmed one of the top pevic Floor specialists - 1- She wants to know a full history of what led the patient to get to this point. 2 - She listens intensley to the patient 3- She does not rush you 4- Extremely skilled at giving pelvic floor injections 5- I thank my luck stars she...
The staff was friendly and helpful. Dr. Siefferman was thoughtful, listened, asked questions and proposed simple safe ways to come to further conclusions regarding my pain and discomfort. The office staff including Dr. Siefferman is responsive even after the initial in-person visit. Very pleased.
Dr. Siefferman is a brilliant provider. While my pain is still a work in progress, Dr Siefferman always gives me options and explains his reasoning behind things. He listens to my feedback and concerns. I never feel rushed; and am grateful he works to meet me where I am. I highly recommend him.
What a great find! They listen to me, I listen to them and the diagnosis is made and a plan developed to develop an approach to treat all of my chronic pain. I wish I could have discovered this type of treatment sooner. This doctor and group give me hope.
Pelvic pain can come from several sources, including gynecologic, urologic, gastrointestinal, musculoskeletal, nerve-related, pelvic floor, abdominal wall, hip, sacroiliac, inflammatory, vascular, and chronic pain contributors. Common overlapping causes may include endometriosis, fibroids, pelvic floor dysfunction, pudendal neuralgia, abdominal pain, constipation, hernia pain, hip impingement, labral tears, sacroiliac joint dysfunction, EDS, hypermobility, and central pain sensitization.
Pelvic pain is often considered chronic when it persists or recurs for several months, commonly six months or longer. Chronic pelvic pain may be constant or intermittent. It may involve the lower abdomen, pelvis, groin, hips, tailbone, genitals, bladder, bowel, or pelvic floor. Chronic pelvic pain can have one cause, but many patients have multiple overlapping drivers.
Yes. Pelvic floor dysfunction can contribute to pelvic pain when the pelvic floor muscles are too tight, too weak, overactive, underactive, or poorly coordinated. Symptoms may include pelvic pressure, sitting pain, pain with sex, urinary symptoms, bowel symptoms, rectal discomfort, tailbone pain, or pain that feels difficult to localize. Pelvic floor dysfunction often requires coordinated care, including pelvic floor physical therapy and pain-focused evaluation when symptoms persist.
Yes. Pelvic pain can be nerve-related. Pudendal neuralgia, abdominal wall nerve entrapment, peripheral nerve irritation, scar-related nerve pain, and sympathetically mediated pain patterns can all contribute to pelvic symptoms. Nerve-related pelvic pain may feel burning, sharp, electric, shooting, numb, tingling, or worse with sitting. MPM evaluates whether a pelvic nerve, abdominal wall nerve, spine-related nerve pathway, or chronic pain mechanism may be contributing.
Yes. Hip impingement, labral tears, sacroiliac joint dysfunction, anterior pelvic tilt, piriformis syndrome, spine referral, and altered pelvic mechanics can all refer pain into the pelvis, groin, buttock, tailbone, or lower abdomen. In patients with EDS or hypermobility spectrum disorder, joint laxity and instability may further complicate pelvic mechanics and muscle guarding.
Yes. Endometriosis, fibroids, and other gynecologic conditions can coexist with pelvic floor muscle guarding, nerve sensitization, abdominal wall pain, bowel or bladder symptoms, and central pain mechanisms. Treating one diagnosis may not resolve all symptoms if other pain generators remain active. MPM evaluates pelvic pain in coordination with gynecology and other specialists when medical or surgical pelvic conditions are part of the clinical picture.
Treatment depends on the diagnosis and pain pattern. Options may include pelvic floor therapy coordination, medication management, pain psychology, biofeedback, acupuncture, Feldenkrais, trigger point injections, pelvic floor trigger point injections, pudendal nerve block, ganglion impar block, superior hypogastric plexus block, lumbar sympathetic blocks, sacroiliac joint injection, sacrococcygeal ligament injection, nerve hydrodissection, peripheral nerve stimulation, ketamine therapy, lidocaine and ketamine infusions, regenerative options, or other selected treatments when clinically appropriate.
A pain specialist may help evaluate pelvic pain when symptoms involve nerve pain, pelvic floor muscle pain, abdominal wall pain, hip-related pain, sacroiliac joint pain, coccyx pain, complex chronic pain, or pain that persists after gynecology, urology, GI, orthopedic, imaging, or pelvic floor workups. MPM’s role is to identify and treat pain generators when appropriate while coordinating with the specialists needed for the broader medical picture.
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.
Jason W. Siefferman, MD
Jason W. Siefferman, MD
MPM
Pelvic pain is rarely simple. The pelvis is an area where multiple systems overlap, including the reproductive organs, bladder, bowel, pelvic floor muscles, nerves, blood vessels, hips, sacroiliac joints, spine, abdominal wall, connective tissues, and central nervous system.
For some patients, pelvic pain begins after a clear event, such as surgery, injury, childbirth, infection, flare of endometriosis, hernia, hip injury, or abdominal procedure. For others, symptoms develop gradually and may become difficult to explain. Pain may be felt in the lower abdomen, groin, pelvis, rectal area, genitals, tailbone, hips, low back, or inner thighs.
Pelvic pain is a symptom pattern. It does not automatically point to one cause. Some patients have pain driven mainly by pelvic floor muscle overactivity. Others have nerve irritation, hip pathology, sacroiliac joint dysfunction, endometriosis, fibroids, abdominal wall pain, hernia-related pain, bowel or bladder contributors, autoimmune or inflammatory overlap, hypermobility, or central pain sensitization.
Many patients have more than one driver. This is why MPM begins with source-finding rather than assuming that pelvic pain is only gynecologic, only muscular, only nerve-related, or only psychological.
The pelvic floor is a group of muscles that supports pelvic organs and helps coordinate bladder, bowel, sexual, and core function. Pelvic floor dysfunction can occur when these muscles are too tight, too weak, overactive, underactive, or poorly coordinated.
Pelvic floor dysfunction may cause pelvic pain, pressure, pain with sitting, pain with sex, urinary urgency, constipation, bowel symptoms, rectal pain, tailbone pain, or a feeling of muscle tightness that does not release. Some patients experience pelvic floor guarding after injury, surgery, endometriosis, infection, trauma, hip pain, nerve pain, or chronic stress physiology.
MPM evaluates pelvic floor dysfunction in context and may coordinate with pelvic floor physical therapy, gynecology, urology, GI, pain psychology, and other clinicians when needed.
Pelvic pain can be nerve-related. Pudendal neuralgia is one possible pelvic nerve pain pattern that may cause pain in the perineum, genitals, rectal area, or pelvic floor region. Pain may worsen with sitting and improve when standing or lying down, although patterns vary by patient.
Other pelvic nerve pain patterns may involve abdominal wall nerves, ilioinguinal or iliohypogastric pathways, genitofemoral nerve irritation, scar-related nerve pain, sacral nerve irritation, or sympathetically mediated pelvic pain.
Nerve-related pain may feel burning, electric, sharp, shooting, tingling, numb, hypersensitive, or deep and difficult to localize. MPM evaluates the pain distribution, triggers, prior procedures, neurologic symptoms, pelvic floor findings, hip and spine mechanics, and prior treatment response to determine whether nerve-targeted care may be appropriate.
Pelvic pain may come from the hip, sacroiliac joint, lumbar spine, abdominal wall, tendons, ligaments, or surrounding muscles. Hip impingement and labral tears can cause groin or deep hip pain that may be mistaken for pelvic pain. Sacroiliac joint dysfunction can refer pain into the buttock, groin, low back, or pelvis. Piriformis-related pain may overlap with sciatic-like symptoms or deep pelvic discomfort.
Anterior pelvic tilt, pelvic instability, muscle guarding, altered gait, and abdominal wall pain can also contribute. In some patients, ACNES or other abdominal wall nerve entrapment patterns may feel like lower abdominal or pelvic pain, especially when GI or gynecologic workups do not explain the symptom.
MPM evaluates these musculoskeletal and nerve-related contributors alongside pelvic organ and pelvic floor considerations.
Patients with EDS or hypermobility spectrum disorder may experience pelvic pain for several reasons. Joint laxity can affect the hips, sacroiliac joints, lumbar spine, ribs, abdominal wall, and pelvic ring. Muscles may overwork to stabilize joints, leading to guarding, trigger points, fatigue, and pain. Hypermobility can also overlap with pelvic floor dysfunction, hip impingement, labral tears, sacroiliac joint dysfunction, abdominal pain, POTS-like symptoms, and central pain sensitization.
MPM does not assume that hypermobility is the cause of every pelvic pain symptom. Instead, the evaluation looks at whether joint instability, connective tissue differences, pelvic mechanics, nerve irritation, muscle guarding, or chronic pain sensitization are contributing to the patient’s specific pattern.
Gynecologic conditions such as endometriosis and fibroids can contribute to pelvic pain, but they can also coexist with other pain generators. A patient may have endometriosis and pelvic floor muscle guarding, fibroids and pressure symptoms, abdominal pain and constipation, or nerve sensitization after prolonged pelvic inflammation.
Even after surgery or medical treatment, some patients continue to have pain because pelvic floor dysfunction, nerve pain, hip mechanics, abdominal wall pain, or central sensitization remains active. This does not mean the original diagnosis was wrong. It means pelvic pain can become layered over time.
MPM works within a coordinated model and may collaborate with gynecology, GI, urology, pelvic floor physical therapy, and other specialists when pelvic organ conditions are part of the pain picture.
When pelvic pain persists, the nervous system can become more sensitive. Central sensitization means pain pathways may become more reactive, making pain feel stronger, spread more widely, or continue even after the original tissue trigger has changed.
This does not mean the pain is imagined. It means the nervous system may be contributing to how pain is maintained and amplified. Chronic pelvic pain can also overlap with medical trauma, anxiety around symptoms, sleep disruption, sexual pain, bowel or bladder fear, and avoidance of activities that previously triggered pain.
Pain psychology and biofeedback can support nervous system regulation, coping, sleep, pelvic muscle awareness, fear reduction, and function. These approaches are not a replacement for medical evaluation. They are one part of coordinated pelvic pain care when appropriate.
Treatment depends on the diagnosis and dominant pain generator. Some patients benefit from pelvic floor therapy coordination, movement retraining, biofeedback, medication management, acupuncture, Feldenkrais, or pain psychology. Others may need targeted interventions when a specific pain generator is identified.
Selected image-guided procedures may include trigger point injections, pelvic floor trigger point injections, pudendal nerve block, ganglion impar block, superior hypogastric plexus block, lumbar sympathetic blocks, sympathetic blocks, sacroiliac joint injection, sacrococcygeal ligament injection, peripheral joint injections, nerve hydrodissection, or peripheral nerve stimulation. These are not routine treatments for every pelvic pain patient. They are considered only when the diagnosis, anatomy, pain pattern, risk profile, and treatment goals support them.
Regenerative options such as PRP, prolotherapy, or other selected treatments may be considered for carefully chosen musculoskeletal or instability-related patterns, but they should not be presented as universal pelvic pain treatments.
Pelvic pain can sometimes reflect urgent medical conditions. Patients should seek urgent or emergency care for sudden or severe pelvic pain, fever, vomiting, fainting, heavy vaginal bleeding, pregnancy with pelvic pain, blood in urine or stool, inability to urinate or pass stool, severe worsening pain, new neurologic deficits, severe abdominal pain, signs of infection, suspected ectopic pregnancy, testicular pain or swelling, or symptoms after trauma.
Pain procedures should not replace appropriate gynecologic, urologic, gastrointestinal, orthopedic, neurologic, surgical, oncologic, or emergency evaluation when those are needed.
MPM approaches pelvic pain through a diagnosis-first, coordinated model. The goal is to identify whether pain is pelvic floor-related, nerve-related, hip-related, sacroiliac-related, abdominal wall-related, hernia-related, gynecologic, gastrointestinal, urologic, inflammatory, hypermobility-related, centralized, or mixed.
For patients looking for pelvic pain treatment in Manhattan, MPM offers a careful pain medicine perspective focused on source-finding, functional impact, patient education, and coordinated treatment planning. The care plan is individualized and may involve conservative care, pelvic floor coordination, pain psychology, biofeedback, acupuncture, Feldenkrais, medication management, selected image-guided procedures, nerve blocks, neuromodulation, or referral to the appropriate specialist when needed.
