The pelvic floor is a hammock of muscle and connective tissue that stretches from the pubic bone to the tailbone. It supports the bladder, bowel, and, in women, the uterus. It closes the urethra and rectum when you cough or lift, relaxes to let you urinate and have a bowel movement, and contributes to sexual function in both sexes. Like any muscle group, it can become weak, overstretched, injured, or too tight, and each of those problems produces different symptoms.
Pelvic floor rehabilitation treats those problems through targeted muscle training, supported by technology that lets you see what the muscles are doing. It is the least invasive effective treatment for many forms of urinary leakage, pelvic pain, and bowel control problems, and it is often the right first step before medication or a procedure. It fails so often when attempted alone at home for a simple reason: most people cannot feel these muscles well enough to train them correctly.
At NYMD Center, gynecology and urology work under one roof, so pelvic floor problems in women and men are handled jointly. That matters because the pelvic floor, the bladder, and the reproductive organs cannot be separated, and a program that addresses only one of them usually disappoints.
Who it affects and the symptoms that bring people in
In women, pregnancy and childbirth are the most common causes of pelvic floor weakness, though symptoms may not appear until years later. Menopause thins the supporting tissue further. In men, prostate surgery is the classic cause of leakage, and chronic pelvic tension is a common and underdiagnosed source of pain. In both sexes, chronic constipation, heavy lifting, chronic cough, obesity, and simply aging contribute.
The symptom that brings most people in is urinary leakage: with coughing, sneezing, laughing, or exercise, which points to weak support of the urethra; or with sudden urgency that cannot be held, which points to the bladder itself. Many people have both. Others come in with a feeling of pelvic heaviness or bulge, difficulty emptying the bladder or bowel, pain with intercourse, chronic pelvic or tailbone pain, or, in men, testicular or perineal ache that has not responded to antibiotics. Some are referred after childbirth or prostate surgery before symptoms have become established, which is the ideal time to start.
How we evaluate it at NYMD Center
The evaluation begins with a detailed history of what leaks, when, and how much, along with bowel habits, sexual function, pain, and any prior surgeries or deliveries. A bladder diary for a few days, recording what you drink and when you urinate or leak, is more informative than most tests and we ask for it early.
The physical exam assesses the pelvic floor directly: whether the muscles can contract and relax on command, how strong they are, whether they are tender or in spasm, and whether there is prolapse of the bladder, uterus, or rectum. In women this is done during a pelvic exam; in men, during a rectal exam. We check for urine left behind after voiding with a bladder scan, and test the urine for infection.
When leakage is significant, or when the type of leakage is unclear, we do not guess. Urodynamics measures how the bladder fills, how much pressure it generates, and whether it contracts when it should not, which distinguishes weak support from an overactive bladder. Cystoscopy, a brief look inside the bladder with a thin scope, rules out stones, growths, or inflammation that would change the plan. These tests take under an hour in the office, and they prevent months of treatment aimed at the wrong problem.
Treatment options
Rehabilitation is the foundation, and other treatments are layered on when the evaluation shows they are needed. Our urinary incontinence and overactive bladder pages explain the bladder-directed side; here we focus on the pelvic floor.
Biofeedback-guided muscle training
Kegel exercises are correct in principle and usually wrong in execution. Biofeedback fixes that. A small sensor placed in the vagina or rectum, or surface electrodes on the skin, measures muscle activity and displays it on a screen in real time. You see whether you are contracting the right muscles, how strongly, and whether you are fully relaxing between contractions. For people whose problem is a pelvic floor that is too tight, the same tool teaches release rather than squeeze, which is what relieves pain and emptying difficulty.
Sessions are guided by a trained clinician and paired with a home program. The cost to you is time and consistency; there are no side effects. Improvement is gradual over weeks to months, and the gains last as long as you maintain them.
Emsella
The Emsella chair uses focused electromagnetic energy to contract the entire pelvic floor thousands of times in a thirty-minute session while you remain fully clothed. It builds strength in muscles that are difficult to activate voluntarily, and it is particularly useful for people who cannot isolate the muscles, who have had recent childbirth or prostate surgery, or who have plateaued with training alone. It is painless and has no recovery. It is not a substitute for learning to control the muscles yourself, which is why we pair it with biofeedback rather than offering it in isolation.
Bladder retraining and behavioral measures
For urgency, the muscles are only half the story. Timed voiding, gradually extending the interval between trips, urge suppression techniques, and adjusting fluid and caffeine intake retrain the bladder's signaling. These are taught alongside muscle training and cost nothing.
Pessaries and supports
For women with prolapse or stress leakage who want to avoid surgery, a pessary, a removable silicone support fitted in the office, holds the pelvic organs in position. It is an immediate, reversible solution that many women use for years, either alone or while completing a rehabilitation program.
When the pelvic floor is not the problem
If urodynamics shows that an overactive bladder is driving urgency leakage, muscle training alone will not fix it. Bladder-directed treatments then apply: medication, percutaneous tibial nerve stimulation or bladder Botox, each with its own trade-offs in convenience and side effects. For stress leakage that persists despite a completed rehabilitation program, surgical options exist and we discuss them honestly, but they come after rehabilitation, not instead of it.
Pelvic pain
A pelvic floor in chronic spasm causes pain that is often misattributed to infection, endometriosis, or prostatitis. Rehabilitation focused on release, combined with treatment of any coexisting condition, is the mainstay. Our chronic pelvic pain page covers this in more detail.
What to expect at your visit
Bring your bladder diary if we have asked for one, a list of medications, and records of any prior pelvic surgery, deliveries, or prostate treatment. The first visit includes the history, exam, and bladder scan, and we decide together whether urodynamics or cystoscopy is needed before treatment starts.
Biofeedback sessions last about thirty to forty-five minutes. You leave each session with specific exercises to practice, and we track your progress at each visit. Emsella sessions are thirty minutes, fully clothed, and require no preparation.
Women are seen by our gynecology team and men by our urology team, in the same offices, with the same rehabilitation resources, at both our Midtown Manhattan and Forest Hills locations.
Questions patients ask
I have been doing Kegels for months. Why are they not working?
Most people cannot tell whether they are contracting the right muscles, and many are unknowingly bearing down, tightening the buttocks, or holding their breath instead. Some pelvic floors are too tight rather than too weak, and Kegels make those worse. Biofeedback shows you exactly what the muscles are doing, so training becomes effective. If leakage persists despite correct training, the problem may not be muscular, which is why we evaluate before assuming.
Is pelvic floor rehabilitation only for women?
No. Men have the same muscles and the same problems. Leakage after prostate surgery, urgency, dribbling after urination, chronic pelvic or testicular pain, and some forms of erectile difficulty all involve the pelvic floor. Because our urologists and gynecologists work in the same office, men and women are evaluated by the right specialist and treated with the same rehabilitation tools.
How many sessions does it take?
It depends on the problem and how consistently you practice between visits. Many patients notice a change within a few weeks of guided training, with a typical program running about two to three months. Emsella is usually given as a series of short sessions over three weeks. We reassess partway through, and if progress has stalled we look for a reason rather than simply adding sessions.
Why do you recommend testing before treatment?
Because leakage has different causes that need different treatments. Stress leakage from a weak support system responds to muscle training; urgency from an overactive bladder does not, and needs bladder-directed treatment instead. Many people have both. Urodynamics shows how your bladder actually behaves under filling and pressure, and cystoscopy rules out problems inside the bladder. Treating first and testing later wastes months when the guess is wrong.
What is the Emsella chair?
Emsella is a chair that generates a focused electromagnetic field, which causes the pelvic floor muscles to contract thousands of times during a half-hour session while you sit fully clothed. It builds strength in muscles that are hard to train voluntarily and is useful for people who cannot isolate the muscles or are recovering from childbirth or prostate surgery. It works best alongside biofeedback training, not instead of it.
Make an appointment
Manhattan (212) 991-9991 · Forest Hills (718) 360-9550 · same-week visits, most major insurance accepted.