Pelvic floor therapy is physical therapy for the muscles, fascia, and nerves at the base of your pelvis. Here at Synergy Therapeutic Group in Carbondale, Illinois, we treat leaking, urgency, pelvic pain, painful intimacy, constipation, and pelvic pressure in women and in men, and all of our treatment is external. We do not do internal exams. We start with the pelvis itself, because in my experience the way the pelvis sits and holds is what so often leaves the pelvic floor too weak or too tight.
Key Takeaways
- Pelvic floor therapy is physical therapy for the muscles, fascia, and nerves at the base of your pelvis. It helps with leaking, urgency, pelvic pain, painful intimacy, constipation, and pelvic pressure, in women and in men.
- These problems are common, but common does not mean normal. You do not have to plan your life around a bathroom.
- Before the pelvic floor comes the pelvis. The pelvic floor hangs from the pelvis, so when the pelvis is tilted, unstable, or not moving well, that can affect how the floor works. In my experience, it is often part of why the floor is too weak or too tight.
- There is no such thing as a normal pelvis. Every pelvis is unique, which is why we look at yours as a whole instead of following a checklist.
- In my experience, that is why Kegels alone so often fall short. They work on the floor and ignore the frame it hangs from.
- At Synergy, all of our pelvic floor treatment is external. We do not do internal exams. We start with the biomechanics of the pelvis, then the breath, core, hips, and fascia.
- Men have pelvic floor problems too, far more often than most people realize. They just rarely call about it.
So let me start with something I hear almost every week. A woman sits down across from me, and before she tells me why she came, she apologizes. I know this is embarrassing. Then she tells me she leaks when she sneezes. Or that intimacy has hurt for years. Or that she has not taken a long car ride since her second baby because she does not trust her bladder.
And then she tells me the part that bothers me the most. My doctor said this is normal after children. Or: I figured this is just getting older.
It is common. But it is not something you have to live with, and you do not have to suffer in silence. Pelvic floor problems respond to the right physical therapy the same way a stiff shoulder or a bad back does. The pelvic floor is a group of muscles. Muscles can be trained, released, and coordinated again.
But there is a bigger problem, and it is a myth most of us were taught. When people hear “pelvic floor,” they think of two things: women, and the pelvic floor muscles themselves. Squeeze them, strengthen them, done. That is not the whole truth. Men have a pelvic floor too. And before the pelvic floor, there is the pelvis.
Watch · 90 seconds
Before the pelvic floor comes the pelvis
Why pelvic floor problems so often start with the pelvis, and what external pelvic floor therapy looks like. Sound optional. Every point is on screen.
What is the pelvic floor, and what is pelvic floor dysfunction?
Your pelvic floor is a group of muscles that forms a hammock across the bottom of your pelvis. It holds up your bladder, your bowel, and in women the uterus. It helps you hold urine and stool, and it lets go when you want it to. It plays a part in sexual function. And it is part of your core. It helps steady your trunk and pelvis every time you stand, lift, or walk.
Pelvic floor dysfunction means those muscles are not doing their job the way they should. They may be too weak to hold, too tight to relax, or simply not coordinating with the rest of your body. The symptoms depend on which one it is, and that is exactly why the treatment has to start with finding out which one it is.
Pelvic floor problems we help with
Here is the list of what people come to us for. Most people have more than one of these. So when I see three of them together, I start looking for the one thing underneath.
- Leaking when you cough, sneeze, laugh, lift, or run (stress incontinence)
- Urgency and frequency: a sudden need you cannot ignore, or going “just in case” all day and night
- Pelvic pain: aching, burning, or pressure in the pelvis, pain with sitting, or tailbone pain
- Painful intimacy: pain during or after sex
- Constipation and straining, or a feeling that you never fully empty
- Pelvic pressure or heaviness, a feeling that something is dropping
- Pregnancy and postpartum changes, including abdominal separation (diastasis recti) and C-section scars
- Men’s pelvic floor problems: chronic pelvic pain, and leaking after prostate surgery
- Low back, hip, and SI joint pain that keeps coming back because the pelvis underneath it was never addressed
Before the pelvic floor comes the pelvis
When I assess the pelvis, I often find a movement or stability problem that the Kegels-only plan never addressed. Treating that can change what the pelvic floor is able to do. Think of your body as a house. The pelvis is the basement, the foundation everything sits on. The pelvic floor is the sling that hangs across the bottom of that basement and holds your bladder, your bowel, and in women the uterus, in place.
Now, what happens to that sling if the foundation has shifted, if the pelvis is tilted, rotated, or not holding up the way it should? The sling may not sit where it works best. Think of this as a simple picture, not a rule for every body: one side can end up working from a stretched position and the other from a shortened one. In many of the patients I see, the pelvic floor is weak, tight, or both, and the pelvis is part of why.
That is why, in my experience, working only on the pelvic floor, or only on the bladder or the bowel, without looking at the pelvis often does not hold. You can strengthen the sling, and that has real value. But if nobody looks at the frame it hangs from, the old pattern often comes back.
Why the pelvis was left out for so long
This is not something I was taught when I went to school in 1988. Much of the manual therapy we learned then came from the tradition of James Cyriax, the British physician often called the father of orthopaedic medicine. His teaching largely set the sacroiliac (SI) joint aside. In his 1954 textbook he wrote that “lesions of the sacroiliac joint are as rare as pain felt at the inner aspect of the buttock is common,” and he counted SI strain in women at about one in five hundred back pain patients.
For decades after that, attention went to the discs in the spine, and the pelvis became almost an afterthought. That view has changed. Studies using controlled diagnostic injections have found that the sacroiliac joint is the source of pain in roughly 10 to 27 percent of people with chronic low back pain in whom it is suspected (Pain Physician, 2009). The pelvis matters. It always did.
When the pelvis is unstable, other muscles take over
Your body will not leave the pelvis unsupported. When it is not stable on its own, other muscles start working to hold it together: the piriformis deep in the buttock and the TFL at the front of the hip. The TFL pulls on the IT band, the thick band of connective tissue down the outside of the thigh, so that tissue gets loaded too. None of them were meant to be full-time stabilizers. So the muscles tighten, they get tired, and the whole area starts to hurt. Your body is not broken. It is adapting, and those muscles are trying to protect you.
That is how one unstable pelvis can turn into buttock pain, hip pain, pain down the leg, knee pain, and low back pain, alongside the leaking, the pelvic pressure, or the pain with intimacy. It is also why the same people keep getting treated for each of those separately and never quite get better.
And there is the breath. Your diaphragm on top, your deep abdominal muscles in front, your spine behind, and your pelvic floor below all work as one pressure system. Every time you cough, lift, or pick up a child, they have to coordinate. When the pelvis at the bottom of that system is off, the pressure goes where the tissue is weakest.
What “fixing the pelvis” really means
I use the words “fixing the pelvis” because that is how most people understand it. But let me be clear about what it means, because it is not like straightening a picture frame.
There is no such thing as a normal pelvis. Every pelvis is unique: the shape, the angles, the way the two sides meet the sacrum at the back. Some people’s pelvis is less stable to begin with. And the reasons it becomes a problem are many. Childbirth can move the pelvis, and it never fully settles back. The hormones of pregnancy can leave the muscles that support it weaker. Some people were weaker there to begin with. So we do not spend your time hunting for one single reason. It is a mechanical problem, and we treat the mechanics.
Here are the mechanics in one sentence: a muscle can only work well from the right length. That is true of every muscle in your body: the pelvic floor, a muscle at your elbow, a muscle at your hip. Every muscle has an optimal range where it can contract, relax, and hold. If the pelvis has a torsion or a tilt, the muscles attached to it can end up working from a length that is too long on one side and too short on the other. Then they may not fire as well, and they can struggle to give you the stability you need. When we improve how the pelvis sits and moves, I often see the same exercises start to work better.
The pelvis also takes its influences from above. Large muscles like the latissimus dorsi run from your upper arm, across your back, and down into the thick connective tissue over your low back and pelvis. So the way your rib cage, shoulders, and upper back move changes what the pelvis has to do underneath them.
That is why we look at the whole pelvic alignment, the way you would look at the foundation when you check how stable a house is. Not as step one, step two, step three, step four, but as one picture. Some people have an unstable pelvis and tight pelvic floor muscles at the same time. Some have a pelvis that moves too much. Others have one that barely moves at all.
And some people surprise you. I have treated patients whose pelvic floor muscles were not tight at all. They had had two or three pelvic surgeries over the years, for different reasons, and scar tissue had built up. The pelvis was stuck in the wrong position, and the scar tissue was not letting it go. For them, no amount of pelvic floor exercise would have helped. The work was releasing the scar tissue and the restrictions around it, so the pelvis could move again.
So everything has to be addressed together: the pelvis, the muscles, the scar tissue, the breath, the body above it. I will be honest with you. We may not get you back to some perfect “normal,” because there is no perfect normal pelvis to go back to. But in my experience, improving how the pelvis moves and holds can reduce symptoms, often much more than people were told to expect.
How pregnancy, childbirth, and menopause affect the pelvis
Women are not small men. I say this often in our clinic. A woman’s pelvis is unique, anatomically and physiologically. It is built differently from a man’s, and it goes through things a man’s pelvis never will: pregnancy, labor and delivery, the hormonal shifts of every month, and later, menopause.
During pregnancy your body makes hormones, relaxin among them, that help loosen ligaments so the pelvis can open for birth. That is a good thing for delivery. But it also means stability changes, and the pelvic floor carries more of the load for months. Labor then stretches those muscles further. Many women are told at six weeks that they are cleared, and then they are on their own. The tissue is not always finished healing at six weeks. Many times it needs real rehabilitation, and nobody offers it.
Menopause brings its own change. Falling estrogen affects the tissue of the pelvic floor and the bladder, and symptoms that were mild for years can suddenly get worse. That is not a reason to give up on them. It is a reason to address them.
Men have a pelvic floor too
Here is the other half of the myth. Men have pelvic floor problems too. They just do not complain about them. We have run this clinic for a long time, and we rarely get a phone call from a man asking for help with a pelvic problem. We do see men for it, but usually the appointment was made by his wife, his girlfriend, or his mother. So if you are reading this for someone in your life, that is how it usually starts.
Every body has a pelvis and a pelvic floor, and men develop pelvic floor problems too. The most common ones we see are chronic pelvic pain (sometimes diagnosed as chronic prostatitis when there is no infection), groin and perineal pain, pain with sitting, and leaking after prostate surgery. Many men spend years going from test to test before anyone looks at the muscles.
The approach is the same as for women: start with the pelvis, then find out whether the floor is too tight, too weak, or out of coordination, and treat the whole system: breath, core, hips, and the tension pattern that keeps it locked. One of our patients, Jeffrey, came to us for groin discomfort. He left feeling much better and, in his words, understanding “how to use breathing exercises and physical exercises to increase my overall wellness and health.” That second part is what keeps it from coming back.
The Kegel mistake: tight is not the same as weak
If you have ever told anyone about a pelvic floor problem, somebody has told you to do Kegels. Squeeze and hold. And for a weak pelvic floor, strengthening does help.
But here is what I see over and over. Many people with pelvic floor symptoms do not have a weak floor. They have a floor that is too tight — a muscle that is already clenched all day and has forgotten how to let go. A muscle that cannot relax also cannot contract well, so it can leak anyway. It can spasm. It can hurt with sitting and with intimacy. And when that person does fifty more squeezes a day, the problem can get worse, not better.
I hear some version of this all the time. A woman tells me her doctor said, “You just have a grade one prolapse. It is not a problem. Go ahead and do your Kegels, and if it gets too bad, we will do the surgery.” Her doctor is not wrong: supervised pelvic floor muscle training is a recommended first option for an early prolapse, a pessary (a small removable support fitted by a doctor or nurse) is another good option for some women, and surgery is there if it is ever needed. But notice what that plan leaves out. It treats the symptom, and it waits. Nobody looked at the pelvis the organs are sitting in, or asked why the support is failing in the first place.
That is the impression so many people leave with: that there is one exercise, and after that there is surgery. My whole point is to show you there is much more you can do in between, because it is not one thing. It is the whole system.
And remember why the floor got that way in the first place. In many of the patients I see, the pelvis it hangs from is part of that story. Kegels work on the sling. On their own, they do nothing for the frame.
So the question is never “should you do Kegels?” The question is: what is your pelvic floor actually doing? Too weak needs strength. Too tight needs release first, then coordination. Most people need a mix. So in our clinic we focus on control, not intensity, and a good plan often starts with learning to relax before learning to squeeze.
What pelvic floor therapy looks like at Synergy in Carbondale
All of our pelvic floor treatment is external. We do not do internal exams. I want to say that clearly, because the fear of an internal exam keeps many people from ever getting help. Nothing is internal, you stay in control, and we go at your pace.
And it is not a compromise. Internal work is not necessary for the way we treat, because we start with the biomechanics of the pelvis itself, and that is the key part. I have done this for a very long time, and many women come in nervous because of what they experienced somewhere else. When they see what we actually do, the reaction is often: oh, wow, so this is what it takes.
Your first visit starts with a conversation. We talk about your symptoms, your history (pregnancies and births, surgeries, back or hip problems, your bladder and bowel habits) and what you want to get back to. Then we look at the whole system: how you breathe, how your ribs and diaphragm move, your posture, your deep core, your hips, and your low back.
We call our approach Whole Body Synergy Techniques, because we treat the pelvis, the pelvic floor, and everything connected to them as one system. From there, treatment usually includes:
- Fixing the pelvis first. We look at your whole pelvic alignment: how it sits, how it tilts, how the two sides and the SI joints move, what the upper body is doing to it from above, and whether it is stable enough that the overworked stabilizing muscles can finally stand down.
- Breath and diaphragm work, because the diaphragm and the pelvic floor move together. Learn to breathe well and the pelvic floor often starts to follow.
- Hands-on myofascial release of the abdomen, hips, low back, and the muscles that have been holding the pelvis together (the piriformis and TFL, and the IT band they pull on), and scar tissue from C-sections or other pelvic surgeries, to release the restrictions that keep the pelvis stuck and the floor guarded.
- Posture and movement retraining for how you sit, stand, lift, and carry.
- Core and pelvic floor coordination: strength where you need it, release where you need it, and timing so the system works together.
- Bladder and bowel habits, such as how to stop the “just in case” bathroom trips and how to sit and breathe so you are not straining.
- A simple home program, so the work keeps going between visits.
In the welcome talk for our pelvic floor workshop I put it this way: when your symptoms are reproducible, they are often reducible. If sitting, standing, lifting, or getting out of the car changes your symptoms, that is actually good news. It means there is a mechanical pattern we can find, and work on.
Real patient stories
Joanna came to us after a neurologist could not explain the numbness and tingling in her left foot and leg and suggested she “wait and see if it goes away.” When we evaluated her, it turned out to be connected to changes in her pelvis after her first pregnancy. She wrote: “I had many postpartum issues that I believed were just something all women have to live with after having children. After physical therapy at Synergy, my body was back in shape again! My pelvic problems were gone and I was even walking and running correctly.” She came back after each of her later babies to get her body back on track.
Frances came in with three concerns that often travel together but are rarely treated together: limited walking, balance problems, and minor incontinence. We treated them as one connected system. In her words: “I am able to walk farther. I am maintaining my balance so much better. No problems with minor incontinence now.”
Jelau is a mom of two young children. “The thing that sets this place apart from others is the focus on the fascia and the importance of the mind/body connection in healing. I feel much stronger, balanced, and better.”
Individual results vary. These are the experiences of specific patients and are not a prediction of your outcome.
You can read more on our patient success stories page.
Safety first
When to see your doctor first
Pelvic floor therapy is safe for most people, but some symptoms need a medical workup before, or alongside, therapy. Please see your doctor if you have:
- Blood in your urine or stool
- Pain or burning when you urinate, fever, or frequent urinary tract infections
- A new bulge you can see or feel at the vaginal opening
- Sudden loss of bladder or bowel control, being unable to pass urine or feel it passing, numbness in the groin, genitals, buttocks, inner thighs, or around the back passage, or new weakness in the legs. Go to an emergency department immediately.
- Unexplained weight loss, or pelvic pain that is getting steadily worse
- Any new pelvic symptom during pregnancy
In Illinois you can usually see a physical therapist directly, without a referral, although some insurance plans require one, and traditional Medicare requires your doctor to sign off on your therapy plan. We are happy to work alongside your OB, urologist, or primary care doctor.
What I want you to remember
- Leaking, urgency, pelvic pain, and painful intimacy are common, but they are not something you have to accept.
- Before the pelvic floor comes the pelvis. When the foundation moves and holds better, the floor has a better chance to work the way it should.
- Tight is not the same as weak. More Kegels is not always the answer, and “do your Kegels and wait for surgery” is not the only plan.
- At Synergy, pelvic floor therapy is external only, private, and at your pace.
- Men have pelvic floor problems too. It is fine to make the call for them.
Keep reading
Frequently asked questions
Do you do internal pelvic exams?
No. All of our pelvic floor treatment at Synergy is external. We start with the biomechanics of the pelvis itself, then work through breath, posture, the deep core, the hips, and hands-on myofascial release. Nothing is internal, and you stay in control of the pace.
What does “fixing the pelvis” mean?
It means restoring how your pelvis sits, moves, and holds itself stable. There is no single normal pelvis, so we look at your whole pelvic alignment, the muscles that have been compensating for it, the upper body above it, and any scar tissue from past surgeries that may be holding it in the wrong position.
Why do you treat the pelvis and not just the pelvic floor?
Because the pelvic floor hangs from the pelvis. If the pelvis is tilted, unstable, or not moving well, that can change how the pelvic floor works, and in many of the patients I see it is part of why the floor is weak, tight, or both. In our experience, treating only the pelvic floor, the bladder, or the bowel without addressing the pelvis usually does not last.
Is pelvic floor therapy embarrassing?
Almost everyone worries about this before the first visit, and almost everyone tells us afterward that it was much easier than they expected. We talk through everything before we do anything, the treatment is external, and nothing you tell us is anything we have not heard many times before.
Are Kegels enough to fix pelvic floor problems?
Not for everyone. Kegels strengthen a weak pelvic floor, but many people with pelvic pain, urgency, or leaking have a floor that is too tight rather than too weak, and more squeezing can make their symptoms worse. The first step is finding out what your pelvic floor is actually doing.
Can men get pelvic floor therapy?
Yes. Men have a pelvic floor too, and it can cause chronic pelvic pain, groin or perineal pain, pain with sitting, and leaking after prostate surgery. The treatment follows the same approach we use for women: we start with the pelvis, then work on the breath, core, hips, and releasing the tension pattern. And it is fine for his wife, girlfriend, or mother to make the call.
I was told I have a grade one prolapse and to just do Kegels. Is there more I can do?
Often, yes. Supervised pelvic floor muscle training is a recommended first option for an early prolapse, a pessary fitted by your doctor or nurse is another option for some women, and surgery is there if a prolapse ever becomes severe. But in between there is a lot that can be done: looking at how your pelvis sits and moves, how you breathe and brace, how you lift and strain, and whether scar tissue or tight muscles are part of the picture. Please see your doctor first if you notice a new bulge, bleeding, or trouble emptying your bladder.
How long does pelvic floor therapy take?
It depends on how long the problem has been there and what is driving it. Many people notice a change within the first few weeks, and a typical plan runs several weeks to a few months. Symptoms that have been present for years usually take longer, because the body has had longer to adapt around them.
Do I need a referral for pelvic floor therapy in Illinois?
Usually not. Illinois allows direct access to physical therapy, so most people can call us directly. Some insurance plans still ask for a referral, and with traditional Medicare your doctor will need to sign off on your therapy plan of care. We can check what your plan needs when you call.
Can pelvic floor therapy help after having a baby?
Yes, and it is never too late. Many women start around six weeks postpartum once their doctor has cleared them, and we also treat women whose symptoms began years or even decades after their last delivery.
Where can I get pelvic floor therapy in Carbondale, IL?
At Synergy Therapeutic Group, 1110 N Cedar Court, Carbondale, IL 62901. All of our pelvic floor treatment is external, and we see women and men from across Southern Illinois. Call (618) 243-7822 or book an evaluation online.
1110 N Cedar Court · Carbondale, Illinois
Start with the pelvis. We will take it from there.
External-only pelvic floor therapy for women and men across Southern Illinois. If you are making this call for someone else, that is how it usually starts.
Want the bigger picture first, like pain, sleep, stress, and how the whole body heals together? Read about our Synergy Healing Program.
Clinically reviewed by Subrat Bahinipati, PT on September 25, 2026. Last updated September 25, 2026.
References. Solonen KA. The sacroiliac joint in the light of anatomical, roentgenological and clinical studies. Acta Orthop Scand Suppl. 1957 (cites Cyriax, Textbook of Orthopaedic Medicine, 1954). · Rupert MP et al. Evaluation of sacroiliac joint interventions: a systematic appraisal of the literature. Pain Physician. 2009. · Dumoulin C et al. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2018. · Gordon AM, Huxley AF, Julian FJ. The variation in isometric tension with sarcomere length in vertebrate muscle fibres. J Physiol. 1966. · FitzGerald MP et al. Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes. J Urol. 2009. · Hodges PW, Sapsford R, Pengel LHM. Postural and respiratory functions of the pelvic floor muscles. Neurourol Urodyn. 2007. · National Institute for Health and Care Excellence (NICE). Urinary incontinence and pelvic organ prolapse in women: management (NG123). 2019. · American Association of Neurological Surgeons. Cauda equina syndrome.
Medical disclaimer. This page is for medical information and education only. It is not medical advice, and it does not replace an evaluation by your physician or a licensed physical therapist. Everyone’s body and history are different, so please talk to your healthcare provider about your own situation. If you have any of the warning signs listed above, contact your doctor first.