Pain that builds when I sit
Worse on firm chairs and while driving, and usually easier when you stand, walk or shift your weight.
Levator ani syndrome often feels like a dull, gripping ache deep in the rectum, or like sitting on a golf ball. It builds with sitting and can flare after bowel movements, stress or travel. The pain may also reach the tailbone, perineum or genitals.
The levator ani is the main muscle group of the pelvic floor. It includes the puborectalis, which loops around the rectum. In this condition the muscle usually becomes guarded and oversensitive. Trigger points, which are tight spots that send pain elsewhere, can form here and in nearby hip muscles. Nearby nerves can also become sensitive, which is why the pain map can seem inconsistent.
I treat the pelvic floor and hip muscles with dry needling, a form of acupuncture. Needling the levator ani and obturator internus helps ease their grip on the pudendal nerve, which runs right alongside them. The aim is to lower tension, calm the tissue, and gradually increase how long you can sit comfortably.
Most people have had imaging or an endoscopy, and sometimes medication. Those tests rule out serious disease, but they don’t measure muscle tension, trigger points or nerve sensitivity. Medication may ease symptoms for a while without changing why the pelvic floor stays reactive. Surgery usually isn’t indicated, because the problem is commonly soft tissue rather than a structural lesion. Strengthening programs can add tension when the muscle is already tight. In New York, pelvic floor PT for rectal pain can’t include needling, because the state doesn’t permit PTs or chiropractors to dry needle.
I start by asking what sets off your pain, how long you can sit, and what testing you’ve already had. Then the exam:
I work alongside your primary care doctor, gastroenterology and pelvic floor PT. If something on exam suggests your GI doctor or primary care should take another look, I’ll say so and share my notes.
It can feel similar, but levator ani syndrome usually comes from pelvic floor muscle tension and trigger points rather than the bowel itself. Many people have normal GI testing. That testing still matters, so I want to know what has been done.
If the pelvic floor is already tight and slow to relax, strengthening can add tension and make symptoms worse. I focus first on helping the muscles relax and coordinate. Strength work comes later, and only if it helps.
I needle the trigger points and tight muscle that reproduce your pain. Depending on the exam, that includes the pelvic floor, obturator internus, inner thigh, glutes and lower abdomen. Softening the levator ani and obturator internus also relieves pressure on the pudendal nerve beside them.
Yes. Imaging isn’t designed to show muscle tension, trigger points or nerve sensitivity. Those are found on a hands-on exam, and they can be treated.
Mild soreness or a brief increase in symptoms can happen when irritable tissue is treated. I’ll give you heat, gentle movement and pacing strategies for this. If a flare is intense or lasts, tell me and I’ll adjust the plan.
See a doctor promptly for rectal bleeding, fever, unexplained weight loss, a new lump or mass, or new numbness or weakness. Rapidly worsening symptoms also need medical evaluation before needling.
Adults with pelvic floor, nerve and orthopedic pain, along with neurological conditions. Most of my patients come to me after other care hasn't fully settled things. If you're looking for general wellness acupuncture, I'm not the right fit.
We review your history and what you've already tried. I assess the muscles and nerves involved, and you're treated the same day.
It depends on the condition. Pelvic and orthopedic plans usually run 4 to 6 weeks. Neurological plans are usually 2 visits a week for 6 weeks or 3 a week for 4. After that, visits space out so the changes hold. These are typical timelines, not promises.
Yes. I work alongside doctors, physical therapists and specialists. If something I find needs a closer look from one of them, I'll tell you.
I'm an out-of-network provider. You pay at the time of your visit, and my office submits the claim so any reimbursement comes to you. Free benefit checks are available before your first visit through the verification form, and HSA and FSA cards work. I don't take Medicare or Medicaid, though some Medicare Advantage plans reimburse out-of-network care. Full insurance details
Yes. I treat adults, teens and children, though I don't specialize in infants or toddlers.
Yes. Book a free discovery call to ask your questions and see whether we're a good fit.
Dry needling is a form of acupuncture. Fine needles go into tight bands of muscle and trigger points to lower muscle tension and change how the area is signaling.
You may feel a brief twitch or a deep ache as the needle reaches tight muscle. It passes quickly, and any soreness afterward usually fades within a day or two.
It's generally safe with a properly trained practitioner. Needles are sterile and single-use, and I check your health history first, including blood thinners. In New York, dry needling can only be performed by licensed acupuncturists, MDs and DOs. Physical therapists and chiropractors aren't permitted to perform it.
Eat something light beforehand and wear loose clothing that lets me reach the area being treated.
Usually not. Ultrasound helps in a few specific cases, but it hasn't been shown to improve results for common trigger points. A careful hands-on exam is what guides the needle. More on ultrasound-guided dry needling
Dry needling aimed at the pelvic floor and the hip and abdominal muscles around it, for pain, tension and urinary symptoms driven by those muscles and their nerves. More on pelvic floor dry needling
Sometimes, depending on the muscles involved, and you'll be draped throughout. Treatment always follows your consent and comfort. I don't do internal exams or internal treatment.
No, though it helps if you've already seen a doctor or pelvic floor physical therapist. Bring any notes or imaging you have.
Completely. I've heard it all, and there's no judgment here, just a straightforward conversation so we can treat what's going on.
Yes, I treat adults of every gender and identity. After gender-affirming surgery involving the pelvis, bring your surgical notes and we'll decide together what fits.
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Evidence-based acupuncture and dry needling on the Upper West Side. From chronic pain and headaches to pelvic floor dysfunction, Dr. Jordan Barber pairs the highest level of training with care that actually listens.
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