Male Pelvic Pain and Chronic Prostatitis

15% of adult men worldwide suffer from pelvic pain.

Male Pelvic Pain

Most men are suffering in silence with their pelvic pain. Often they will go to the urologist and participate in testing that returns with normal results. Then men don’t know where to turn and are left searching the internet for answers. A vast majority of these men have pelvic floor dysfunction and can benefit from pelvic floor physical therapy but may never find it if they don’t search for the right term. Pelvic floor dysfunction can have varying symptoms in men and are frequently misdiagnosed.

Symptoms Include:

  • Penile/scrotal/perineal/anal pain

    • “golf ball in the rectum”

    • “feel like sitting on a rock”

  • Pain within the perinueum region during sitting

  • Urinary urgency/frequency

  • Burning during or after urination

  • Erectile dysfunction (change in erectile quality, strength of ejaculation)

  • Post-ejaculatory pain

  • Painful bowel movements or delayed genital/bladder pain after bowel movements

  • Pain to the tailbone

Chronic pelvic pain is a complex problem in men that endures for 6 months or more and involves sensory, behavioral, and psychological processes contributing to pain presentations. Pelvic pain may be caused by prostatitis. 


The National Institute of Health categorization of Prostatitis:

  • I: Acute infection of prostate or bladder

  • II: Chronic bacterial prostatitis, usually with recurrent UTIs

  • III: Chronic prostatitis/chronic pelvic pain syndrome(CPPS) and possible voiding symptoms in the absence of UTI

  • IIIa: CPPS with inflammatory cells in prostatic secretions

  • IIIb: CPPS without inflammatory cells in prostatic secretions

Categories II, IIIa and IIIb have no active infection. 


Prostatitis is the third most common diagnosis of men under 50 presented to urologist annually, and 90%-95% of all “prostatis” diagnosis are actually male pelvic pain, showing the over diagnosis of actual prostatitis and the underdiagnosis of male pelvic pain. (2) If there is no infection, what’s going on?  Majority of research supports that the pelvic floor muscles are a major factor into male pelvic pain.   Each person is individual and it is essential that treatment is individualized.

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In a pelvic floor physical therapy assessment you can expect:

  • Performing a questionnaire related to your symptoms and medical history to include bladder, bowel, and sexual functioning, as these affect the symptoms of your pelvic floor

  • Postural and movement pattern assessment

  • Assessment of your hips, spine, abdominals and pelvic girdle as these can contribute to pelvic floor dysfunction

  • Depending on your complaints, an internal pelvic evaluation via the rectum may be indicated.  Not everyone needs to have internal evaluation.  If the patient is not comfortable with this exam, it is not required.

  • Why?  This is the best way to exam the pelvic floor musculature that can lead to your pelvic pain symptoms.  This exam is where strength, muscle tension, and muscle coordination is assessed.

  • Most importantly, you run the evaluation and you have the opportunity to proceed or terminate at any time.  The goal is to provide a safe comfortable environment to seek treatment.

Treatment for male pelvic pain can involve various therapy interventions:

  • Manual therapy for myofascial tissues

  • Therapeutic pain science education

  • Bladder/Bowel behavioral recommendations

  • Abdominal, hip, low back and pelvic floor muscle training with or without biofeedback

  • Postural training

  • Stress management strategies

  • Modalities for pain management

Check out these blog posts on success stories of men that resolved their pelvic pain with the guidance of pelvic floor physical therapy.

https://pelvicpainrehab.com/male-pelvic-pain/4603/prostatitis-pelvic-pain-physical-therapy/

https://pelvicpainrehab.com/male-pelvic-pain/4454/male-pelvic-pain-chronic-nonbacterial-prostatitis/

https://pelvicpainrehab.com/male-pelvic-pain/4454/male-pelvic-pain-chronic-nonbacterial-prostatitis/


References:

  1. Systematic Review of Acupuncture for Chronic Prostatitis/Chronic Pelvic Pain Syndrome. Qin Z, Wu J, Zhou J, Liu Z. Medicine (Baltimore). 2016 Mar;95(11):e3095.

  2. J Bergman and S Zeitlin, “Prostatitis and Chronic Prostatitis/Chronic Pelvic Pain Syndrome,” Expert Review of Neutotherapeutics 7(2007): 301-307

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