• Nashville PT

Male Pelvic Pain: There is a solution.

By: Sandy Gibson, PT, PRPC, CMPT (Certified Pelvic Floor and Manual Physical Therapist)


If you are a man who is suffering with pain or discomfort in the pelvis or genitals that may or may not be related to urination, bowel movements and sexual activity, you are not alone. Risk factors that may lead to this condition are excessive cycling or spin classes, rowing, weight-lifting, HIIT, sports that involve kicking such as soccer, as well as hockey. Overtraining, such as with marathon running and triathlons, can also cause dysfunction.




Men who have these symptoms are often diagnosed with Chronic Pelvic Pain Syndrome (CPPS). It is common, affecting at least 10% of men at some point in their lives, yet rarely discussed. Many physicians don’t understand or appreciate the connection of tension of the pelvic floor muscles and the role they play in causing other bladder and bowel symptoms. Most men find themselves going from doctor to doctor and searching the web to determine what is truly causing their symptoms. Many are misdiagnosed with “prostatitis” and prescribed antibiotics with no improvement. It may take months or years to find a health practitioner who is knowledgeable about this condition.




Common Symptoms

· perineal, scrotal, penile or anal pain, burning, itching

· urinary frequency and/or urgency

· pain or burning before, during or after urination

· frequent night-time urination

· hesitancy urine stream

· pain and difficulty during bowel movement followed by relief

· constipation, IBS, bloating and GI discomfort

· perineum, genital, low back, groin, lower abdomen, tailbone or pubic pain

· pain during and/or after ejaculation

· erectile dysfunction


These symptoms are different for each person, and typically change for each individual with time. Many experience multiple symptoms, but rarely have all of them. They can be intermittent or constant, can occur more during sitting than standing, and have varying degrees of intensity.


Male pelvic pain significantly effects the quality of a man's personal and work life as much or more than other more serious health conditions such as stroke or diabetes. Men feel hopeless and worry that they will never be able to resume the activities they love to do without causing more pain.


Pelvic Floor Muscles

The male pelvic floor muscles are comprised of 3 layers and make up a “hammock” shaped structure that attaches to the bony pelvis from the pubic bone back to the coccyx or tailbone. These muscles function to support the organs, maintain urinary and fecal continence and involved in sexual function during erection and ejaculation. The obturator internus muscles function to externally rotate and stabilize the hip and have fascial attachments to the pelvic floor muscles. It has been found that obturator internus plays an important role in normal function of the pelvic floor muscles. The transversus abdominus muscle works synergistically with the pelvic floor muscles and also has significant impact on normal function of the pelvic floor.

Nerve Supply to the Pelvis

The pudendal nerve is the primary nerve of the pelvis originating from sacral nerves S2-4 and innervates most all of the muscles of the pelvic floor to provide motor function. The sensory supply from the cutaneous (skin sensation) branches of this nerve supply the penis, perineum, scrotum and area near anus.


Why does this happen?

The cause of pelvic floor pain varies, but most often it is because the pelvic floor muscles get tight, which prevents them from being able to function correctly. Similar to having muscles in your neck and upper trapezius that get tight from poor posture and stress that can cause pain. And for some, tightness of the pelvic floor muscles may lead to irritation of the pudendal nerve that travels through the pelvic floor.


Prolonged compression of the pudendal nerve during incorrect sitting or bicycle riding can cause pain, itching and burning in the areas in the perineum and genitals innervated by this nerve. Other common reasons may be related to trauma such as a fall on your hip or buttocks, excessive or incorrect use of abdominal muscles during exercise such as Cross-Fit, weightlifting, and rowing.


Men who suffer from chronic constipation and have the need to bear down excessively during bowel movements may strain the lower abdomen and pelvic floor muscles causing these muscles to become tight. Obturator Internus (hip muscle) strain is associated with kicking sports and overuse in male athletes with initial complaint of groin pain.


Stress and anxiety also play a significant role in causing tightness in the pelvic floor muscles, as this is a common area in our body to hold stress related tension.


For some, symptoms do not come on immediately with these activities, but may take several weeks to develop as the muscles become tighter and tighter.


Most men realize when looking back, that it was actually multiple reasons or a domino effect if you will, that eventually lead to a worsening of symptoms.



Treatment

Pelvic floor physical therapy has been found to be effective in the treatment of pelvic pain syndrome as shown in a prospective study. This study showed that men had significant reduction of symptoms following a multimodal treatment approach of pelvic floor rehabilitation. It demonstrated that effective physical therapy assessment should include a whole-body approach to determine other musculoskeletal dysfunctions such as hip, SIJ obturator internus or abdominal muscles or low back issues that are contributing to the problem.


It is imperative that the pelvic floor physical therapist has received training specifically to treat men with pelvic floor dysfunction.


As an experienced pelvic floor physical therapist who has seen many men with pelvic pain, I understand that what you have been going through is very frustrating. It is difficult for you to even think about having one more visit with yet another person. Trust me when I say, that this will be the visit that will provide you with answers to your questions you have had, and a solid plan to focus on your specific musculoskeletal issues to get to the root of the problem. This will be done in a comfortable one-on-one setting, with a full hour to perform a thorough evaluation and explanation of your specific issues.


For more info, visit our pelvic floor page here or to schedule and appointment with Sandy at our Franklin or West Nashville office, click here. You can also reach out to Sandy via email (sandy@nashvillept.com) or schedule by calling/texting 615-428-9213.



Resources:

1.Masterson TA1, Masterson JM1, Azzinaro J2, Manderson L2, SwainS1, Ramasamy R1.(2017).

Comprehensive pelvic floor physical therapy program for men with idiopathic chronic pelvic pain syndrome: a prospective study. Transl Androl Urol. 2017 Oct;6(5):910-915. doi: 10.21037/tau.2017.08.17.


2.Anderson RU, Wise D, Sawyer T, Chan CA. Sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome: improvement after trigger point release and paradoxical relaxation training. J Urolog. 2006;176(4-Pt 1):1534-1538.


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