Chronic Pelvic Pain in Men
Much of the attention on pelvic pain is directed towards women, understandably. However, it is important to also consider male pelvic pain. Many men have pain for months or years before they can find a provider who is able to provide a diagnosis and appropriate treatment for their symptoms. I want to take some time to look at what the symptoms of male pelvic pain can look like, and what pelvic floor physical therapy can do to help. I also want to look at the difference between prostatitis and muscular pelvic pain and how they overlap.
In men, pelvic pain will often present with pain at the tip of the penis, behind or in the testicles, lower abdomen, and groin area. Often, when we see men in physical therapy, they have been treated with long-term antibiotics for assumed prostate infections. Looking at research, acute or chronic prostate infections are very much in the minority of pelvic pain cases. Most men presenting to their family practice, internal medicine, or urology providers do not have a prostate infection. In these cases, having a consultation with a pelvic floor physical therapist is the best referral. Pelvic floor physical therapists are able to assess the pelvic floor muscles, fascial tissues, and nerves that can cause chronic pelvic pain in men.
Increased tension in the pelvic floor muscles, abdominal wall, hips, and low back can put increased pressure on the arteries, veins, and nerves of the pelvic floor and organs. Decreased blood flow and increased tone in the muscles can irritate the nerves, reproducing the tip of penis, testicular, and lower abdomen pain. Trigger points in these muscles can also refer pain to these sensitive areas. Having a thorough assessment can help to start putting the puzzle pieces together of what is contributing to the pain and how to unravel it.
With the intersection of nerves, muscles, blood flow, and organs, being able to decrease the stress and anxiety of the unknown is important to validate what symptoms you are feeling. Being able to reproduce the pelvic pain with palpation of nerves or muscles can be relieving and help to decrease the hypervigilance of the nervous system. This hypervigilance comes naturally as the system is trying to solve a problem it hasn’t’ been able to solve.
With this in mind, starting with a program to calm the nervous system is important in unraveling pelvic pain. This program should include diaphragmatic breathing. From there, we want to increase muscle length through the pelvic floor and decrease pressure on the nerves and connective tissues in the pelvis. This will look different for every person depending on what he is experiencing.
If you are experiencing pelvic pain and have been on antibiotics without a change in symptoms, I highly recommend a consultation with a pelvic floor physical therapist. We can add additional insight into your symptoms with your other providers. Rarely is the prostate the cause of pain, it is usually everything surrounding it.