Success Story! How Josh recovered from Chronic Pelvic Pain Syndrome (CPPS)

In Male Interstitial Cystitis / Nonbacterial Chronic Prostatitis / Chronic Pelvic Pain Syndrome, Male Pelvic Pain by Cambria Oetken

By Cambria Oetken, PHRC Westlake Village



June is Men’s Health month, and men suffer from pelvic pain too. Research shows that up to 16% of men suffer from Chronic Pelvic Pain Syndrome (CPPS) at some point in their life. However, we suspect this number is lower than the actual prevalence because it is so commonly misdiagnosed as a bacterial infection aka prostatitis. In today’s post we are going to share an all-too-common problem men face and the pelvic floor physical therapy solutions. Keep reading through the end to hear what Josh had to say in his own words. 





Josh is a 27-year-old male who came to PHRC with a 3-year history of the following symptoms:

  • Urinary urgency and frequency
  • Splitting of urine
  • Urinary incontinence 
  • Post void dribble 
  • Groin pain that radiates into the penis (pelvic pain)


Josh also had decreased libido due to fear of urgency following intercourse and increased anxiety levels about his condition. Josh works full time, which requires him to enter and exit a work truck multiple times throughout the day, which would aggravate his symptoms and even cause urinary incontinence. Josh was an avid soccer player, winning championships in his career, which did lead to injuries including hamstring and adductor strains on several occasions. Josh now plays soccer recreationally but has stopped for several months due to worsening of his symptoms. Josh had seen multiple physicians over the years who told him he had prostatitis despite negative findings in urinalysis and blood tests. Josh was put on multiple rounds of antibiotics to “treat” his prostatitis, but none of which were helpful. Josh had to urinate every 5 minutes with only a few drops coming out at a time, which then led him to dig deeper into what he was dealing with. Upon discovering through his own research that pelvic floor muscles could be driving his symptoms, he stumbled upon Pelvic Health and Rehab Center and decided to seek treatment. 


Josh’s Goals

  • Determine if his pelvic floor muscles were the driver of his symptoms 
  • Decrease pelvic pain and discomfort (pain relief)
  • Work a full day without urinary urgency interrupting 
  • Return to soccer


Physical Findings:


Upon physical examination, physical findings include myofascial restrictions to:

  • Medial thigh hip flexors (iliacus)
  • Deep hip rotators (obturator internus and piriformis) 
  • Gluteal muscles
  • Myalgia and restrictions to the right ischiocavernosus and bulbospongiosus (some of our pelvic floor muscles) 
  • Difficulty performing a “pelvic drop” 
  • Difficulty relaxing his pelvic floor muscles after completing a pelvic floor contraction
  • Decreased hip internal and external rotation mobility

Plan and Outcome

The findings listed above likely began following injuries to his right hamstrings/adductors and a lack of stretching and mobility over the years that was not prioritized during his soccer career. Beginning his job a few years ago led to increased stress and anxiety levels, likely exacerbating his physical symptoms to appear 3 years ago. We call this the “perfect storm”.


To start, I provided Josh with a home exercise program that included:

  • Diaphragmatic breathing with pelvic floor drops 
  • Pelvic floor relaxation exercises to target his areas of restrictions and pain
  • Happy baby pose
  • Child’s pose
  • Piriformis stretch
  • Adductor rock backs 
  • Foam rolling to his inner thighs, hamstrings and glutes 


After a few sessions, Josh began to notice a stronger urine stream and did not notice his symptoms worsened as much toward the end of his work day. On Josh’s 4th visit he reported he had a period of normalcy and only urinated 3 times during his work day whereas previously he had to go up to 20 times during his day.


Chronic Pelvic Pain Treatment included:

Manual therapy

including myofascial manipulation and connective tissue mobilization to UGT, medial thighs and deep rotators

Motor control training

to pelvic floor muscles to improve pelvic floor drops. 


on the nervous system’s involvement in the pain cycle


“Explain Pain” pages 

Body scans

to bring awareness of increased clenching through the glutes and abdominals


Progression of Home Exercise Program:

  • At home symptom management (massage gun, heat, stretch routine)
  • Single leg strength training and stability to prepare for a safe return to soccer
  • Dynamic warm up and cool down routine for soccer


Through Josh’s commitment to his home exercise program and consistency with physical therapy sessions, in 3 months he was able to have the confidence and ability to try soccer again, and in 4 months was playing symptom free, without fear and discomfort. Being able to be a part of his treatment team after getting his chronic pelvic pain diagnosed is something we are grateful for! Chronic pain can be tricky to diagnose without a multidisciplinary approach.




Josh’s Story:


My journey with Chronic Pelvic Pain Syndrome began in 2019 when one day I just had the urgent need to urinate more than 10 times per hour, sometimes going more than 60 times per day. As per usual my first instinct was to make an appointment with my doctor to determine the cause of it. After testing negative for bacteria with a urine culture I was told that I needed to take antibiotics and it left me wondering if this was necessary. I eventually took the first round of antibiotics and it did nothing, went back with my doctor and again after testing negative for bacteria in a urine culture I was given Bactrim and this seemed to do the trick because my urge was completely gone. Unfortunately they only helped for so long*, the symptoms eventually returned once more and it took a complete toll on my life as I was crushed mentally dealing with it. My Dr. told me there was nothing he could do at this point and referred me to a Urologist who eventually also prescribed an antibiotic, which was Cipro. After reading and researching on my own I decided not to take it because of the very bad side effects and also because I previously had taken other antibiotics with no great help or any help. At this point I was desperate to find a solution. On doing my own research I found that I could potentially have Chronic Pelvic Pain Syndrome and researched clinics around my area that would take me in. Unfortunately many do not treat men, but I was able to find Pelvic Health and Rehabilitation Center and they were able to take me in. They completely changed and gave me my life back. Upon finding that my urinary issues were due to Chronic Pelvic Pain Syndrome was a complete sense of relief because I knew I had finally found an answer to my problem. I had finally got the answers that I had been looking for.

My Chronic Pelvic Pain Syndrome originated from my early years of playing sports causing my muscles to tighten up as well as sitting for long periods at work and also due to stress. Cambria has been amazing at treating my condition, she is very knowledgeable in this and in any questions that may come up she has the answers. With her help and techniques that I have acquired from PHRC I have better outlook for the future knowing there is a solution to Chronic Pelvic Pain Syndrome. I will forever be grateful for the center for doing what they have done and continue to treat myself and other patients.


* The reason Bactrim temporarily helped Josh is because it is what is called a “broad-spectrum” antibiotic. When it is indicated people usually have a pain-causing infection and this medication includes an analgesic (pain reducing) component in addition to the antibiotic to fight the infection. This gives our patient the false sense that they have an infection because the analgesic may reduce their chronic pelvic pain symptoms while they are taking the medication.


Check out our recently published e-book titled “Vulvodynia, Vestibulodynia, and Vaginismus,” designed to empower and inform individuals on their journey towards healing and understanding.

Did you know we opened our 11th location in Columbus, OH? Now scheduling new patients- call (510) 922-9836 to book!

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What are pelvic floor muscles?

The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.

What is pelvic floor physical therapy?

Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.

What happens at pelvic floor therapy?

During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.

What is pudendal neuralgia and how is it treated?

Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.

Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.

What is interstitial cystitis and how is it treated?

Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.

Who is the Pelvic Health and Rehabilitation Team?

The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.

How many years of experience do we have?

Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.

Why PHRC versus anyone else?

PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.

Do we treat men for pelvic floor therapy?

The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.

Do I need pelvic floor therapy forever?

The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.