How pelvic floor physical therapy helps men with pelvic pain

In Male Interstitial Cystitis / Nonbacterial Chronic Prostatitis / Chronic Pelvic Pain Syndrome, Male Pelvic Pain, pelvic floor physical therapy by Elizabeth AkincilarLeave a Comment

By Elizabeth Akincilar, MPT, Cofounder, PHRC Lexington

In the past, when most folks in the medical community thought about pelvic pain, the assumption often was that it was due to pregnancy or labor and delivery, or something related to a woman’s menstrual cycle or reproductive organs. Thankfully, the medical community has come a long way. Within the community of medical providers who treat pelvic pain, it is common knowledge that all people can suffer from pelvic pain.  

 

The medical literature estimates that 8-12% of men will suffer with pelvic pain at some point in their lives. Pelvic pain in men was typically thought to be due to prostatitis, or inflammation of the prostate due to infection. Interestingly, prostatitis is the most common urologic diagnosis in men under 50 years old. Prostatitis can indeed cause pelvic pain, but, we now know that in many cases of pelvic pain in men, it is not due to dysfunction or pathology of the prostate. Pelvic pain in men is often due to causes other than the prostate, such as neuromuscular impairments (muscles, nerves, tissue). The National Institutes of Health classified Chronic Pelvic Pain Syndrome (CPPS) in men as follows: 

  • Chronic Pelvic Pain Syndrome I: formerly known as Acute Bacterial Prostatitis, defined as acute sudden pelvic pain, typically associated with fevers and other signs of infection as well as bacteria identified in urine or prostate secretions
  • Chronic Pelvic Pain Syndrome II: formerly known as Chronic Bacterial Prostatitis, defined as recurrent or chronic pelvic pain, associated with  bacteria identified in urine or prostate secretions, usually in the absence of fevers or other signs of infection
  • Chronic Pelvic Pain Syndrome III: formerly known as Non-Bacterial Prostatitis or Prostatodynia, defined as recurrent or chronic pelvic pain that is not associated with bacteria identified in urine or prostate secretions. CPPS III may be subdivided into type A, when inflammatory cells are found in urine or prostate secretions and type B, when inflammatory cells are NOT found in urine or prostate secretions
  • Chronic Pelvic Pain Syndrome IV: presence of inflammatory cells in urine or prostate secretions in the absence of any symptoms

CPPS III is by far the most common found in clinical practice. Yet, men are still over prescribed antibiotic therapy in the absence of infection.

 

Those with CPPS III, particularly type B, are the most appropriate to see a pelvic floor physical therapist. 

 

Common symptoms of CPPS include

 

  • Pelvic pain: can be burning, shooting, aching, and/or itching in nature in the lower abdomen, groin, buttocks, and/or inner thighs
  • Genital pain: can include scrotal, testicular, and/or penile pain 
  • Perineal and/or anal/rectal pain
  • Urinary dysfunction: can include urinary frequency, urgency, hesitancy, incomplete emptying, pain, and/or dribbling
  • Bowel dysfunction: can include pain with bowel movements, constipation, incomplete emptying, gastrointestinal distress, and/or bloating
  • Sexual dysfunction: can include erectile dysfunction and/or pain before, during and/or after ejaculation
  • Pain with sitting, particularly in the perineum and/or “sit bones”
  • Pain with exercise, particularly with squatting or heavy lifting

 

Common causes of CPPS

 

  • Excessive sitting, such as with cycling, horseback riding, or long periods of required  sitting
  • Surgical trauma: inguinal hernia repairs, vasectomy, benign prostatic hyperplasia (BPH) interventions
    • For further explanation on how inguinal hernia repairs can contribute to pelvic pain, check out this blog!
  • Orthopedic injuries or trauma: spine, knee, ankle and/or other orthopedic pathologies
  • Biomechanical or structural dysfunction: hip dysfunction, leg length discrepancy, sacroiliac dysfunction
  • Excessive exercise or change to exercise routine
  • Excessive and aggressive sexual activity and/or aggressive lengthening of the penis, also known as jelqing
  • Chronic constipation or straining with bowel movements
  • Chronic infections, such as bacterial prostatitis or sexually transmitted infections

 

How to manage CPPS

 

  • It’s important to consult with your urologist to rule out a prostate infection and/or any other pathology that should be treated medically
    • Check out this interview with urologist Dr. Joshua Gonzalez for more information!
  • Schedule an evaluation with a pelvic floor physical therapist
  • If you have discomfort sitting and your occupation requires a lot of computer time, consider using a standing desk
  • If you have discomfort with sitting, consider using a pressure relieving cushion to minimize compression of the pelvic floor structures
  • If you have increased discomfort with exercise, talk to your physical therapist about how to modify your exercise program
  • Incorporate a daily mindfulness meditation practice

 

Whether you recently developed symptoms consistent with CPPS or you have persistent symptoms and haven’t yet found relief, there is hope. There are treatment interventions available to alleviate your symptoms. Often successful treatment is achieved through a combination of therapies initiated at the right time. Working with a team of providers who are well versed in treating pelvic pain is paramount. That team of providers typically includes a urologist, a pain management specialist, a mental health specialist, and, most importantly, a pelvic floor physical therapist. It’s important to find a pelvic floor physical therapist who is comfortable treating men with pelvic pain, as not all are.

 

Check out these success stories for inspiration!

 

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Are you unable to come see us in person in the Bay Area, Southern California or New England?  We offer virtual physical therapy appointments too!

 

Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.

In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page

Melissa Patrick is a certified yoga instructor and meditation teacher and is also available virtually to help, for more information please visit our therapeutic yoga page

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