Male Pelvic Pain can present as genital (penis, testicular), rectal, lower abdominal, gluteal, hip, or pelvic pain. Often other symptoms are present along with pain including urinary symptoms, bowel symptoms, or sexual dysfunction.
While pelvic floor physical therapy is becoming more well-known, there still is a lack of public awareness of pelvic floor physical therapy for men. This post will touch briefly on pelvic floor physical dysfunction specifically related to Chronic Prostatitis/Chronic Pelvic Pain Syndrome and Pelvic Floor Physical Therapy for men.
Prostatitis
Prostatitis is a common disorder affecting 10% to 14% of men in Europe and the USA (13). Many people assume Prostatitis affects older men however “Prostatitis” like symptoms are the most common urological cases seen in men less than 50 years old (7). According to the National Institute of Health (NIH), male pelvic pain is classified as “chronic prostatitis” however the prostate isn’t always the main culprit. The two main clinical features of “prostatitis” are pelvic pain and lower urinary tract symptoms however there can be a wide range of clinical presentations (1, 3, 5). Let’s look briefly at how the NIH classifies the different types/categories of prostatitis:
Category I: acute bacterial prostatitis: an acute infection of the urinary tract Category II: chronic bacterial prostatitis: recurrent infection of the prostate Category III: chronic non-bacterial prostatitis AKA chronic prostatitis / chronic pelvic pain syndrome (CPPS): May or may not occur with inflammation.
Category IV: asymptomatic prostatitis: higher levels of white blood cells typically with no genitourinary symptoms.
Categories I and II are due to a bacterial infection of the prostate (accounting for about 8–10% of cases). Typically, Categories I and II are treated with antibiotics with evidence demonstrating ability to clear things up/acceptable treatment 40-90% of time (9, 10).
For Category IV, minimal-to-no genitourinary symptoms are present however white blood cells are in the prostatic secretions/tissue. This is an uncommon type of prostatitis in which the prostate may be inflamed but men do not have other symptoms typical of other forms of prostatitis, and usually treatment is not necessary.
Category III is the most common category with 90-95% of persistent pelvic pain cases classified as Category III. This category has relevance to pelvic physical therapy in men and is NOT a bacterial infection. Male patients in this category have neurological or myofascial causes/contributions to their symptoms and hence would benefit from pelvic physical therapy services from a highly trained/specialized pelvic physical therapist.
I need to stress that it is VERY IMPORTANT to consult with a urologist or qualified practitioner if you have the symptoms described below/think you may have prostatitis. The urologist will implement strategic diagnostic procedures (if necessary) and perform an in-depth exam to accurately diagnose and treat based on your results. I would recommend consulting West Texas Urology if you are local to the Midland/Odessa area.
As mentioned earlier, greater than 90% of “prostatitis-like symptoms” fit more appropriately under the term chronic pelvic pain syndrome (11, 12). Let’s discuss briefly how these symptoms may present in men.
Symptoms
This type of pelvic dysfunction in men can cause a variety of symptoms such as urinary/bowel complaints, sexual dysfunction, or pain (groin, genital, pelvic, etc.). Symptoms often include but are not limited to:
Bladder symptoms
Urgency or strong urge to urinate
Urinating frequently
Hesitancy with urination
Changes in stream
Pain during urination
Feeling of incomplete bladder emptying
Bowel symptoms
Increased frequency of bowel movements
Constipation
Difficulty emptying bowels
Pain before/during/after bowel movements
Strong Urge for bowel movements
Sexual Dysfunction
Erectile dysfunction
Pain with arousal/intercourse
Pain with ejaculation
Premature Ejaculation
Difficulty maintaining or sustaining an erection
Genital pain
Testicular pain
Penile pain
Perineal pain aka taint pain (area between testicles and anus)
Anal/Rectal pain
Pain in the anus or rectum
can cause pain or trouble with bowel movements
Often times people report a feeling of “golf ball in rectum” or “feel like sitting on a rock”
Other
Other symptoms such as musculoskeletal complaints: hip pain, groin pain, tailbone pain, abdominal pain (often lower belly near pubic bone), or low back pain.
If you are a male and experiencing any of the symptoms above, musculoskeletal dysfunction of the pelvis and pelvic girdle may be the cause! Let’s briefly discuss the male pelvis and how dysfunction can cause these symptoms.
The Male Pelvis
The male pelvic floor muscles attach to the front, back, and sides of the pelvis and have several important roles relating to overall body functions. The muscles, tissues, and nerves support the bladder, prostate, bowel, and other pelvic organs and allow for proper urination, defecation, and sexual intercourse. The muscles of the pelvic floor contract and relax just like any other muscles in the body. These pelvic floor muscles can also develop dysfunction like any other muscle in the body (i.e. muscle spasm, tightness, weakness, impaired coordination) which typically lead to symptoms mentioned above. A highly trained pelvic floor physical therapist (with experience/specialty certification treating men) can work to help reduce these symptoms and restore normal functioning of the pelvic floor/pelvic girdle region associated with Prostatitis/Chronic Pelvic Pain Syndrome.
Pelvic Floor Physical Therapy for Men with Prostatitis
The first visit or PT Evaluation will be detailed and targeted at getting all necessary subjective and objective information that determines the cause and contributing factors to each individual patient’s complaints. By the end of the PT evaluation the physical therapist will discuss the findings of evaluation, work with you to develop a plan of care, and get you started on a beginning home program to work towards reducing your complaints and restoring optimal functioning. Your home program is individualized to you and could consist of exercises, stretches, and behavioral modifications to get you closer to being pain and symptom free.
Follow up pelvic floor physical therapy visits can involve several different therapy techniques such as:
Myofascial release
Coordination Exercises/Training
Therapeutic Exercise
Manual therapy
Relaxation Exercises
Diaphragmatic Breathing
Behavioral Recommendations
Postural Education/training
Biofeedback
Education/training on home exercise program
Modalities (e-stim, TENS, ultrasound, dry-needling, etc.)
Compliance with your home exercise plan in combination with specialized pelvic physical therapy intervention can help you restore proper functioning and diminish symptoms.
For information on how to schedule an evaluation at COM Physical Therapy or for specific questions regarding pelvic physical therapy services please call 432-618-9952 or email amoe@comaquatics.com. Amanda Moe, PT, DPT, PRPC is in network with major insurance providers and is available for Monday-Friday with flexible appointment times to meet your scheduling needs.
References
1) Krieger JN, Nyberg L, Nickel JC (1999) Consensus definition and classification of prostatitis Journal of American Medical Association 283 (3) 236-237
2) Schaeffer, A. Chronic Prostatitis and the Chronic Pelvic Pain Syndrome N Engl J Med 2006; 355:1690-1698 October 19, 2006
3) Schaeffer AJ: Prostatitis: US perspective. Int J Antimicrob Agents 1998, 10:153–159.
4) Roberts RO, Lieber MN, Bostwick DG, et al.: A review of clinical and pathological prostatitis syndromes. Urology 1997, 49:809
5) Dorey, G. (2006). Pelvic dysfunction in men. 2nd ed. Chichester, England: John Wiley & Sons, pp.44-64.
6) Nickel JC. Prostatitis. Can Urol Assoc J. 2011;5(5):306-315. doi:10.5489/cuaj.11211
7) Collins, M.M., Stafford, R.S., O’Leary, M.P., & Barry, M.J. (1998). How common is prostatitis> A national survey of physician visits. The Journal of Urology, 154 (4), 1224-1228
8) Doiron, R., Shoskes, D., &Nickel, J.C. (10`9). Male CP/CPPS: Where do we stand? World Journal of Urology, 37, 1015-1022.
9) Bowen, D. K., Dielubanza, E., & Schaeffer, A.J. (2015). Chronic bacterial prostatitis and chronic pelvic pain syndrome. BMJ Clinical Evidence, 2015 (1802), 1-30.
10) Rees, J., Abrahams, M., Doble, A., & Cooper, A. (2015). Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline. BJU International, 116 (4), 509-525
11) Magistro, G., Wagenlehner, F., Gra, M., Weidner, W., Stief, C., & Nickel, J.C. (2016) Contemorary management of chronic prostatitis/chronic pelvic pain syndrome. European urology, 69 (2), 286-297
12 )Anothaisintawee, T., Attia, J., Nickel, J.C., Thammakraisorn, S., Numthavaj, P., McEvoy, M., &Thakkinstian, A. (2011). Management of chronic prostatitis/chronic pelvic pain syndrome. JAMA, 305 78-8y6.
13) Bajpayee P, Kumar K, Sharma S, Maurya N, Kumar P, Singh R, Lal C. Prostatitis: prevalence, health impact and quality improvement strategies. Acta Pol Pharm. 2012 Jul-Aug;69(4):571-9. PMID: 22876597.
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