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Stop Blaming the Prostate for Male Pelvic Pain

Dr. Kathryn Fife PT, DPT


Chronic male pelvic pain symptoms have too long been blamed on the prostate. Chronic male pelvic pain is a cluster diagnosis consisting of debilitating pain in the groin, scrotum, testicles, and perineum. These cluster symptoms are often blamed on prostatitis or inflammation of the prostate.

It is true that these symptoms can occur with prostatitis but often if a culture is done it comes back negative. The culture is testing for infection in the prostatic fluid. They will then get a diagnosis like chronic male pelvic pain or non-bacterial prostatitis. This subsection of men often do not receive relief from treatment from medical management because the underlying cause of their pain rests within their muscles…. their pelvic floor muscles. This is where pelvic floor physical therapy can play a huge role in helping these men manage and improve their symptoms.

Pelvic floor Physical Therapists are specifically trained to treat multiple aspects of male pelvic pain. Before you can truly understand the etiology of this pain syndrome you need to know a little bit more about the pelvis, its anatomy, and the muscles within.

The pelvic floor creates a hammock of muscles within the pelvis that:

● support the organs
● contract to compress lymph nodes which remove inflammation from the pelvis and lower extremities
● sexual functioning including orgasm and erection
● bowel and bladder sphincter control and support
● a major abdominal stabilizer

These muscles are unique in the sense that they are sympathetically innervated. This means that stress and poor sleep hygiene have a large effect on the tension that these muscles hold.

In male chronic pain, we often see hypertonic- or really tight immobile fibers of the pelvic floor. This results in pain with erection or inability to achieve an erection, pain with orgasm, pain due to compression of nerves that traverse the pelvic floor and pelvic cavity, difficulty completely emptying your bladder, and pain in your perineum and pelvis due to decreased clearance of inflammation that leads to chronic inflammation.

During physical therapy treatment we work on normalizing the tone of the pelvic floor. Getting the muscles to move appropriately. This is done through manual techniques such as abdominal manipulation that assists clearance of inflammation and encourages relaxation in the pelvic floor. The nerves that innervate your pelvis come out of the most inferior portion of your spine-mobilizations of that sacrum and nerve gliding can be beneficial.

It is often recommended that men stop biking or horseback riding as the direct compression on the perineum can result in compression of your pudendal nerve that innervates your pelvic floor and testicles.

There are lots of other techniques that help patients regain normal tone in their pelvic floor to decrease their symptoms of pelvic pain. Treatments also include education on general health including sleep hygiene and optimizing your circadian rhythm as we know that improving this regulates our sympathetic nervous system which highly innervates our pelvic floor.