Male Pelvic Pain Syndromes

Pelvic pain syndromes encompass several conditions that cause pain throughout the pelvis and can also cause difficulty with bowel, bladder and sexual function. The following information discusses pelvic pain from the physical therapy perspective.

Musculoskeletal Dysfunction Resulting in or from Pelvic Floor Disorders

Pelvic floor disorders commonly result in a referral pain pattern—that is, the pain radiates into the low back, thighs, and into the suprapubic, abdominal, and pelvic region. The pain may start in one small area, but because the pain persists (and usually for a prolonged period of time), it may cause hypersensitivity and can spread to any or all of the above-mentioned referral areas. Persistent pain may cause increased sensitivity in the local nerves and could potentially spread to the central nervous system (called central sensitization).

From Heal Pelvic Pain by Amy Stein, PT

Conditions of the Prostate

  • Prostatodynia or Chronic Pelvic Pain Syndrome (CPPS):
    Terms used for unexplained chronic pelvic pain associated with either (1) nonspecific voiding symptoms and/or pain located in or around the groin, genitalia, or perineum, or (2) the absence of pus and bacteria in the urine, with or without excess white cells or bacteria, on results from tests of the prostate fluid in male patients.
  • Prostatitis:
    Prostatitis is any type of inflammation of the prostate gland. In 1999, the National Institutes of Health identified prostatitis in four different categories:
    • Acute bacterial prostatitis:
      An acute infection of the urinary tract. Symptoms include fever, chills, pain in the low back and genital area, body aches, urinary frequency, nocturia (nighttime frequency), painful urination (typically burning), and possible penile discharge. See your health-care provider immediately for antibiotic treatment if you suspect you have this condition.
    • Chronic bacterial prostatitis:
      Recurrent infection of the prostate. This condition is rare (less than 5 percent of patients diagnosed). The symptoms mimic intermittent acute bacterial prostatitis. The treatment is a prolonged course of antibiotics. Men with this condition may require physical therapy if antibiotics don't help. Recurrent infections may be caused by incomplete urinary evacuation or by prostatic stones.
    • Chronic nonbacterial prostatitis/chronic pelvic pain syndrome (CPPS)/pelvic myoneuropathy:

      May or may not occur with inflammation. Symptoms include discomfort or pain in the pelvic region including back, rectum, and/or penis. CPPS is also commonly associated with urinary symptoms, sexual difficulties, and pain with sitting.

      This condition is considered chronic as it lasts longer than 3 months. Antibiotics typically DO NOT help with this diagnosis. This condition may be caused by myofascial trigger point pain or nerve inflammation. Treatment includes physical and behavioral therapy.

    • Asymptomatic inflammatory prostatitis:
      Typically, a person with this condition has no genitourinary symptoms, but higher levels of white blood cells have been identified during evaluation. Prostate cancer needs to be ruled out through a PSA (prostate-specific antigen) test given by your urologist.
  • Proctalgia Fugax:
    This is another condition of pelvic pain that has been described as an "anal Charlie horse." Typically, this occurs after sexual activity and is characterized by a brief but painful spasming of the pelvic floor muscles.
  • Levator Ani Syndrome:
    Pain, pressure, or ache in the tailbone, rectum, and pelvis. The symptoms may be intensified by prolonged sitting, sexual activity, defecation, and constipation. The pain may refer to the legs, tailbone, or buttocks. Severe, sharp burning or aching with urination may also occur. This is caused by unusual tension in the levator ani muscles.
  • Anismus:
    This is an inability to penetrate the rectum due to spasmed muscles such as internal and external anal sphincters and the levator ani muscles. It causes increased difficulty when voiding and leads to constipation.
  • Coccydynia:
    Pain in and around the region of the coccyx bone or tailbone is called coccydynia. It may involve the pelvic floor muscles, the coccygeus muscle, and/or the gluteus maximus muscle.
  • Pudendal Neuralgia:
    The pudendal nerve originates from the sacral plexus and supplies motor and sensory control to the genital region. It supplies sensation to the rectum, perineum, vagina, labia, clitoris and urethra, male scrotum and penis. The motor branch of the nerve controls the sphincters of the rectum and urethra as well as the pelvic floor muscles. Neuralgia refers to pain caused by irritation of the nerve. In the case of pudendal neuralgia, pain can be experienced in the distribution of the pudendal nerve as mentioned above. It may also result in muscle spasms. The symptoms could include itching, burning, tingling, cold sensations, and pain. The sensory symptoms may be referred into the groin, abdomen, legs, and buttocks.
  • Sexual Dysfunction:
    Pelvic floor disorders may result in pain with sexual activity and/or weakness of the muscles, which may lead to decreased libido or difficulty or inability to reach orgasm. While decreased libido can be caused by hormonal imbalance or medications (for example, as a side effect of antidepressants), it can also be caused by decreased blood flow or congestion as from pelvic congestion. In addition, both men and women can experience pain during or after sexual activity. Men may suffer erectile dysfunction, the persistent failure to achieve and sustain erections of sufficient rigidity during sexual activity. This may be due to pelvic floor muscle tension, weakness, or pelvic congestion. It could also result from pain during or after intercourse.

Post Prostate Cancer Treatment

Beyond Basics Physical Therapy offers a unique and comprehensive rehabilitation program focused on the healthcare needs of people who have:

  • Incontinence due to prostate treatment (with or without surgery)
  • Pain due to prostate treatment (with or without surgery)

Our physical therapists have extensive training and knowledge in pelvic related issues and are able to evaluate and design a treatment program to meet the needs of patients with prostate cancer.

We have created a comprehensive rehabilitation program for men undergoing prostate treatment due to cancer.

Prior to starting prostate cancer treatment, patients will be seen by a therapist to evaluate their current function, and provide exercises for before and after treatment. The evaluation will include:

  • Muscle strength testing including pelvic floor and lower extremities
  • Biofeedback evaluation using either internal rectal sensors or external anal sensors
  • Education of what to expect after surgical or non-surgical treatment
  • Posture and functional evaluation

Post-treatment (surgical or non-surgical), the patient will be seen 2-4 weeks after treatment and physical therapy will include the following:

  • Muscle re-education utilizing biofeedback
  • Bladder re-education
  • Postural education
  • Overall core stabilization when appropriate
  • Behavioral modifications

Our treatment sessions are individually tailored and last for 45–60 minutes. All sessions are in private rooms, using state of the art biofeedback technology. If you have specific questions, please do not hesitate to contact us!