Hi friends! Often when we think about the pelvic floor we think about those with female anatomy, but men have pelvic floors, too! Just like females those with a male pelvic floor can have pelvic pain.
There can be many causes for this pelvic pain. Your physician should perform many tests to help them learn about what is happening like urine samples, prostatic fluid samples, digital rectal exam, imaging (i.e. ultrasound, CT scan), and a thorough history and physical exam (Habermacher, 2006).
Prostatitis is the most common reason men under the age of 50 present to a urologist (Habermacher, 2006). There are four subtypes used to classify prostatitis and treatment varies depending on the subtype.
Acute bacterial prostatitis: This is an active bacterial infection of the prostate gland. Symptoms often begin rapidly and can include pelvic pain, pain with peeing, peeing often, incomplete emptying of the bladder with peeing, or inability to pee (urine retention). This type of prostatitis is also associated with systemic symptoms like fever, chills, and malaise. With acute bacterial prostatitis, individuals often need IV antibiotics, hydration, and a urinary catheter to resolve symptoms (Habermacher, 2006).
Chronic bacterial prostatitis: This is similar to acute bacterial prostatitis in that there is a persistent infection of the prostate, but it is not associated with the systemic symptoms like fever, chills, and malaise. With chronic bacterial prostatitis, there is usually discomfort or pain when urinating. Individuals often have a history of recurrent urinary tract infections (UTIs). A one to three month courses of antibiotics cure up to 80% of these infections, but about one-third of individuals will have recurrent episodes in the future (Habermacher, 2006).
Chronic prostatitis/chronic pelvic pain syndrome: This is the most common type of prostatitis and accounts for up to 95% of cases (Habermacher, 2006). Symptoms can include pain in the pelvic or abdominal region, going pee frequently, pain with peeing, incomplete emptying of the bladder with peeing, pain with ejaculation, and erectile dysfunction (Polackwich, 2016; Habermacher, 2006). This diagnosis is often one of exclusion, meaning the physicians diagnose it after they have ruled out all other possible causes for the pelvic pain. Many individuals seek helps countless times from medical providers without successful resolution of symptoms.
Tightness in the pelvic floor muscles can mimic pain in the prostate. For this reason, may individuals with chronic prostatitis find pelvic floor therapy beneficial in treating symptoms (Polackwich, 2016). Pelvic floor therapy has been shown to decrease pain and improve sexual function (Polackwich, 2016). It is important to find a skilled physical therapist who can provide high quality therapy as this can greatly impact outcomes (Polackwich, 2016).
A skilled physical therapist will perform a throughout evaluation, looking at the pelvic floor and beyond, to address pelvic floor tightness, improve posture and body mechanics, and improve any areas of tightness or weakness. A therapist will develop a treatment plan individualized to you and your specific needs for the most success.
Treatment for chronic prostatitis may also include medications like antibiotics, anti-inflammatories, neuromodulators, and alpha-blockers (Polackwich, 2016).
With any chronic pain condition, many individuals have higher level of lifetime stress and depression (Polackwich, 2016). We know from research that stress can impact the way our bodies and brains respond to pain and the treatments for it. For this reason, cognitive behavior therapy can be a beneficial treatment option (Polackwich, 2016).
Asymptomatic inflammatory prostatitis: This last type of prostatitis is unique in that individuals do not experience pain or symptoms, but inflammatory markers are found with other testing (Habermacher, 2006).
If you are experiencing pelvic pain, it is important to see your physician to rule out active bacterial infections and other conditions like prostate cancer. If you have seen many physicians and have had serious medical conditions ruled out but your pain remains, you may find a pelvic floor therapist a great resource. You can ask your physician for a referral or find one near you at https://www.mypfm.com/find-a-pt.
To learn more about your pelvic floor muscles, check out these great resources:
Written by Emily Reul, PT, DPT
Habermacher GM, Chason JT, Schaeffer AJ. Prostatitis/chronic pelvic pain syndrome. Annu Rev Med. 2006;57:195-206.
Polackwich AS, Shoskes DA. Chronic prostatitis/chronic pelvic pain syndrome: a review of evaluation and therapy. Prostate Cancer Prostatic Dis. 2016;19(2):132-8.