Male Pelvic Pain Explained

Pelvic pain in men is often misunderstood, underdiagnosed, and undertreated. Many individuals experiencing symptoms are left searching for answers after visits to urologists, gastroenterologists, or general practitioners. What’s often missing from the conversation is the role of the pelvic floor muscles and how pelvic floor physical therapy (PFPT) can offer relief.

This blog outlines the causes of male pelvic pain, the role of the pelvic floor, and how physical therapy can provide effective, evidence-based treatment.

What Is Male Pelvic Pain?

Male pelvic pain refers to discomfort or pain in the area between the lower abdomen and the perineum (the space between the scrotum and anus), and may include symptoms involving the bladder, bowel, genitals, or sexual function. It can be constant or intermittent and ranges from mild to debilitating.

Common symptoms include:

• Pain in the perineum, testicles, penis, lower abdomen, or rectum

• Pain with sitting

• Burning or discomfort with urination or ejaculation

• Sensation of a “lump” or pressure in the rectal or pelvic area

• Urinary frequency, urgency, or incomplete emptying

• Constipation or straining with bowel movements

• Erectile dysfunction or painful ejaculation

Many of these symptoms are consistent with Chronic Pelvic Pain Syndrome (CPPS) or Chronic Prostatitis, which are often not caused by infection but by musculoskeletal dysfunction, including overactive or tight pelvic floor muscles.

The Role of the Pelvic Floor in Male Pelvic Pain

The pelvic floor muscles support the bladder, bowel, and sexual organs. These muscles help control urination, bowel movements, and sexual function. In men, tightness, weakness, or poor coordination of the pelvic floor can lead to pain and dysfunction.

Muscular issues in the pelvic floor may result from:

• Prolonged sitting (especially on hard surfaces)

• Stress or anxiety (leading to chronic muscle tension)

• Straining during bowel movements

• Past trauma or injury (including sports injuries or falls)

• Post-surgical changes (e.g., after prostate surgery)

• Overuse from activities like heavy lifting or cycling

Just like any other group of muscles, the pelvic floor can develop trigger points, tension, or imbalance - leading to referred pain and dysfunction in the pelvic region.

What Is Pelvic Floor Physical Therapy?

Pelvic floor physical therapy is a specialized branch of physical therapy focused on evaluating and treating the muscles, nerves, and connective tissue of the pelvic region.

For men experiencing pelvic pain, a pelvic floor physical therapist will typically perform:

1. Comprehensive Evaluation

• Detailed medical and symptom history

• Postural and breathing assessment

• Evaluation of pelvic floor muscle tone, strength, and coordination

• Internal (rectal) or external muscle assessment, if appropriate and with consent

2. Individualized Treatment Plan

Depending on findings, treatment may include:

• Manual therapy: To release tight muscles, address trigger points, and improve tissue mobility

• Neuromuscular re-education: Training the pelvic floor to contract and relax appropriately

• Breathing and relaxation techniques: To reduce pelvic floor tension and address the stress-pain connection

• Postural and movement retraining: To reduce strain on the pelvic region

• Biofeedback: To help patients visualize and learn control over pelvic floor muscles

• Home exercise program: Including stretches, relaxation work, and functional retraining

Why Pelvic Floor Therapy Works

Research and clinical experience have shown that many men with CPPS and related symptoms benefit significantly from pelvic floor therapy, especially when infection or other urologic causes have been ruled out. Unlike medications, which may not address the root cause, physical therapy directly targets the muscle and nerve dysfunction contributing to pain.

When to Consider Pelvic Floor Therapy

Pelvic floor therapy may be appropriate if you’ve been experiencing:

• Unexplained pelvic or testicular pain

• Pain with ejaculation or urination

• Chronic prostatitis symptoms not responding to antibiotics

• A sensation of pelvic tightness or pressure

• Persistent symptoms despite seeing multiple specialists

It’s important to work with a provider who specializes in male pelvic health, as not all physical therapists are trained in internal pelvic floor techniques or the complexities of male anatomy.

Final Thoughts

Male pelvic pain can have a significant impact on daily function, mental health, and quality of life - but it is treatable. Pelvic floor physical therapy offers a targeted, non-invasive, and effective approach to managing these symptoms.

If you're dealing with persistent pelvic discomfort and haven’t found relief, consider consulting a pelvic floor physical therapist trained in male pelvic health. Treatment is confidential, respectful, and focused on helping you return to comfort and function.

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References:

• Anderson, R. U., Wise, D., Sawyer, T., & Chan, C. A. (2005). Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men. Journal of Urology, 174(1), 155–160.

• Clemens, J. Q., et al. (2016). Diagnosis and treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). American Urological Association Guidelines.

• Fitzgerald, M. P., et al. (2009). Pelvic floor physical therapy improves symptoms of chronic pelvic pain. Journal of Urology, 182(1), 321–327.

• National Institutes of Health (NIH) – Chronic Prostatitis/Chronic Pelvic Pain Syndrome https://www.niddk.nih.gov

• International Pelvic Pain Society – Men and Pelvic Pain Resources https://www.pelvicpain.org