Male Pelvic Pain: Getting to the Root Cause

Jun 8, 2021

Pee, poop, sex, pain…the pelvic floor has a role in all of them. And no matter who you are, if you are a human, you have a pelvic floor. So these things are relevant to everyone. Especially when you start to notice something is off “down there.”

A lot of times it is assumed that you have to have a baby in order to experience changes “down there,” but that simply isn’t the case. In fact, you don’t even have to be a woman (or anyone who has a vagina and/or uterus). Men (or anyone with a penis) commonly have pelvic health complaints including:

  • urinary urgency/frequency
  • pain with urination
  • weak stream or incomplete emptying
  • dribbling
  • penile, testicular pain
  • pelvic pain
  • anal pain
  • abdominal pain
  • constipation
  • fecal urgency
  • erectile dysfunction
  • painful erection or post-ejaculatory pain

1 in 10 men will experience pelvic pain at some point, and lots of them will have trouble identifying the root cause. After countless hours on Dr. Google or per the advice of a trusted friend, most men will end up visiting a urologist. Unless that urologist is trained to recognize pelvic floor symptoms, most of them will be given a diagnosis of chronic prostatitis, a prescription for antibiotics, and not a lot of answers. Usually, the antibiotics don’t work so they try another round, and the cycle continues. Not once will they be taught about a group of muscles called the pelvic floor that could easily be contributing to all or a majority of their symptoms.

The pelvic floor is like a trampoline in the bottom of the pelvis; the muscles attach around the pubic bone, sit bones, and tailbone. The muscles work together to contract and maintain continence or pull in blood flow for erections, or they relax enough for peeing and pooping. Sometimes however, the muscles get stuck in a pattern of contracting too much or not contracting enough.

Many of the symptoms listed above are associated with the pattern of contracting too much. Since the pelvic floor muscles have properties just like our biceps or quad muscles, they too can be susceptible to things like tightness, injury, and guarding. But since it’s not second nature to “see” your pelvic floor contracting all the time (like seeing a bicep curl or leg extension), it gets bypassed as a factor in pelvic pain, urinary urgency, etc by patients and urologists alike.

The pelvic floor also has a super close relationship with the autonomic nervous system so that we can do things like walk and talk without having to also volitionally control continence. When there is mixed messaging in the nervous system and pelvic floor, however, it might feel like we have to think all the time about going to the bathroom. The mixed messaging can come from acute or chronic stress, bathroom habits, or pain responses and it can lead to issues like pelvic pain, weak stream, constipation, or post-ejaculatory pain.

Other root causes that might point to the pelvic floor include:

  • previous orthopedic injuries (ankle sprains, hip impingement, or throwing your back out),
  • sports/activities like gymnastics, heavy weightlifting, abdominal exercises, cycling
  • desk jobs or other prolonged sitting
  • falls on your tailbone
  • chronic straining or breath holding
  • recurrent UTIs
  • hemorrhoids or fissures
  • hernias

Your next steps to treating your pelvic floor and finally getting to the root cause of your symptoms involves seeing a pelvic floor physical therapist. PFPTs take extra training outside of school to learn the intricacies about the musculoskeletal and neuromuscular systems within and surrounding the pelvic floor. They are experienced in treating the whole person since physical, mental, social, and contextual factors all influence the pelvic floor. They work closely with other providers (including your urologist) to ensure your plan of care is coordinated and comprehensive.

A PFPT will help you determine how to find balance between your pelvic floor muscles, nervous system, prior injuries, movement patterns, breathing strategies, work and lifestyle habits, and most importantly your GOALS. Stop guessing and start healing by working with a pelvic floor physical therapist. This process is complex and frustrating, but there is hope. Call us today to see how our team can help you. We offer in-person visits to those local to New Haven, CT, and virtual sessions for those near or far. We are here for you!


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