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Male Pelvic Health

Chronic pelvic pain in men is a misunderstood diagnosis. It is a condition that affects men of all ages. It accounts for over 2 million outpatient doctor visits per year. In urology practices, it is the most common diagnosis in men less than 50 years of age, and the third most common diagnosis in men greater than 50 years of age. For a diagnosis that presents so commonly, much confusion exists as to how to treat it properly. This has caused men to continue to suffer from this complicated issue.

Common symptoms associated with male pelvic pain Include:

  • Pain at the tip of the penis
  • Pain in the testes
  • Perineal pain
  • Suprapubic pain
  • Pain with sitting
  • Low back pain
  • Groin pain
  • Rectal pain
  • Pain with bowel movement
  • Painful ejaculation
  • Pain for 1-2 days following ejaculation
  • Premature ejaculation
  • Sexual dysfunction
  • Increased frequency of urination
  • Increased urgency of urination
  • Chronic constipation

Common diagnosis associated with pelvic pain in men:

  • Chronic pelvic pain
  • Pudendal neuralgia
  • Proctalgia fugax
  • Chronic non-bacterial prostatitis
  • Levator ani syndrome
  • High tone pelvic floor dysfunction
  • Low back pain
  • Sacroiliac joint pain

Men that have experienced pain in the pelvic region lasting for greater than 3 months are classified as having Chronic Pelvic Pain Syndrome (CPPS). Many men with CPPS may have been previously treated for chronic prostatitis without relief. Since CPPS is typically not related to infection, antibiotics typically will not alleviate the patient’s symptoms.

Traditional treatment of this disorder by physicians has been based on the premise that the patient’s symptoms stem from an infection or inflammation of the prostate, therefore, most men will be prescribed antibiotics. If the patient’s symptoms do not improve, the physician will typically try a longer course of antibiotics, or a different antibiotic. If the patient does not respond to a course of antibiotics, literature demonstrates that in many cases the patient’s symptoms are not caused by an infection.

If antibiotics have not completely eliminated pelvic pain in men, proper assessment of associated musculoskeletal structure is indicated. Over the past 25 years, clear evidence suggests structural asymmetry and increased internal pelvic tension can mimic symptoms previously considered as infection. As the musculoskeletal experts of the pelvis, physical therapists play an invaluable role in the musculoskeletal treatment of CPPS. In order to better understand the pelvic floor component of your CPPS symptoms, your physical therapist will perform a comprehensive evaluation. Physical therapists conduct a detailed history, a postural assessment and a comprehensive external assessment of the pelvis, lumbar spine, and sacroiliac joints. In addition to the external examination, an internal assessment of the pelvic floor muscles which attach to the boney pelvis, sacrum, pubic bone, and coccyx will be performed. Structural imbalance of the external joints can create an abnormal pull on the muscular attachment of the pelvic floor causing increased tension and the inability to relax after contraction of the pelvic floor. The increased tension of the pelvic floor, or inability to relax, leads to pain and a new, learned high tone state of pelvic floor tone.

Based on the findings of the initial evaluation, your therapist determines your plan of care. Physical therapy treatment of CPPS involves many facets of care including manual therapy techniques, therapeutic exercise, neuromuscular re-education of the pelvic floor and supporting musculature including postural corrections, relaxation techniques and body mechanic training. Patient education is key in gaining understanding and managing your condition. Your physical therapist will instruct you in a home exercise program, as well as self-help techniques to help foster a sense of control and empowerment in managing your symptoms. Your physical therapist will answer any questions you may have concerning your condition. We encourage open communication for you to achieve maximal benefit from your treatment.

CPPS can be complicated to evaluate and treat. Proper treatment of CPPS requires a team approach in which urologists, gastroenterologists, nurse practitioners, and physical therapists work together to provide an interdisciplinary approach to the treatment of each patient’s condition. When treated by medical practitioners who are familiar with recent literature and who have experience working as a medical team, patients with symptoms associated with CPPS can finally have relief and return to the quality of life that they have been lacking.

If you have any questions about our men’s pelvic health treatment, feel free to email our staff on our contact us page.
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