Talking about the pelvic floor has been increasingly less “taboo” over the last few years. But I see a bit of a problem, do a quick google search of “pelvic floor” and see what comes up. I’ll share my result below.
Search social media and you run into the same problem. Wildly available pelvic floor information creates a very female centric image.
And this is an issue. All genders have a pelvic floor. If you have a pelvis in fact, you have a pelvic floor.
An illusion exists that pelvic floor dysfunction affects only women. Comparatively, men see very little, if any information. For this reason, men suffering from pelvic floor dysfunction can feel so isolated or weird because this apparently isn’t supposed to happen to men.
But the truth is, so many men experience pelvic floor dysfunction. Because of the lack of information/ misinformation out there, I’ve seen the path to diagnosis and treatment take years.
Today let’s put the spotlight on chronic pelvic pain syndrome (CPPS) or prostatitis. An estimated 4-9.5% of the male population will experience CPPS….far from a rarity (1).
True or False?: Prostatitis is an infection of the prostate
False….kind of. I apologize for starting with a trick question.
Prostatitis can be classified into four major categories, and in only two of those categories is an infection actually present.
||Bacterial infection with urinalysis typically treated with antibiotics|
||Persistent UTI with bacteria present typically treated with antibiotics|
||Pelvic pain without the presence of identifiable infection/illness|
||Inflammation without symptoms|
Adapted from (2).
Only an estimated 10% of men with “prostatitis” fall into the type I category with an infection (3).
Most men with pain fall into type III or chronic pelvic pain syndrome.
Is it normal to hurt _________ with CPPS?
Men feel their pelvic pain in different ways. The experience is different for everyone (2).
Chronic pelvic pain syndrome can feel like:
- Dull ache
You may experience pain in the:
- Lower abdomen
- Low back
- Perineal area
You may experience:
- Pain during or after ejaculation
- Erectile dysfunction
- Urinary frequency/ urgency
- Difficulty starting a urine stream
- Irritable bowel
As you can see, quite the myriad of possible symptoms.
Why is this happening to me?
Unfortunately, we don’t always know why this started. Researchers continue to look into theories on triggers for CPPS, inflammatory processes, and hard to detect bacteria, but the evidence is inconclusive.
We DO know that the pelvic floor muscles can contribute to the symptoms you experience with CPPS. Generally, the pelvic floor muscles are overactive.
Where do I start?
Overwhelmed, start with a medical doctor. Your provider will rule out serious infection or illness.
Next, find yourself a pelvic floor specialist.
What can physical therapy do for me?
Specifically, you need a trained pelvic floor physical therapist. Research supports pelvic floor physical therapy for decreasing pain with CPPS (2).
We do a whole lot more than kegels….kegels can actually make CPPS worse.
A pelvic floor PT will look at the big picture and see if your pain can be coming from the spine, the hips, or maybe even the ankles?
Most importantly, a pelvic PT has the expertise to evaluate your pelvic floor muscles both externally and internally.
Treatment may include (but not limited to) soft tissue techniques to decrease muscle tension, breathing and relaxation training, gentle nerve mobilization techniques, management of IBS symptoms, pelvic floor lengthening exercises, and a home program that gives you the power to manage and improve your symptoms.
You are far from alone in tackling prostatitis/CPPS, and there is NOTHING to be ashamed or embarrassed about. For more information on our care for men call 914 831 9575. Follow us on Facebook and Instagram for tips, stretches, and self management tools for pelvic pain.
- Clemens JQ, Meenan RT, O’Keeffe Rosetti MC, Kimes T, Calhoun EA. Prevalence of and risk factors for prostatitis: population based assessment using physician assigned diagnoses. J Urol 2007; 178 (4 Pt 1): 1333-1337.
- Polackwich, A.S., and D.A. Shoskes. “Chronic prostatitis/chronic pelvic pain syndrome: a review of evaluation and therapy.” Prostate Cancer and Prostatic Diseases 19, no. 2 (2016): 132+. Gale OneFile: Health and Medicine (accessed November 13, 2020). https://link.gale.com/apps/doc/A455069726/HRCA?u=nysl_me_nyuniv&sid=HRCA&xid=3713d318.
- Coker, T., Dierfelt, D. Acute Bacterial Prostatitis: Diagnosis and Management Am Fam Physician. 2016 Jan 15;93(2):114-120.
OneFile: Health and Medicine (accessed November 13, 2020). https://link.gale.com/apps/doc/A455069726/HRCA?u=nysl_me_nyuniv&sid=HRCA&xid=3713d318.