Men, Listen Up! You Have a Pelvic Floor Too!!

Most people believe that pelvic floor issues only affect women. It is true that the female pelvic floor may be the recipient of more trauma, mainly due to pregnancy and childbirth. However, male pelvic pain is much more common than people believe.

As I mentioned in my previous blog about interstitial cystitis (IC), this condition affects almost as many men as it does women. Studies done by the RAND research organization found that IC affects 6.5% of women and 4.2% of men. In total, this condition affects over 12 million Americans.

Often, men who go to the doctor with pelvic pain complaints are diagnosed with chronic prostatitis (CP) and treated with antibiotics. Unfortunately, this treatment does not always work because the cause of the problem is not actually an infection after all. Both pain and urinary symptoms of “chronic prostatitis” stem from dysfunction and trigger points in the pelvic floor muscles. When these muscles are tight and strained, they begin to irritate the nerves that run through the pelvis. Pain can radiate anywhere along the pathway of those nerves. Also, the brain can also interpret that irritation as an urgent need to urinate. We now know that the diagnoses of IC and CP are interchangeable in most cases. Regardless of which diagnosis is received, the symptoms are generally the same.

What are some common complaints of men with pelvic floor dysfunction?

- Pain in the penis, often with penetrative intercourse and with ejaculation

- Pain in the scrotum

- Often accompanied by hip or low back pain

- Urinary urgency and frequency

- Painful bowel movements and/or constipation

- Erectile dysfunction

How does pelvic floor physical therapy help?

Studies have demonstrated that in both men and women with pelvic pain syndromes, there is a correlation between general symptoms and local, specific pain sites (known as either trigger or tender points, depending on severity of symptoms). A research study with 200 participants found that the number of tender points was associated with quality of life, pain experience, anxiety, and stress. This finding is important because it suggests that reducing or eliminating trigger and tender points with pelvic floor physical therapy can demonstrate global improvement in chronic pelvic pain. The most common external trigger point sites for both men and women were on the hip flexor muscle in the groin region, but men were more likely to have trigger points in the lower abdomen than women. On average, researchers found that men had four significant trigger points and thirteen tender points. This study did not investigate internal trigger points, but my personal experience is that both men and women nearly always have trigger points present in their pelvic floor muscles. By resolving the trigger points in these muscles, pelvic floor physical therapy works to address the underlying cause of pelvic pain and urinary symptoms. This typically involves both external and internal trigger point release techniques as well as clearing inflammation from the fascia and a customized at home program.

One great example was a man who came to me with tennis elbow. In the process of getting his medical history, he shared with me that he was recovering from bladder cancer. Although the cancer was gone, he was still suffering from urinary pain, urgency, and frequency. He was getting up 6-7 times at night to urinate. With his doctor’s permission, I evaluated his pelvic floor and found multiple trigger points. This had likely occurred in his case as a muscular response to the bladder pain he experienced during his cancer treatments. After three visits of pelvic floor physical therapy, he reduced his nighttime bathroom visits to once and his pelvic pain by 90%. Not everyone gets better this quickly, but the vast majority of patients experience great relief over time.

At Catalyst Physical Therapy, approximately 30% of our pelvic floor patients are men who we are proud to serve. We are all certified in trigger point dry needling which can be an extremely effective addition to all our other treatments. We spend one hour with each patient, which is the gold standard for pelvic floor physical therapy because that time is necessary to address and treat all the components and driving factors behind pelvic pain in a holistic approach. Are you experiencing symptoms of pelvic pain and/or urinary urgency and frequency? Give us a call or message us to set up an evaluation and start you on a path to recovery.

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