Pelvic Pain in Men: Why do I have pain in my pelvis?

Pelvic floor physical therapy can help all people, not just women.

If you have pain in your penis, scrotum, buttocks, or pelvis… and assuming you have ruled out infections, STDs, urinary tract infections, and acute prostatitis, you may have pelvic floor dysfunction. Pelvic floor dysfunction is when muscles in the pelvic floor are not working correctly and are not doing their job to help serve the roles listed below.

Men often suffer from pain in their pelvis for months or years and have seen multiple doctors… often without mentioning pelvic floor dysfunction, which is often the culprit.

The pelvic floor muscles have multiple roles.

1. Pelvic floor muscles are the bottom part of the core chamber which is important for supporting the abdominal cavity, including our vital organs!

2. The pelvic floor muscles help you to control your bladder or bowel movements.

3. Pelvic floor muscles are also important for sexual function. The pelvic floor engages during orgasm and for men, helps keep blood flowing into the shaft of the penis during erections.

So if I do a bunch of Kegels, I will be good, right? NO!

Looking online, you will likely read that Kegels (pelvic floor contractions) can help strengthen your pelvic floor to solve urinary/bowel leakage and help strengthen erections and orgasms.

However, when it comes to pelvic pain in men, much of the time the pelvic floor is already too short and too tight. This tension compresses the nerves and muscles creating pain. If you have ever had a headache due to tension in your neck or shoulders, pelvic pain is similar: a headache in the pelvis.

Kegels make this problem much worse!

Pelvic floor physical therapists are movement specialists that have special training in working with the pelvic floor and assessing WHY patients are having bladder, bowel, and sexual function symptoms. They are 100% comfortable addressing the pelvic floor musculature and components that directly and indirectly affect the pelvic floor. A pelvic floor physical therapist would help direct you on how to appropriately address your pelvic floor concerns.

What could pelvic floor dysfunction look like?

• Urinary Urgency/Frequency

• Pain with Urination and/or Ejaculation

• Pain or Sensitivity in the Penis/Testicles/Scrotum

• Perineal/Rectal Pain

• Split or Splayed Urinary Stream

• Tailbone Pain

• Hip/Buttocks Pain

• Low Back Pain

• Bladder Pain

• Feeling of Never Getting Empty with Urination

• Urinary Leakage

• Erectile Dysfunction

• Constipation

• Chronic Prostatitis

So now what? How do we help patients with pelvic floor dysfunction?

We start by listening to your story. This is important because we want to fully understand your history, when symptoms started, and what specifically is going on. We get detailed because it’s a bit like detective work. If we don’t fully understand your story and symptoms, it will be a lot harder to get to the WHY.

Below is a picture of the nerves that supply the pelvis: we have to do detective work to see if the pain is coming from the spine (commonly L1-2 and L5-Sacrum), the nerve (which nerve and where along the pathway of the nerve) or the muscles. Once we have figured out the WHY, we can start to find solutions for lasting relief.

What does a Pelvic Floor Physical Therapy Examination look like?

If you have ever been to an orthopedic physical therapist, our examination portion will start by looking very similar to your orthopedic exam. We look at the whole body, how you stand, walk, squat, and bend. We look at spinal mobility, extremity mobility, and strength. We run through special orthopedic tests as well as flexibility and connective tissue mobility. Then, we look at the pelvis, including. pelvic alignment, and what muscles might be causing dysfunction. We can evaluate this both internally and externally. We talk about what exactly an internal pelvic examination might look like and whether or not we should evaluate this day 1 or complete it at a subsequent visit. This is a collaborative examination with you, the patient, so your input and comfort level is priority #1.

Once we go through the examination, we discuss a plan. This might include things to work on at home from as simple as how to correctly breathe and dietary changes to exercises and corrective postural changes. A lot depends on your symptoms and clinical presentation.

What Kind of Treatments might you get in the clinic?

• Manual Therapy (joint mobilization, fascial/connective tissue mobilization, therapeutic massage, visceral mobilization)

• Therapeutic Exercise (Stretching, Strengthening, Postural and Movement Correction, and Pilates-based therapeutic programs)

• Neuro Re-education (calming down the nervous system, working on changing how the body interprets nerve signals, desensitization techniques)

• Dry Needling

• Other amazing tools (Laser, Electrical Stimulation, Biofeedback, Ultrasound)

What is needed to be able to start physical therapy?

Contact us to get scheduled right away. Some things our patients have said about us are:

“Fellas, I was referred to them by another PT for issues down there. They see men and it can really help with “that ED thing.” Definitely has helped me out quite a bit.”

“I was diagnosed with chronic prostatitis and suffered for years. Then, I saw RVA Holistic PT and my pain was 80% better in just a few visits. I should have done this long ago, but had not heard of pelvic floor PT!”

Have additional questions? We are here to help. You can check out our website: www.rvaholisticpt.com for more information or book an appointment. You can also reach out to us via phone or text at 804-372-0291.

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1. Gender Ratio in the World. Statistics Times. https://statisticstimes.com/demographics/world-sex-ratio.php#:~:text=As%20of%202021%2C%20There%20are,50.42%25%20of%20the%20world%20population.