As with any area of the body, the pelvic floor can suffer injury or begin to dysfunction in ways that lead to significant pain and difficulties with everyday tasks. Chronic pelvic pain can happen to anyone, and, while anything related to the pelvis is commonly seen as a female-only concern, chronic pelvic pain in men is a very real issue.
One of the consequences of not talking about pelvic health as a key component of broader men’s health, is delayed seeking of care and a higher risk of overlooking treatable conditions. For chronic pelvic pain issues, the search for a diagnosis and helpful treatment plan can be confusing to put it mildly. It can be incredibly helpful to know the defining characteristics of some of the major diagnoses and causes of pelvic pain in men when searching for your own next steps while speaking with your healthcare team. This is never truer than with the conversations surrounding the world of prostatitis and the pelvic floor.
Prostatitis
Prostatitis is an inflammation and swelling of the prostate which can cause groin and genital pain, pain with ejaculation, and difficulty and pain with urination. Prostatitis constitutes a broader category of subtypes, and this is often where things get confusing, so bear with me!
- Acute Bacterial Prostatitis: Symptoms of pelvic pain, painful and frequent urination appear suddenly and severely. It’s also accompanied by a fever which is part of your body’s responses to fighting the infection. As it is caused by bacteria, first-line treatment is antibiotics.
- Chronic Bacterial Prostatitis: Symptoms are similar to those of Acute Bacterial Prostatitis, but are often less severe and begin slowly, typically over the course of at least a few months. Sometimes symptoms will completely go away between flairs and other times they stay fairly constant. The primary treatment is antibiotics, but these are often given for longer duration than for treatment of it’s acute counterpart.
- Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS): This category is a bit tricky. The “itis” at the end of the word prostatitis means that there is an infection. However, sometimes there is no actual infection for CP despite the pelvic symptoms being potentially identical to either Acute or Chronic Bacterial Prostatitis. Antibiotics are still often tried to see if the bacteria was simply missed. However, repeat trial of antibiotics should likely not be continued past your first round if they aren’t providing symptom improvement. An alternative term for CP is growing in popularity: Chronic Pelvic Pain Syndrome (CPPS). Unlike a disease which can be identified as having a specific cause, a syndrome is a cluster of symptoms. As a result, CPPS can overlap with other conditions such as issues with the pelvic floor muscles.
Pelvic Floor Dysfunction
This leads us into the next diagnostic category, pelvic floor muscle disorders. For men, tight (also known as hypertonic) pelvic floor muscles can present with the same symptoms as prostatitis. Additionally, the body’s natural response to prolonged pain in an area is to tighten the surrounding muscles and limit movement. This alone can cause pelvic floor muscle issues. Because of this, even if there was a very real infection in the prostate, symptoms can linger long past successful treatment of the infection. To say that this can be a frustrating experience is a tremendous understatement.
There are more subcategories of pelvic floor dysfunction (PFD) than we will have time to cover in this post (though as always, keep an eye out for more to come!). When PFD creates pelvic pain, it is commonly because the muscles stay too tight. When too tight, the muscles do not get the normal movement in of the good stuff (oxygen, nutrients…) and have a harder time getting rid of the bad stuff (essentially their waste products). The muscle fibers can knot up on themselves and the sustained pull from their contractions and shortening can pull and pinch on neighboring structures such as nerves and the spine. The result? Ouch.
A Pelvic Floor PT can diagnose PFD and return the muscles to proper functioning. They can stretch areas that are too tight and teach all muscles in the area the correct ways to fire to prevent further strain and pain. As Pelvic Floor PTs, we love some good detective work. Giving us all the details surrounding your symptoms will help us identify the best strategies for giving you the best care. Talking about these topics can be understandably uncomfortable for many, but we’re here to help, we care, and your wellbeing matters.
Take Aways
Make sure you are checked for an infection prior to starting treatment for suspected Bacterial Prostatitis. Check again at the end of treatment to ensure that the infection is gone. If symptoms linger or return and no infection is found, it may very well be due to the pelvic floor muscles even if the symptoms feel identical to the symptoms you had in the past. Lastly, seeing a Pelvic Floor PT should occur early in your treatment journey for any form of pelvic pain. Addressing the pelvic floor early can help identify other drivers of your pain and help symptoms resolve more quickly.
As always, reach out with any questions! We look forward to hearing from you!