Chronic pelvic pain encompasses a host of symptoms including pain in the perineum with sitting, penile or testicular pain with erection or ejaculation, and pain with bowel movements. Symptoms can also include urinary urgency and frequency.
With pelvic floor physical therapy we address myofascial trigger points and muscle tension in the pelvic floor muscles as well as surrounding abdominal, back, leg and buttock musculature, which are often key contributors to chronic pelvic pain. Imagine having tension and trigger points in your neck and shoulder muscles and how painful that can be. Now imagine that same tension in your pelvic floor muscles. When these muscles are unable to relax appropriately it can cause difficulty and pain with voiding the bladder, bowels and with sexual activity.
Treatment for these issues often includes manual therapy to address muscle tension as well as postural re-Erectile dysfunction can be associated with chronic pelvic pain, but in contrast, men may also experience erectile dysfunction with weakness of their pelvic floor muscles. Muscles of the pelvic floor surround the base of the penis internally and with erection they contract to hold the blood there and maintain the erection. Weakness in these muscles can cause difficulty maintaining an erection, and a strengthening program for these pelvic floor muscles may be needed. We may utilize pelvic floor muscle contraction or “Kegel” exercises in combination with biofeedback.training, stretching and instruction in relaxation exercises for key muscle groups.
Chronic Pelvic Pain Syndrome (“CPPS”): is most likely to affect males 35-45 years old. Studies have shown that patients with CPPS have increased pelvic muscle tenderness and pelvic floor dysfunction. Biofeedback combined with education and pelvic floor muscle exercise has been shown to decrease pain and increase quality of life.
Pudendal Neuralgia: is a cause of chronic pelvic pain. It typically presents in the penis, scrotum, perineum, or anorectal area for men, and can be aggravated by prolonged sitting. Conservative treatment including electrical stimulation has been shown to decrease pain and increase quality of life for these patients.
Urinary Incontinence after Prostate Surgery: The prevalence of urinary incontinence after radical prostatectomy is as high as 60%. While some of these cases resolve with time, many men experience incontinence for years afterwards. Treatments recommended are usually conservative and include pelvic floor muscle training and education and electrical stimulation.
Fecal Incontinence and Constipation: Patients with chronically dysfunctional lower gatrointestinal tracts tend to show uncoordinated relaxation of one or both of these muscles, or no relaxation at all. Physical therapy is an effective treatment for this pelvic floor diagnosis.
Pre-operative/Post-operative Education and Bladder Training: If a patient has a weak external urethral sphincter before radical prostatectomy, he will need to strengthen it to optimize the resolution of incontinence post-operatively. Possible reasons for weak sphincter include: disuse, back injury with neuropathy, neurologic disease, poor body awareness, valsalva habit with function, and generalized trunk weakness.
Prostatitis: inflammation of the prostate
- Bacterial prostatitis
- Non-bacterial prostatitis
Isolated orchalgia: chronic pain of the testicles or scrotum that typically lasts for more than three months. Orchalgia may be caused by injury, surgery, cancer, or testicular torsion.
Proctalgia fugax: severe, episodic, anal pain caused by spasm of the smooth muscle of the anal sphincter; most often occurs in the middle of the night.
Interstitial cystitis: urinary bladder disease of unknown cause, characterised by urinary frequency, urgency, pressure and/or pain in the bladder and/or pelvis.
Levator ani syndrome: caused by chronic tension of the levator muscle; characterized by a vague, indefinite rectal discomfort or pain. The pain may be felt high in the rectum or in the low pelvis or perineum.
Pudendal nerve entrapment syndrome: entrapment of the pudendal nerve that causes pain in the area between the legs, including the genitals and the inside of the thigh. This is often aggravated by sitting.