Up to 88% of men with pelvic pain have pelvic floor myalgia (muscle pain) and pelvic floor dysfunction (Urology, 1999). Despite this knowledge, men suffer for months and even years without getting help for muscular tension. They are often diagnosed with prostatitis, with symptoms of suprapubic pain (bladder pain), urinary retention and/or sexual dysfunction. After multiple invasive tests and multiple rounds of antibiotics (the symptoms may have started with an infection), the problem may be identified as a pelvic floor issue. Treatment from a qualified pelvic floor physical therapist may be the next step.
At our physical therapy clinic, the men we treat have tight muscles in general and the pelvic floor is no exception. With 35 muscles attached to the pelvis, tightness in the hamstrings, hips, back or groin can increase tension on the pelvic floor. Often, the person has had hip tightness or other issues such as psoas syndrome or piriformis syndrome or a hamstring pull. Compensations result when these issues are not treated or addressed. Add a urinary tract infection, kidney stone or an enlarged prostate and it's a perfect storm!
Let's begin with anatomy. The prostate gland is about the size of a walnut, however in middle aged men, it increases to the size of a golf ball. Nerves in the pelvis and abdominal wall can get compressed through adhesions and tight muscles, perpetuating the problem. Nerves typically involved with pelvic pain include the pudendal nerve, sciatic nerve and obturator nerve. Visceral mobilization is a form of myofascial release used at our clinic that is specific to these areas. Tension on any of the peripheral nerves can contribute to muscle contraction in the distribution of the nerve. For example, the sciatic nerve holds the hamstring tight, the pudendal nerve holds the pelvic floor tight and the obturator nerve holds the groin tight. Tightening the muscles through strength training can make the muscle tighter and contribute to muscle spasms and compensations. The pelvic floor is no exception and Kegels (tightening the pelvic floor) only makes it worse. The pelvic floor muscles have to relax in order for the bladder to contract through the sacral micturition reflex. Thus, the bladder is a smooth muscle similar to a blood vessel and does not contract on its own, but receives a message from the pelvic floor. If the pelvic floor muscles are tight, or if there is a stricture in the urethra from an enlarged prostate or scar tissue, the bladder is "confused" and cannot contract to eliminate urine.
Stretching can sometimes provoke the symptoms if myofascial trigger points are not addressed in the pelvic floor, obturator internus, piriformis, adductors and iliopsoas muscles. Before attempting to stretch, be sure to release tension and trigger points in these muscles, or get help from a physical therapist that specializes in pelvic pain. If muscle knots are not untied first, stretching can make the knot bigger. At Healthy Core, we cater to individuals with pelvic pain and dysfunction.
Top 5 Exercises for Men to Prevent and Improve Pelvic Pain:
1. DIAPHRAGM BREATHING/ REVERSE KEGEL
Lie on your back with your knees bent. Inhale and allow your breath to expand into your lower abdomen for a count of 5. Exhale and allow your abdomen to fall or gently hollow for a count of 5. Your rib cage should not move more than your abdomen as you breathe. Repeat 10 times.
2. HIP FLEXOR STRETCH
Lunge onto one knee. Place a pillow under your knee for comfort. Tuck your pelvis underneath your spine while lunging forward until you feel a stretch in the front of the hip. Extend your arm towards the ceiling for an additional stretch through the trunk. Hold 30 seconds.
3. FROG STRETCH
Start with feet flat on the wall about shoulder width apart. Allow the knees to fall towards the floor, using your hands to support your knees, if necessary. Keep the tailbone on the ground and the spine long. Hold for 30 seconds while breathing slowly and rhythmically.
4. WIDE V STRETCH
Start by lying on your back with your bottom as close to the wall as possible, with legs together. Inhale and allow the legs to slide down the wall, like a snow angel. Exhale and return to the start position.
Repeat 10 times. Hold in stretch position for 30 seconds after.
5. HAPPY BABY
Start with knees bent and spine neutral. Bring one knee up, then the other. Keep the legs wide towards the armpits. Hold the feet and draw the knees down, keeping the tailbone on the floor. If unable to reach the feet, modify by holding the back of the thighs. Hold 30 seconds.
If pelvic pain is keeping you from sitting or enjoying your favorite activities, we can help. Our treatment approach will help identify the source of the problem while addressing tension in your abdomen, hips and back using visceral mobilization and Integrative Dry Needling. For more information about dry needling, click here to read our blog.
Disclaimer: These exercises are not intended to replace the advice of your medical provider. If you have pain DURING or AFTER exercise, STOP and contact your health care provider.