Understanding Pelvic Pain for Men: Effective Treatment Options

Pelvic floor therapy isn't exclusive to women with pelvic pain. Up to 88% of men experiencing pelvic pain suffer from muscle pain called pelvic floor myalgia and pelvic floor dysfunction (Urology, 1999). Despite this understanding, many men endure muscular tension for months or even years without seeking help. They are frequently first diagnosed with prostatitis, exhibiting symptoms like suprapubic pain (bladder pain), urinary retention, and/or sexual dysfunction. After undergoing numerous invasive tests and several courses of antibiotics (as the symptoms might have initially been triggered by an infection), the underlying issue could be related to the pelvic floor, and consulting a qualified pelvic floor therapist may be the next appropriate step.

At our physical therapy clinic, the men we treat have tight muscles in general and the pelvic floor is no exception. With more than 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 over a period of several years. Add a urinary tract infection, kidney stone or an enlarged prostate and it's a perfect storm!

Understanding anatomy and physiology can help you comprehend what is happening and guide you to seek the appropriate assistance. The prostate gland, initially the size of a walnut, enlarges to the size of a golf ball in middle age, occupying more space in the pelvis. If there are adhesions and tight muscles, nerves may become compressed, leading to pain and dysfunction. The nerves commonly associated with pelvic pain include the pudendal nerve, sciatic nerve, and obturator nerve. At our clinic, we use visceral mobilization, a type of myofascial release, specifically targeting these areas. Tension on any peripheral nerves can lead to muscle contraction along the nerve's path. For instance, the sciatic nerve keeps the hamstring tight, the pudendal nerve keeps the pelvic floor tight, and the obturator nerve keeps the groin tight.

Strength training can lead to tighter muscles, which may increase muscle spasms and compensations. The pelvic floor is no exception and performing Kegels (tightening the pelvic floor) can exacerbate the issue. For the bladder to contract through the sacral micturition reflex, the pelvic floor muscles need to relax. The bladder, like a blood vessel, is a smooth muscle and does not contract independently; it receives signals from the pelvic floor. If the pelvic floor muscles are tense, or if there is a urethral stricture due to an enlarged prostate or scar tissue, the bladder becomes "confused" and cannot contract effectively to expel urine. This can lead to postvoid dribble and other dysfunctions of the pelvic floor.

Stretching may cause symptoms if myofascial trigger points in the pelvic floor, abdomen, obturator internus, piriformis, adductors, and iliopsoas muscles are not addressed. We recommend prioritizing lengthening before strengthening to alleviate tension and trigger points prior to stretching or strengthening. If muscle knots are not resolved, stretching might enlarge the knot and extend the problem. At Healthy Core, we assist individuals with pelvic pain and dysfunction, teaching them, including men, how to release knots in order to exercise without exacerbating pelvic pain or dysfunction.

Relaxing the pelvic floor starts with an ABDOMINAL BREATH referred to as a REVERSE KEGEL. When you're stressed and in a fight or flight state, proper breathing becomes nearly impossible. It's crucial to reset the nervous system and learn how to regulate it over the long term to help calm and relax both your body and your pelvic floor muscles.

If pelvic pain is preventing you from sitting or enjoying your favorite activities, customized pelvic floor therapy can help. Our holistic treatment approach will help identify the source of the problem while addressing tension in your abdomen, hips and back.

edited June 2025