Pelvic Pain & Sexual Pain

Pelvic Pain

Pelvic pain defined as pain anywhere between your belly button and SIT bones (your SIT bones are located at the base of your pelvis) If pelvic pain lasts for more than 6 months, it’s called persistent or chronic pelvic pain.

Unfortunately, male pelvic pain is often misdiagnosed or incorrectly managed as it doesn’t show up on routine scans and investigations. This adds to the frustration of the condition and it can have a major impact on men’s quality of life.

Men suffer from a wide variety of pelvic pain symptoms including:

  • Pain when sitting: this can be in the coccyx (tailbone), perineum, rectum or genitals

  • Pressure, throbbing, tingling or burning sensation anywhere in the pelvis, including the penis, testicles, urethra, tailbone or rectum

  • Bowel issues: including rectal or anal pain, a sense of incomplete emptying, pain with opening bowels, or inability to pass wind

  • Bladder issues: bladder pain, the need to go to the toilet frequently, reduced urine flow or incomplete emptying

  • Sexual pain: can be during or after intercourse, or with ejaculation

  • Anxiety, depression and high levels of stress

 

 

Our trained Harmony Physiotherapy Ottawa physiotherapists will listen to your history, then carefully and accurately assess your pelvic pain. Following your initial consultation, they will develop an individual patient plan to help you move forward and regain your quality of life which is so often compromised with pelvic pain.

Chronic Prostatitis and Chronic Pelvic Pain Syndrome (CPPS)

Chronic Prostatitis (or prostatitis 3b) or Chronic Pelvic Pain Syndrome (CPPS) are often considered synonymous where the pain in the pelvis is of a persistent nature.  

In Prostatitis, there is often an infection affecting the prostate gland.  However, only about 5-10% are actually bacteria related to the vast majority related to inflammation or non-specific pain syndromes. Prostatitis can affect all men at any age and accounts for about ¼ of all pelvic pain conditions, genital or urinary conditions in young to middle-aged men.  Where pain persists after a period of time and after the medicine has failed to resolve pain, by process of elimination, CPPS or Chronic Prostatitis type 3b is a diagnosis often assigned.   

Types:

  • Acute Prostatitis is the least common form of the condition and manifests with an increased frequency of micturition, particularly at night.  There is often a pain in the pelvis and genitals, and there are other cardinal signs of infection including vomiting, fever, and chills.  This condition would make you feel quite ill and requires prompt treatment.  Left untreated symptoms lead to a drop in blood pressure, confusion, and increased mortality.

  • Chronic prostatitis is diagnosed in situations where the symptoms of prostate infections are recurrent.  The symptoms are much less severe than in acute states but they are often difficult to treat with many trials of antibiotics proving unsuccessful and the patient suffering recurrent pain and symptoms.

Chronic Pelvic Pain 

Where pain persists but inflammation and bacteria are absent a condition of chronic non-bacterial prostatitis or chronic pelvic pain can be assigned.  This condition is the most common form of pelvic pain and accounts for up to 90% of cases.  You may have been seen by a colorectal specialist or urologist with multiple tests and only negative findings.  CPP is, therefore, a diagnosis often determined by a process of elimination. 

Pain may start in the bladder or bowel.  It may be located in the lumbar spine, groin or hip. It may also start in a joint or muscle.  It may not have even started with prostatitis in mind.  This can, on occasions, delay treatment because we are searching for an identifiable cause yet the actual structural entity remains elusive.  Perhaps even absent. 

 

Pain is considered ‘chronic’ when it has been present for more than 3 months.  We have limited understanding as to why some men experience pain for a short time and then recover, while others are left in continuing pain.  Whatever the cause, after three months there is often sensitization of organs or muscular structures in the pelvis.  If in the hip or groin, or lumbar spine there may be sensitivity which causes widespread sensitization (referred pain).  The area of pain may spread into the pelvis.  Sensitization may not be something that we can see on a scan because it relates to a change in behavior of our nervous system and therefore a change in our tolerance to irritation.  Our defense mechanism in situations of pain sensitivity is often muscle spasm and the pelvis is full of muscles.  This can be the most painful part of the pain.  It is the body defending itself only instead of a hamstring or calf muscle it is something on the inside of the pelvis. 

 

Something we will find difficult to press, massage or touch.  Pain prevents the normal contraction of muscles in the pelvic girdle, muscles essential for urination, sexual and colorectal function.  The muscles are in spasm and therefore will have difficulty letting go.  We need to let go in order to pass urine or for sufficient blood flow for erectile function.   Therefore, CPP may cause problems with normal functioning processes.  If you have chronic pelvic pain it is likely to be painful & tender spasms in the muscles that are causing your day to day pain.

Signs and symptoms are varied, mixed and often do not a clear algorithm for diagnosis.  Clinical examination with a solid patient history is essential. 

 

However, typical symptoms may include: 

  • Low back pain, abdominal, buttock or groin pain

  • Urinary symptoms

  • Rectal symptoms

  • Pain on sexual activity 

  • Loss of Libido, erection or the ability to ejaculate

  • With low mood, anxiety,  often difficulty with relationships

Treatment

The treatment at Harmony Physiotherapy Ottawa will start by the assessment of the pelvic floor muscles, identifying the dysfunction in control, abnormal activation and sensitivity in the muscles.  We will also conduct a full musculoskeletal assessment of the hips, pelvis, nervous system and lumbar spine.  It is essential that we consider all structures and muscles surrounding the pelvis to allow us to determine the most appropriate techniques to help you with your pain.  We may also ask questions concerning your stress levels.  Stress can cause or be a result of pain.  In any case, it is a nasty emotional state and only adds to the already mounting sensitization of your pelvic area.  More sensitization causes greater pain through spasms.    

Treatment at Harmony Ottawa may consist of manual therapy directed at the spine, pelvis and soft tissue around the area, we may also consider internal massage of the pelvic muscles.  While this does not cure pain it certainly helps to reduce sensitivity.   Exercise rehabilitation is vitally important as are relaxation and education about the problem.  We will not just send you to a gym but we will show you how to switch these muscles off.   Our rehab is centered around the switching on and switching off of the muscles and to teach the muscles to behave normally.  Counseling and relaxation techniques are key to reducing emotion and helping you avoid situations where stress will cause a re-surfacing of the problem.

We may also discuss bowel and bladder habits. These can only add to muscle and nervous sensitivity and therefore optimizing the function of the bowel and bladder ensure the stress on the pelvic floor is reduced to a minimum.

Harmony Physiotherapy Ottawa is an accredited DN4MSK © Teaching Facility

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