Male Pelvic Pain: It’s Not Always the Prostate

A young grad student working abroad was suddenly faced with severe urinary symptoms. He sought medical help and was told he had an inflamed prostate and was put on antibiotics. The issue with urinary urgency and frequency improved.

When he made it back to the U.S., the student the similar symptoms returned. But antibiotics did not help this time. Instead, the problem worsened, and the abdominal pain increased.

He was tested for sexually transmitted diseases, urinary tract infection, and acute prostatitis. All turned out to be negative. Next, he had a CT scan and a cystoscopy, with no findings. With no root cause to tackle, the young student received no treatment or relief.

Eventually, he proceeded on with his education, completed grad school and moved to a different state. The symptoms did not cease, and a co-worker informed him about N2 Physical Therapy.

First Treatment Evaluation

By the time of evaluation, the symptoms had progressed to the following:

• Abdominal tightness and pain
• Constipation
• Fear of physical activity
• Pain and discomfort near the tailbone and rectum when seated
• Pain with ejaculation
• Urinary urgency

Evaluation Findings

• Poor Posture: After years of sitting slouched over a desk the young man had adopted a poor posture with a slumped lower back and with his head and shoulders pushed forward.
• Connective Tissue: The fascia in his hips and lower back had restricted mobility and high sensitivity.

Muscle tightness/trigger points

He was a shallow breather; the muscles of his abdominal wall were very taut and had restricted mobility. Trigger points were present in muscles around his hips, including the rotators and inner thigh.

Pelvic floor muscles

Jake didn’t realize he had a strong tendency to clench his pelvic floor muscles, especially when he was under a lot of stress. As a result, the pelvic muscles lacked coordination and relaxation.

Treatment and treatment plan

Jake came in for treatment weekly, for a duration of six weeks.

His treatment consisted of:

Connective tissue mobilization: manual fascial work, focusing on areas around the hips and pelvis

Trigger point release: manual release and trigger point dry needling

Home program: postural awareness exercises, breathing, pelvic floor relaxation exercises and gentle stretches. (After three visits Jake started running, one of his favorite activities.)

Education: Jake was instructed in dietary irritants for the bladder, urge suppression techniques, constipation management, and to get a standing station at work if possible.

Results

After six sessions, Jake’s bowel and bladder symptoms had resolved. He continued to experience abdominal tightness and discomfort and could correlate his symptoms with stress.

We saw him for another three visits spread out over four months. Jake was discharged after nine visits. He got a standing desk at work and even trained and completed a half marathon!