Maybe it's not about the prostate (Part 1)

Melissa McElroy, PT, DPT, WCS

October 18, 2018


Men who suffer with pelvic pain have an incredibly difficult time finding the medical care that they need. On average, it takes 7 years and 5 different physicians to get a diagnosis and treatment plan that can help. Oftentimes they are tested, scoped, and swabbed for years before finding the root of the issue. They are prescribed antibiotics for infections that aren't there, and most commonly they are asked to take these antibiotics for months, or even years, with no change to their symptoms.

If you google "male pelvic pain" the first website that comes up is from the Mayo Clinic. Click the link and it takes you directly to their "symptoms checklist." If you are checking your symptoms and report that you are experiencing discomfort, pressure, or pain in the lower abdomen or groin, pain/discomfort in the penis, painful intercourse or ejaculation, and testicle pain, accompanied by frequent urination or urge to urinate, and difficulty urinating or emptying the bladder completely, you will be diagnosed with anything from bladder stones to genital herpes.

Prostatitis is the diagnosis most often given to this population with symptoms that include, but aren't limited to:

  • Pain/tension with sitting
  • Pain at the testicles
  • Pain/pressure/discomfort in the lower abdomen or groin
  • Painful intercourse or ejaculation
  • Sensitivity at the tip of the penis
  • Itching of the penis, anus, scrotum
  • Pain in rectum
  • Difficulty urinating or having a bowel movement
  • Abdominal sensitivity
  • Pain during/after urination/orgasm/BM
  • Increased frequency/urgency of urination

Prostatitis is the most commonly diagnosed urologic condition in men, with over 200,000 cases diagnosed in the U.S. each year.

If all causes of infection are ruled out, but symptoms persist, the diagnosis that is given is Chronic Abacterial Prostatitis (nonbacterial prostatitis), also known as Type III prostatitis, as labeled by the National Institutes of Health (NIH). The medical treatment for someone with Type III prostatitis is multifaceted, but often most of these have been tried/prescribed/utilized, through the process of coming up with a diagnosis. These should include activity and dietary modifications, cognitive behavioral therapy, exercise, and manual therapy, but often don't. This is where our medical system fails this population. In our current medical model, if medications won't fix it, and surgery is not warranted, then a stigma surrounds you, and "it must be in your head." By the time that the conclusion has been drawn that "it must be in your head," years have gone by and the actual treatment can be more complicated.

A diagnosis of abacterial prostatitis/nonbacterial prostatitis/Type III prostatitis says that it's likely not a problem with your prostate. 90-95% of all prostatitis diagnoses are not prostatitis related, despite what it's called.

If it's not the prostate, then what is it?

A few of the diagnoses that are less discussed, but often placed under the "prostatitis" umbrella, are:

  • Chronic Pelvic Pain Syndrome (CPPS)
  • Interstitial Cystitis (IC)/ Painful Bladder Syndrome (PBS)
  • Levator Ani Syndrome
  • Anismus
  • Obturator Internus Syndrome

Based on any of the above diagnoses, the pain that is being experienced could be caused by muscle spasms, scar restriction, nerve entrapment/irritation/compression, poor bowel or bladder habits, or breath-holding patterns. All of this can be compounded by stress and worry of how this pain is affecting your family, your career, and your overall quality of life.

The next step to recovery is finding a pelvic health specialist in your area. Pelvic health physical therapists (commonly known as Women's Health therapists… sorry for the name – we do treat men) are the most educated and equipped professionals to manage and treat your pelvic pain. The American Physical Therapy Association (APTA) has a "Find a PT" resource page to help you locate a pelvic PT in your area.

In the meantime, taking steps to improve your general health, gut health, activity levels, and decreasing the impact of the stressors in your life can make a difference in your pelvic pain. Tune in for part 2 to discuss more specific self-care options!

We accept most major insurances in the Louisville area including Medicare and Passport.