What is chronic pelvic pain?
Chronic pelvic pain syndrome (CPPS) is any pain or discomfort in your pelvic area that lasts for at least three months or up to six months. Your pelvic area is from your navel (belly button) to the middle of your thigh. CPPS is a debilitating condition that is infamous for the pain and impaired quality of life it causes. Patients who present with CPPS are often frustrated by the persistent and severe nature of this pain. CPPS can be challenging to deal with.
What are the symptoms of men’s chronic pelvic pain?
Male pelvic pain is defined by three simultaneous factors: (1) continuous or recurring pain in your pelvic region; (2) the pain lasts at least three months; and (3) there is no identifiable reason, such as an infection or apparent underlying cause. This condition is complex and can significantly impact your quality of life.
Common symptoms include:
- Discomfort or lower abdominal pain.
- Discomfort or pain in the perineum (the area between the scrotum and anus), rectum, or lower back.
- Pain at the tip of the penis, in the testicles, or the groin.
- Pain while sitting or during certain activities.
- Abnormal urinary symptoms (including frequent urination, urgency, trouble urinating, such as hesitancy, weak stream, the feeling of incomplete bladder emptying, or pain or burning during urination).
- Sexual dysfunction.
- Pain during or after ejaculation (post-ejaculatory pain).
- Erectile difficulties or other forms of sexual dysfunction.
- Discomfort or burning during ejaculation.
- Bowel problems, such as discomfort during bowel movements or constipation.
Regarding symptoms, please note that:
- Symptoms can be constant or change over time, sometimes coming and going.
- Pain is not limited to the prostate and may involve the pelvic floor, abdominal, or back muscles.
- Many men experience a combination of urogenital pain, urinary symptoms, sexual dysfunction, and emotional disturbance.
What are the common causes of pelvic pain in men?
Pelvic pain in men may begin suddenly, as with a kidney stone or a pulled muscle. On the other hand, it can come on gradually, as with prostatitis, a urinary tract infection (UTI), a bladder infection, or even digestive problems. Sexually transmitted infections (STIs) are also among the causes of male pelvic pain.
Yet, the cause of male pelvic pain is often not the result of a single, easy-to-identify issue. Instead, it is a combination of multiple factors acting simultaneously. And there can be a lot of them, including:
Prostatitis
Prostatitis is an inflammation of the prostate gland. A bacterial infection can cause sudden or acute cases. Chronic prostatitis, on the other hand, is usually caused by inflammation, often without an infection. In addition to pelvic pain, prostatitis may cause urinary problems or problems with ejaculation.
When a bacterial infection does not cause prostatitis, the condition can be referred to by several names, including chronic prostatitis, chronic pelvic pain syndrome, prostatodynia (painful prostate), nonbacterial prostatitis, or abacterial prostatitis.
Benign prostatic hyperplasia (BPH)
Benign prostatic hyperplasia (BPH) is a non-cancerous condition that occurs when the prostate gland is enlarged, which can lead to chronic pelvic pain in men.
Hernia
A hernia occurs when a body part protrudes through the muscle or tissue that usually holds it in its proper place. Sudden pain in the lower abdomen may be a sign of a hernia.
There are several different types of hernias, but the two that are often a reason for men’s pelvic pain are:
- Inguinal hernia (which is a bulge into your inguinal canal, the tunnel through which your testes descend)
- Femoral hernia (when the bulge is through your groin)
Irritable bowel syndrome (IBS)
IBS commonly causes intestinal issues such as:
- Cramps and bloating
- Diarrhea or constipation
- Mucus in the stool
These symptoms tend to go away temporarily after a bowel movement.
Testicular torsion
Testicular torsion is a medical emergency where a testicle twists around the spermatic cord, cutting off its blood supply. This causes sudden, severe pain and swelling in the scrotum and requires immediate treatment to save the testicle.
Pelvic floor dysfunction
The pelvic floor is a group of muscles that form a basket to support the pelvic organs, including your bladder, prostate, and bowels. Contracting and relaxing these muscles allows you to control your bowel movements and urination, and assists in sexual activity.
However, when your pelvic floor muscles stop working as they should, pelvic floor dysfunction causes your pelvic muscles to either tighten or weaken. When the muscles tighten or spasm, you will have difficulty peeing or passing stool, along with chronic pelvic pain. When they weaken, you may experience trouble controlling your urine and stool.
Research shows that men with CPPS are more likely to have abnormal pelvic floor muscles.
Stress
Some men are more prone to stress and have a harder time relaxing than others. Thus, these men unknowingly tense their pelvic muscles under stressful situations, leading to trigger points and sore, painful muscles. These clenched pelvic muscles further perpetuate stress, driving a never-ending vicious cycle of pain and anxiety.
Hormone imbalances
Sometimes, male pelvic pain may be caused by hormonal imbalances, particularly an imbalance in the stress hormone and the network that regulates its release.
Trapped nerves
Pelvic pain can also result from the compression of the pudendal nerve. In men, this nerve supplies the skin of your scrotum, the perineum (the skin of the area behind the scrotum), and your penis.
Neural crosstalk
Research shows us that there’s a two-way crosstalk between your bladder and bowels. This means that the two systems communicate with each other. If something irritates your bowels, it can also affect the nerves feeding your pelvic organs and vice versa.
Painful bladder syndrome
Sometimes, the source of CPPS can be painful bladder syndrome, also called interstitial cystitis. This condition affects the lining of your bladder, causing chronic pelvic and bladder pain. It also causes you to urinate more often and with smaller amounts of urine than usual.
Autoimmunity
At times, your immune system may go haywire and start attacking your prostate, leading to chronic pelvic pain.
How do we diagnose the cause(s) of pelvic pain?
A medical evaluation with your Tower urologist will include a thorough review of your medical history and a physical examination. You may also need a blood test, urinalysis, and/or imaging.
Suppose you have a concern that you may have a bladder infection or inflammation. In that case, your Tower urologist will probably order a urinalysis to evaluate your urine for evidence of infection or a tumor.
We might order a blood test to check for an infection in your body or to help determine if you have appendicitis. A blood test can also detect prostate-specific antigen (PSA), which is one indicator of the potential for prostate cancer.
We may order imaging tests, such as an X-ray, CT scan (computerized tomography), ultrasound, or MRI (magnetic resonance imaging) to detect numerous possible issues, including:
- Appendicitis
- Pelvic infection
- Kidney stones
- Gastrointestinal disease
- Testicular torsion
- Enlarged prostate
- Tumors
How is chronic pelvic pain in men treated?
We use a multi-disciplinary approach to treat CPPS. Some commonly used treatment options and therapies for CPPS include:
Pelvic floor therapy
Pelvic floor therapy focuses on methods to release overly tense pelvic floor muscles. It combines pelvic floor physical therapy with trigger point injections to help loosen tight muscles.
Medications
Depending on the cause of CPPS, we offer various medications, such as:
- Antibiotics to treat any underlying infection
- Pain medication to help relieve discomfort or chronic pain, anti-inflammatory drugs, muscle relaxants to relax your prostate and the bladder and neck muscle to improve urinary flow and minimize urinary obstruction
- Hormone supplements
- Alpha-blockers
- Antidepressants
Sitz bath
Sitz baths may provide some relief from acute episodes of CPPS.
Dietary changes
While none of the following food products cause actual physical damage to your prostate, it’s best to avoid excessive use of certain substances that may irritate your gland. These include:
- Tobacco (cigarette smoking)
- Alcohol
- Tea
- Soda
- Caffeine (coffee)
- Spicy foods
Tower Urology offers the most advanced treatment for pelvic pain in men in Los Angeles
We take a personalized, evidence-based approach to general urology care at Tower Urology. All our professionals at Tower Urology are dedicated to providing you with expert care and follow-up. We take the time to understand you and personalize your treatment plan to your needs.
We invite you to establish care with Tower Urology.
Tower Urology is a proud affiliate of Cedars-Sinai Medical Center, ranked #1 in California and #2 nationwide by U.S. News & World Report. This partnership reflects our dedication to delivering the highest standard of urologic care alongside the best urologists in Los Angeles. Our years of experience and access to Cedars-Sinai’s world-class facilities ensure that our exceptional and innovative urological care positions Tower Urology as a leader in Southern California.
Tower Urology is conveniently located for patients throughout Southern California and Los Angeles, including Beverly Hills, Santa Monica, West Los Angeles, West Hollywood, Culver City, Hollywood, Venice, Marina del Rey, Burbank, Glendale, and Downtown Los Angeles.
Our services include treatment for low testosterone, chronic testicular pain, Peyronie’s disease, and male infertility.
Men’s Chronic Pelvic Pain FAQs
If you are a man experiencing pelvic pain, you must see your healthcare provider promptly, especially if you are experiencing:
- Hematuria (blood in urine).
- Hematospermia (blood in semen).
- New onset of urinary incontinence or fecal incontinence.
- Difficulty urinating, urinary retention, or inability to urinate.
- Painful urination, especially with fever or chills.
- Penile or testicular mass.
While the cause may not always be serious, there are other cases when it can be. Plus, the pain can rapidly worsen and even cause long-term complications such as infertility without appropriate treatment.
Prostatitis is a common condition in men, though estimates of how common vary depending on definitions and populations studied. In the United States, prevalence (commonness) rates have been reported as high as 16%. Studies from different regions, including North America, Europe, and Asia, generally estimate prevalence between 2% and 10%.
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is the most common form, accounting for 90–95% of prostatitis cases. Acute and chronic bacterial prostatitis are much less common, representing 2–5% of cases.
Yes, stress can contribute to pelvic pain in men. Multiple studies and clinical observations have found a strong association between psychological stress and the development or worsening of pelvic pain, particularly in conditions like chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).
Sources
Definition & Facts for Irritable Bowel Syndrome
https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/definition-facts
Prostatitis: Inflammation of the Prostate
https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostatitis-inflammation-prostate
Definition & Facts for Irritable Bowel Syndrome
https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/definition-facts
Prostatitis: Inflammation of the Prostate
https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostatitis-inflammation-prostate
