Chronic pelvic pain syndrome is only one of a number of male pelvic floor dysfunctions that physiotherapists can treat. Chronic pelvic pain syndrome is hard to diagnose and diagnosis is only the beginning of what can be a long—and painful—journey. This condition affects 90 million men worldwide. 
 
Male chronic pelvic pain syndrome is defined as chronic pain, pressure, or discomfort localized to the pelvis, perineum, or genitalia of males lasting more than 3 months that is not due to readily explainable causes (infection, tumour, or structural abnormality). Faced with a negative test result, family doctors and urologists are often stumped. After months and maybe even years of dead ends and dashed hopes, patients are told there’s not much their doctors can do. They’ll have to learn to live with it. 
This syndrome occurs only in men and common symptoms include pain or discomfort in the perineum, suprapubic area, penis, and testicles, as well as pain on peeing and ejaculatory pain. 
 
Patients may also have urinary symptoms, both obstructive (slow, intermittent stream) and irritative symptoms like urgency and increased frequency. Sexual dysfunction is also common. Other symptoms include muscle and joint aches and unexplained fatigue. 
For many years the prostate was (and often still is) wrongly assumed to be the source of the pain and dysfunction. The vast majority of cases are not caused by the prostate gland, and are therefore more accurately called Chronic Pelvic Pain Syndrome (CPPS) rather than Chronic Prostatitis (CP). 
 
The background cause is still incompletely known and is probably a complex process comprising many issues that eventually results in a chronic nerve and/or muscular pain syndrome. Triggers of this condition are believed to include infection (including sexually transmitted diseases and organisms and viruses), trauma (including perineal and urethral trauma), nerve overstimulation, non-infection-related inflammation (auto-immune or neurogenic), dysfunctional peeing, and pelvic floor dysfunction/muscle spasm. Common conditions associated with this include depression, stress, and anxiety disorders. 
Current research has shown that tension and dysfunction in the muscles of the pelvic floor play a significant and are often the primary role in the development of this condition and its subsequent symptoms, including pain. However, many Doctors neither appreciate nor understand the havoc that chronic tension plays in the pelvic floor. 
 
The impact of this condition on quality of life and activities of daily living can be significant. Coping with chronic pain is exhausting and it can negatively affect almost every area of life. If the pain impacts sexual function, it can cause self-image and relationship woes, problems sitting—sometimes for anything longer than a few minutes—and difficulty with bowel and bladder management can affect a wide range of activities, including employment, athletics, driving and socializing. Some men are prescribed antidepressants or anticonvulsants to help manage the pain, which have their own set of side effects. Simply feeling alone and without answers can be debilitating. 
How did this happen to me? 
A pain may start in a pelvic organ such as your bladder, bowel, or prostate, it may also start in muscles, or joints following an injury. It may start following prolonged stress with tension in muscles. Whatever the original cause of pain, if it doesn’t settle then the pain can become chronic. Generally it is considered ‘chronic’ if it is still present after 3-6 months. No-one understands why a similar condition in some men might lead to chronic pain, while in another man might go away completely. 
 
Once a pain has become chronic, the pain situation is usually more complicated. There may still be the original problem, but there is now pain from tight painful pelvic muscles and a change in the nerve pathways that send pain messages to the brain. Both of these types of pains are pains that cannot be seen from the outside and do not show on scans or during operations. Often the pain from pelvic muscle spasm can become the worst part of the pain, it can be a cramp on the inside of the pelvis. Many say the feeling is like sitting on a golf ball. 
 
Once muscles and nerves in the pelvis start behaving abnormally, other organs can develop problems too. There may be difficulty passing urine, with bowel function or with sexual function. 
Treatment: 
How can I manage my pain? - Learn more about your pain 
Everyone is different and it is important to learn more about your individual condition – why you have pain; where it is coming from; and what makes it better or worse. Remember that no matter how the pain started, if you have pain on most days, it is likely that tight, tender and painful pelvic floor muscles are part of the problem. 
 
Learn how to locate and then relax the pelvic floor muscles 
Locating and understanding the pelvic floor muscles allows the muscles to work normally again. The pelvic floor muscles are all internal muscles that cannot be seen externally, so you may not be familiar with their position, size and function. Reducing the tension in the muscles of your pelvic floor will help reduce your pain. 
Internal exams, which can be performed only by a pelvic floor therapist with special training, help to identify the key objective findings. Men with chronic pelvic pain syndrome usually have at least one—and usually more—of the following: increased pelvic floor muscle activity on EMG biofeedback and/or Real time Ultrasound scanning, increased pelvic floor tone on palpitation, presence of pelvic floor trigger points, increased external anal sphincter tone and poor or decreased pelvic floor proprioception and motor control. 
 
Treatment from a Specialist pelvic floor physiotherapist may include combinations of the following interventions: 
 
Pelvic floor proprioception and motor control exercises, both with Real time Ultrasound scanning with or without EMG biofeedback, to teach pelvic floor relaxation techniques 
Pelvic floor trigger point release. Stretches to release overtensed muscles in the pelvic or anal area (commonly referred to as trigger points) including digital intrarectal massage, physical therapy to the area. 
Progressive relaxation therapy to reduce causative stress. 
 
TENS 
 
Acupuncture has reportedly benefitted some patients 
Visceral mobilization and myofascial release techniques 
 
External trigger point release 
 
Behavioural and dietary bladder and bowel interventions and education to help with constipation and bladder pain 
Peripheral and central pain pathophysiology education and interventions to increase the patient’s ability to minimize pain sensation 
 
Sexual health education and referral to sex therapists if warranted 
Referrals to other health professionals, including doctors, counsellors, dietitians,employment supports and ergonomists, who have an interest and experience in managing chronic pelvic pain 
Aerobic exercise can help those sufferers who are not also suffering from Chronic Fatigue Syndrome (CFS) or whose symptoms are not exacerbated by exercise. Acupuncture has reportedly benefited some patients 
Referral to GP for advice on medication (using tricyclic antidepressants and benzodiazepines). A number of medications can be used to treat this disorder. Alpha blockers and/or antibiotics appear to be the most effective with NSAIDs such as ibuprofen providing lesser benefit. 
 
If you, or anyone you know, is suffering with any degree of Pelvic Pain 
then please contact Katrina Wade in complete confidence. you can 
email her directly at katrina.wade@bodyworksphysio.net or phone 
her on 01206 844410. 
 
Anything that you wish to talk about will be in complete confidence. Do Not Suffer In Silence. 
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