What To Do About Your Pelvic Pain [ARTICLE]

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According to Dr. Reutter, the pelvic floor consists of a network of muscles that act as a sling to support the pelvic floor organs (the prostate, bladder, rectum and seminal vesicles), stabilize the connecting joints and assist in bladder, bowel and sexual function. Unlike the muscles you see when you hit the gym, these muscles are mostly internal and (hopefully) not visible to the general public. But they are critical to your everyday function and easily affected by stress, sleep, and other lifestyle factors.

With quarantine and a terrifying global pandemic in full-swing, many men are experiencing heightened symptoms. Dr. Weber believes this may be due to the current circumstances. Quarantine and a global pandemic might just be the perfect storm for pelvic floor dysfunction. Dr. Reutter adds that working from home, stress, uncertainty, sitting, lack of exercise, and lack of social connection contribute to any of these symptoms. According to Dr. Weber, the pelvic floor muscles often respond to our emotional state, acting as our human tail. During times of stress, fear and anxiety, we tend to tuck our tails and contract our pelvic floors. Sitting on a couch or make-shift home office doesn’t help the situation.

How You Can Handle Pelvic Floor Dysfunction

To avoid this perfect storm of tension, Dr. Weber advises that you try to connect with your breath to help reduce any unwanted tension. Taking deep belly breaths can reduce any pelvic floor gripping that might unconsciously happen in response to our current situation, she advises.

Also, adjust how you’re sitting. Make sure you are sitting with your feet grounded, maintaining the neutral arch in your lower back. Try to “sit on your junk,” avoiding rolling back onto the SITS bones and slouching. Now take a big inhale and imagine that space relaxing. As you exhale, think of drawing that space together, lifting the scrotum. You should feel a contraction and subsequent relaxation of your pelvic floor muscles.

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In addition to breath work, Dr. Reutter suggests you take warm baths, increase aerobic activity (which increases endorphin levels, the bodys natural painkiller) and avoid prolonged sitting on hard surfaces to help relax the pelvic floor and mitigate symptoms. If you dont respond to conservative treatment, injections could be administered to help break up the tension in the contracted pelvic floor muscles, reduce nerve inflammation, and improve blood flow to the affected region. But as tempting as injections might sound (ouch!), youll want to try conservative options such as physical therapy first.

Common Pelvic Floor Conditions

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Dr. Reutter and Dr. Weber go deep on a few common conditions below. If you are experiencing the symptoms described here, reach out to one of these experts to help determine the true cause of your symptoms and whether or not there is more you can do. If not addressed, your pelvic pain could have a large range of effects, from reducing your ability to produce power during your workout to impacting you emotionally and socially.

Prostatitis

The prostate is a small gland located directly below the bladder that enlarges over time. According to Dr. Reutter, prostatitis consists of swelling and inflammation of the prostate gland. This gland secretes a fluid that helps constitute semen or seminal fluid. Prostatitis can be bacterial or non-bacterial. Non-bacterial prostatitis is more common form and can be due to nerve irritation, chemical irritation, stress, and often a weak or spastic pelvic floor. Symptoms normally include painful urination, pain w ejaculation, and pain in the groin, genitals, and pelvic floor.

Levator Ani Syndrome

The levator ani is one of the muscles of your pelvic floor. It is primarily responsible for preventing urinary incontinence and supporting the pelvic organs. Dr. Reutter explains that this syndrome can be due to chronically contracted pelvic floor muscles.

Symptoms often present as pain in the rectum resulting in an achy feeling during and after intercourse, pain with bowel movements, constipation, and/or a feeling of rectal fullness or pain. Dr. Reutter notes: Patients often describe a feeling of a golf ball or similar in the rectum. He adds that stress, anxiety, chronic constipation, a history of hemorrhoids, anal fissure, and prior colorectal surgery are all causes of levator ani syndrome.

Pudendal Neuralgia

Pudendal neuralgia is a condition that involves pain of the pudendal nerve, which runs from the anal region to the genitals. This condition is commonly associated with pinching or compression of the nerve. Symptoms include aching, burning, or stabbing pain in the penis or scrotum. This pain can increase with sitting and ejaculation.

Common causes are nerve entrapment, straining from bowel movements, trauma, and prolonged pressure on the pudendal nerve due to prolonged sitting on a hard surface, biking, and similar activities.

Chronic Pelvic Pain Syndrome (CPPS)

Anything chronic means youve been experiencing the pain for quite a while. Dr. Weber describes this syndrome as pain over a longer duration of time, often causing discomfort with urination and ejaculation. As a physical therapist, she usually finds patients have pain throughout the lower back/sacrum and lower abdomen/hip flexor/adductor muscle groups.

Men with CPPS undergo testing that rule out a bacterial infection, or are often given antibiotics as a trial for pain relief without success. We find that the root of the pain is the overactive pelvic floor muscles. To treat this type of overactivity, Dr. Weber creates a physical therapy plan consisting of reducing the muscle tension using manual therapy techniques applied to both the pelvic floor muscles and surrounding muscles/fascia throughout the pelvis (abdominals, hip flexors, adductors and deep hip rotators). Another important part of the intervention includes activity and exercise modification, along with postural education.