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Writer's pictureFiona McMahon

Male Pelvic Pain Explained



Fiona McMahon PT, DPT, PRPC


Fiona is a pelvic floor therapist in Ho-Ho-Kus. She is currently accepting new patients. Call 551-244-1186 or e-mail Fiona@Emberphysicaltherapy.com to find out more!


Why write this blog? If you have landed here you’re either one of two types of people. You’re either a provider who is interested in the contributions of pelvic floor dysfunction, or you are a man (or someone in a male body) or the loved one of a man who is experiencing pelvic pain. Either way, I am so glad you are here. As a general disclaimer, I will be referring to folks with penises as men or male in this blog. I want to acknowledge that not everyone with male anatomy identifies as male. No matter your gender identity, pelvic floor dysfunction can contribute to pelvic pain and should be treated comprehensively and compassionately. Men often find difficulty finding pelvic floor care practitioners who can effectively treat their symptoms. I am hoping through this blog you find hope, and some next steps in your journey to feeling better!


So you have been dealing with pain down below, or you have noticed a change in your voiding habits, how do you know if you are experiencing pelvic floor dysfunction? It can be really confusing. The symptoms of pelvic floor dysfunction can be non-specific. Meaning these symptoms can have many different causes. Pelvic floor dysfunction can often look and feel like a sexually transmitted infection, infectious prostatitis, as well as other medical genitourinary conditions. Many of the men I see in the clinic have spent countless hours in doctors’ offices with little to no results. They are frustrated, burnt out, and often feel like giving up. I always strongly encourage my patients to visit their doctor before starting physical therapy to rule out any infectious cause. One, we obviously don’t want to miss it and two, it can be a relatively easy fix. If you have seen the doctor but no improvement, you may be experiencing pelvic floor dysfunction and it may be time to see a pelvic floor specialist.


Symptoms of Pelvic Floor Dysfunction in Male Bodies:


  • Penile pain- especially in the glans (aka the head of the penis)

  • Golf ball sensation in the rectum

  • Constipation

  • Tailbone pain

  • Urinary frequency

  • Painful urination

  • Pain with bowel movements (pooping)

  • Abdominal pain/bloating

  • Pain with arousal and orgasm


To better understand how one could develop pelvic floor dysfunction and why pelvic floor dysfunction causes these types of symptoms, it is important to understand what the pelvic floor is and how it works. 



What is the Pelvic Floor

The pelvic floor is the group of muscles that live between your tailbone and pubic bone. If you envision the area that makes contact with a bicycle seat you will envision your pelvic floor. The pelvic floor of males is similar to that of females with a few key exceptions. First, the male pelvis is narrower than the female pelvis. Second, the muscle at the base of the penis, the bulbospongiosus, is not bifurcated as it is in females ( the female version is called the bulbocavernosus). 


The pelvic floor is responsible for so much in our body. Typically the work of the pelvic floor goes on in the background unnoticed until the pelvic floor goes into dysfunction, which is when you will see symptoms. The following functions may be impacted by pelvic floor dysfunction.


Sexual: sexual function depends heavily on a healthy pelvic floor. The muscles of the superficial layer of the pelvic floor work to allow blood flow into the penis, propelling sperm with ejaculation as well as providing the rhythmic contractions associated with orgasm.


Sphincteric: The pelvic floor also contains the urinary and anal sphincters these sphincters maintain continence and allow for defecation and urination


Stabilizing: Did you know that the pelvic floor is part of the core? The abs get all the credit, but yes the pelvic floor is part of the core. The core helps to stabilize our trunk, which helps us to do pretty much anything we want to do in a day, from lifting weights to sitting upright. If the core does not adequately support the trunk back and pelvic pain can sometimes result.


Sump pump: This one is one that we don’t often think about. Blood has to work against gravity to make it back up to the heart. The muscles of our lower half are responsible for helping blood return from the bottom half of our bodies back to our hearts.. Without healthy pelvic floor muscles, blood can pool and result in a heavy draggy sensation in the pelvis. 


So what is Pelvic Floor Dysfunction and what does it feel like? 


There are two main types of pelvic floor dysfunction. The first type is what some of us will describe as “low-tone” pelvic floor dysfunction. This type of dysfunction involves muscles that are weak and lax. Believe it or not, I do not typically see many men with this type of presentation complaining of pelvic floor pain. Because many men with pelvic floor pain do not have the weak and lax subtype, kegels usually do little to help or make dysfunction worse..


The far more common presentation of pelvic floor dysfunction that I see associated with pelvic pain is the tight, short, or hypertonic pelvic floor presentation. This occurs when the muscles of the pelvic floor become tight, spasmed, or rigid. Sometimes these muscles will develop trigger points which can refer to areas like the head of the penis, the rectum, tailbone, and elsewhere in the pelvis. Additionally, tight or short pelvic floor muscles will ache or burn when asked to perform functions like sexual activity, urinate, or assist in bowel movement.  


The pain with pelvic floor dysfunction can come in “flavors”. The English language is notoriously ineffective in describing pain. Some of the most common descriptions folks will give to describe their pain as “burning in the urethra, aching in the perineum, spasm, sharp sensations, ice pick-like sensations, burning, and zapping” All of these sensations can be related to pelvic floor dysfunction. 


What causes pelvic floor dysfunction in men?

“Why the h*ll am I dealing with this?” or some variation thereof is the number one question I am asked when treating pelvic pain and pelvic floor dysfunction in people of all genders. It’s such a reasonable question. If you know the cause, you can take steps to prevent its recurrence. Oftentimes with pelvic pain, regardless of gender, the cause can be multifactorial. It’s not like an ACL injury where there was a very clear “before/ after”. Typically, pelvic floor dysfunction will come on slowly with no clear identifiable accidents or injuries. Pelvic floor dysfunction often occurs after a buildup of physiological and/or psychological stressors over time. 

Some common contributors to pelvic floor dysfunction include:

  • Poor body mechanics

  • Myofascial restriction

  • Psychological stress

  • History of repeated infection

  • Bowel Issues- resulting in straining

  • Overuse injuries

  • Hip/back dysfunction


Identifying all the factors contributing to your pelvic pain and dysfunction can provide many different options for where to start. A skilled clinician can identify the primary drivers of your condition and help you determine how and where to start for the fastest recovery. 


What are the treatments for pelvic floor dysfunction in men?

I have been treating pelvic pain for long enough and side by side with many other talented clinicians to know that there is no one perfect way to treat pelvic floor dysfunction. Selecting the appropriate treatment depends on how you present as the patient as well as your individual clinician’s skill set. Let’s explore common treatment techniques that I use at Ember!


Manual Therapy

Manual therapy is an umbrella term for the work physical therapists do on the body with their hands. These techniques can include joint mobilizations, myofascial release, visceral release, and much more. The point of these techniques is multi-fold. Pelvic floor physical therapists may use a skill like myofascial release to reduce painful areas of spasm in the pelvic floor and abdomen. They may use desensitization techniques to allow painful areas of the body to be more tolerant of pressure/ discomfort, (some folks with pelvic floor dysfunction may be very sensitive to underwear on the genital area as well as tight waistbands).  

Visceral release is another common manual therapy in pelvic floor physical therapy and at Ember. Visceral release allows the organs of the abdomen and pelvis to move properly aiding in bowel and bladder function as well as reducing pain. Other manual techniques include joint mobilization, cupping, skin rolling and many more!


Posture and Coordination Retraining


Honestly, this is a piece of physical therapy that I find to be most powerful. As a primarily manual (hands-on) therapist, I spend a lot of my time with patients working to restore the mobility of tight and dysfunctional tissues. This usually goes a very long way towards reducing symptoms. What’s really important is not only the reduction of symptoms but something physical therapists call “carryover”. Carryover occurs when the changes a patient and therapist make in a session are conserved or “carried over” to the next. This is so important because, though I adore my patients and would love to see them every week, I know that they have better things to do than hang out with me for the rest of their lives, so I use postural and coordination retraining to allow folks to move their bodies in a more efficient way, reduce the forces that originally caused the spasm/dysfunction, and allow them to maintain their results without the need for weekly physical therapy sessions once their symptoms have been resolved.  

Posture is key when it comes to pelvic floor health. The way we sit and stand can place tremendous stress on the pelvic floor, leading to overuse and dysfunction of the pelvic floor and other muscle groups. Training patients to automatically assume more neutral postures is necessary to maintain carryover. 

Similarly, the pelvic floor may also be put under undue stress, due to poor coordination and mechanics. One of the most common conditions we see in folks with pelvic floor dysfunction is called paradoxical contraction. Paradoxical contraction occurs when the pelvic floor tightens when it is meant to open. This often will occur whilst attempting a bowel movement. If paradoxical contraction is present, the person trying to defecate will have to maximally strain to evacuate stool, which can result in the pelvic floor becoming even tighter. 

If we as PTs fail to eliminate movement patterns and postures that contribute to pelvic floor dysfunction, we may fail to prevent symptom recurrence. 


Stress Reduction


Physical therapists are just that “physical” therapists. We do not directly treat psychological issues like anxiety or depression. We know that stress can make pain syndromes worse. Just because stress worsens symptoms does not make your symptoms less real. Managing stress is just part of pushing the body in the right direction to heal. We as physical therapists, often refer to mental health providers in tandem with providing physical tools to help aid in calming the central nervous system such as deep breathing, contralateral tapping, and more.


Why Ember Physical Therapy for the Treatment of Chronic Pelvic Pain


When it comes to pelvic pain, experience is everything. We have to see a lot of cases to be truly effective in diagnosing and treating complex pelvic floor dysfunction. I have honed my practice in treating male pelvic pain by treating exclusively pelvic floor patients since 2015.

Additionally, every treatment plan at Ember is bespoke and tailored specifically to you and your needs. No protocols here!

If you are considering pelvic floor physical therapy for pelvic pain reach out by e-mailing Fiona@Emberphysicaltherapy.com or calling 551-244-1186. 


Cohen D, Gonzalez J, Goldstein I. The Role of Pelvic Floor Muscles in Male Sexual Dysfunction and Pelvic Pain. Sex Med Rev. 2016 Jan;4(1):53-62. doi: 10.1016/j.sxmr.2015.10.001. Epub 2016 Jan 8. PMID: 27872005.


van der Velde J, Everaerd W. The relationship between involuntary pelvic floor muscle activity, muscle awareness and experienced threat in women with and without vaginismus. Behav Res Ther. 2001 Apr;39(4):395-408. doi: 10.1016/s0005-7967(00)00007-3. PMID: 11280339.


van Reijn-Baggen DA, Han-Geurts IJM, Voorham-van der Zalm PJ, Pelger RCM, Hagenaars-van Miert CHAC, Laan ETM. Pelvic Floor Physical Therapy for Pelvic Floor Hypertonicity: A Systematic Review of Treatment Efficacy. Sex Med Rev. 2022 Apr;10(2):209-230. doi: 10.1016/j.sxmr.2021.03.002. Epub 2021 Jun 12. PMID: 34127429.

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