Male Pelvic Pain: The Same Old Story – But It Doesn’t Have To Be

If you’re a man with what feels like pain in your pelvic area, you probably feel like you’re in trouble.

You have a musculoskeletal problem in an area that no one wants to touch (including you, because it reminds you too much of the dreaded prostate exam when you turn 40).

But this is exactly what the problem is in the majority of cases: your pelvic floor muscles are tight and they are causing rectal pain, testicular/penile pain, urgency, frequency, erectile dysfunction and constipation/diarrhea.

You have been treated in a silo (aka everything separately), mostly based on urology consults.

Because of where your symptoms are located, you’ve probably been put on endless rounds of antibiotics for an infection that has never “cultured positive.”


What men need to know about their pelvic health 

 My name is Carolyn Vandyken and my job involves listening to my patient’s story about both who they are and how pain has started to (or currently does) dominate their life.  My role is to help them get their life back by understanding what tissues are affected, the context of their life, and the emotional pieces that circle their particular problem.

I have worked as a neuro, orthopaedic and a pelvic health physiotherapist.  Despite my varying positions in the field, my patients have taught me to stop thinking in silos. Again and again I’ve seen the value in simply treat the person in front of me, including the messy emotional, social, and physical pieces.

The time has come where the evidence states that we can no longer draw a dotted line between the pubic bone, tailbone and ischial tuberosity’s and ignore the most important emotional and physical real estate in our bodies: the pelvic floor.

This specific area is what inspires me to wake up every day and pour my energy into my amazing calling. In order for us to have our basic needs met, sex, bowels movements, voiding, eating and drinking need to be normalized and pleasurable.  Helping men and women normalize these all too common but overlooked problems ensures wellness in what is arguably the most important components of our lives.


How did you get to this point? It started with stress, physical tension in your pelvic floor muscles that went unchecked, and some normal reflexes in your body that continue to sensitive the bladder, prostate and bowels.


This old story

 If you’ve experienced pelvic pain for a while now, I’ve heard your story hundreds of times. This is often how it goes:

  1. You went through a period of high stress at work and probably have a “sitting” job. You worry about your job, and take the worry home with you, which leads to ongoing low-grade stress.

2. You started to feel a dull ache in your rectum. Weird. You didn’t talk to anyone about it because who has that conversation?

3. That dull ache starts to bother you at work. It begins to consume your thoughts during the day.

4. You also start to notice other strange things, like your urine or ejaculate flow is decreasing. You’re now going to the bathroom more often, but you don’t feel like you can empty fully. Hmmm. Are you just “getting old” and your prostate is acting up?  You might resign yourself to the “fact” that this is just part of aging.

5. Then, having sex and/or having a bowel movement start to make you feel sore. You really start to get worried, since having a good bowel movement and an orgasm is an important component of your life. You realize that you need to take action on this.

6. You go to your family doctor and describe your symptoms. Your urine is cultured (and if you’re lucky, your prostate fluid is too), but both came back negative. You’re given antibiotics anyway. He refers you to a urologist.  You may have seen more than one by now.

7. The urologist tries four other types of antibiotics. Now your gut hurts, your bowels are messed up, and your sex life is still derailed.

8. Worse yet, you’re sitting less and standing more. Now your feet hurt. The podiatrist says you have plantar fasciitis. You massage and stretch your feet, but your feet still hurt (FYI on your “foot map,” the feet are located next to the genitals on the brain; a little smudging in the maps of the brain could be contributing to pain in the feet).

9. Panic sets in. You. Are. Falling. Apart. How did this happen?  How will you work? You used to be really active and you have a family, so you can’t quit your job.  Now you constantly feel anxious; your doctor(s) keep telling you that nothing is wrong. Your doctor sends you to a psychologist and you’re told that all you need to do is relax. You’re placed on anxiety medication.


Where to go from here

 How did you get to this point? It started with stress, physical tension in your pelvic floor muscles that went unchecked, and some normal reflexes in your body that continue to sensitize the bladder, prostate and bowels.

To treat it, both the stress and physical tension in your pelvic floor needs to be addressed, as well as the sensitization of your entire system.

A biopsychosocial approach is the key to resolution. You can normalize your system again!

Unfortunately, the statistics for male pelvic pain are highly unreliable, since this is such an under-reported problem.

When it is reported, men often end up in endless urology clinics who fail to provide significant relief because it is not a primary urology problem; the bladder gets involved because the nervous system is hard-wired to talk to all of its neighbours in the pelvis—the muscles, bladder, prostate and bowel.

Coordination and teamwork are essential in this area, and when one area gets “messed up” (it usually starts with tension and the pelvic floor muscles) the other areas experience issues as well.


You’re not alone

 It is estimated that one in six men have pelvic pain and one in nine men struggle with incontinence.

Approximately 50 per cent of men will have a diagnosis of prostate pain or infection in their lifetime, even though the prostatic fluid has never been positively cultured.

Work stress, relationship stress, and our fast-paced society are all major contributors to these problems.  From an evolutionary perspective, we are hard-wired to protect our pelvis’ for the purpose of procreation and survival of the species.

It is time to recognize that this is not a frightening, overwhelming place to be but a natural progression from low grade, chronic stress in our lives.

This issue can be reversed and changed with appropriate strategies to manage stress, tension in your pelvic floor, and appropriate lifestyle changes, such as exercise and good diet.

A physiotherapist can help with all of this.

We get people moving, help them to make good lifestyle changes and treat the bits and pieces that are sore and overworked.

A healthy pelvic floor is an integral part to any man’s survival kit in today’s demanding world.


Don’t suffer any longer. Speak to a physiotherapist who has done extensive training in pelvic health rehabilitation.



Carolyn Vandyken is a pelvic-health advocate, author, educator and researcher who practices physiotherapy in Huntsville, Ontario.  She teaches multidisciplinary audiences internationally about the importance of normalizing pelvic floor health in orthopaedic practice, urology practice, gynaecology practice, midwifery practice and nursing practice.

learn more about pelvic floor disorder

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