Is chronic pelvic pain in men always from the prostate?
While the prostate may be a source of pelvic pain in men, it is likely that in many cases, pain in the male pelvis does not come entirely (or in some cases at all) from issues with the prostate itself.
Pelvic pain can affect males for many reasons and is often nonspecific. Examples include a urinary tract infection (UTI), a sexually transmitted infection (STI), urinary stones, prostatitis, problems with passing urine (called male voiding dysfunction) and rarely, cancer.
Chronic pelvic pain syndrome can sometimes be a type of prostatitis, an inflammation of the prostate, that’s also linked with other inflammatory symptoms. The pelvis, penis, scrotum and testes, rectum, perineum and lower back can also be affected.
Inflammatory conditions of the prostate are quite common. Chronic prostatitis is the most common urological diagnosis in men younger than 50 and the third most commonly diagnosed male urological condition. But, the prostate is most often not the actual issue, but rather, the muscles of the pelvic floor where the prostate sits. Those muscles can become tight, spasm or have trouble relaxing.
If you have chronic pelvic pain syndrome, you may have:
- pain in your pelvis, lower back or rectum
- pain around your scrotum, perineum or penis
- pain during ejaculation
- pain while passing urine
- straining or trouble passing urine
- erectile dysfunction
- frequent need to pass urine
- dribbling or urinary incontinence
Symptom duration is quite variable and can last anywhere from a few days to much longer, even months. The symptoms can also change from mild to severe, and back to mild. Treatment may include medication, pelvic floor physical therapy, biofeedback, local heat application, trigger point release and relaxation exercises.
Dr. Lori Lerner, a urologist and Associate Professor of Urology at Boston University School of Medicine, specializes in male voiding dysfunction, BPH, surgical energies (particularly laser) and urinary tract infections.
Does all pelvic pain need medicine?
Pain in the pelvis can have many possible causes, including:
- Overactive pelvic floor muscles
- Endometriosis, a condition where the lining of the uterus travels out to the pelvis and abdomen
- Interstitial Cystitis/Bladder Pain Syndrome, a chronic bladder health issue
- Infection or inflammation in the prostate
- Constipation or hemorrhoids
Your doctor will recommend treatment for your pelvic pain based on where the pain is located and what the cause is. Treatment may involve medication, exercises to relax the pelvic floor or both. For endometriosis, treatment may include surgery.
Medications may include:
- Pain relievers such as ibuprofen or acetaminophen
- Hormone treatments such as birth control pills
- Antibiotics if the pain is caused by bacteria
- Anti-inflammatories
- Antidepressants, which can be helpful for chronic pain
- Muscle relaxers
Exercises such as diaphragmatic breathing and stretches can relax the pelvic floor and help to relieve pelvic pain.
Diaphragmatic Breathing
- Place one hand on your chest and one hand on your stomach.
- Breathe in deeply for three seconds, then breathe out for four seconds.
- Repeat for 5-10 minutes every day.
Stretches
- Happy Baby Pose – While lying on your back, open your knees wide and pull toward your head. Hold this position or gently roll from side to side.
- Child’s Pose – On your hands and knees, spread your knees wide and keep your toes touching. Lean forward gently and place your upper body between your legs. Stretch your arms out in front of you.
- Lying Butterfly Pose – Relax on your back with the bottoms of your feet together and let your knees relax out to the sides.
- Thread the Needle Pose – While lying on your back with your knees bent, place your left ankle on your right knee. Pull your right thigh into your chest. Repeat on the other side.
For more information on pelvic floor muscle relaxing and strengthening, check out the fact sheets below:
Pelvic Floor Muscle Relaxing: What You Should Know
Pelvic Floor Muscle Strength: What You Should Know
Dr. Raevti Bole, a urologist at Cleveland Clinic Glickman Urological Institute, specializes in men’s health, male infertility, male sexual dysfunction, BPH, male voiding dysfunction and GU cancer survivorship.
What is a hydrocele and does it cause pain?
A hydrocele is a collection of fluid in sac around the testicle. Many babies are born with a hydrocele. Injury and infection of the testicle can cause pain and hydroceles, but most hydroceles in newborns are painless. Even though the swelling may worry parents, it does not bother a baby. During a baby's development in the womb, the testicles drop from the abdomen through a tube that connects the abdomen to the scrotum. Most hydroceles go away by one year of age as this channel shrinks down.
When this tube does not shrink down, the hydrocele is called “communicating” because it connects the scrotum and the abdomen. The swelling may change size as the baby cries or poops because more fluid is pushed into the scrotum. Communicating hydroceles are usually treated with surgery. If abdominal organs like intestines go through this tube, it is called an “inguinal hernia”. If the intestines get stuck, it can cause pain.
In older males, a hydrocele is most often painless. But it may cause minor discomfort due to the larger size of the scrotum. If your child develops a hydrocele, talk to your child’s doctor to find the best treatment option.
Dr. Stacy Tanaka, Professor and Chief of Pediatric Urology at the University of Alabama at Birmingham specializes in neuropathic and non-neuropathic bladder dysfunction with a special interest in spina bifida.