• Melissa Stendahl

Male Pelvic Pain - Chronic Non-bacterial Prostatitis

One of the most common male demographics that I see in the clinic is those between the ages of 18-50 with genital pain that is worse during or after sitting, sex, and/or going to the bathroom. Their lab tests were all negative for infection and their symptoms were not fully responsive to antibiotics.


Approximately 8.2% of males in the U.S. will have prostatitis in their lifetime, accounting for almost two million urology doctor visits per year. Most prostatitis cases (90-95%) are non-bacterial prostatitis, also known as “Chronic Pelvic Pain Syndrome” (CPPS). There may not be an obvious cause of symptoms; urine cultures and medical exams are often normal; and symptoms can vary widely, making it confusing for patients and difficult for physicians to diagnose. This type of prostatitis is different from the age-related types (benign prostatic hyperplasia and prostate cancer), and is not linked to an active infection (such as in bacterial prostatitis).


Common Symptoms:

A person may experience one, some, or all of these, to varying degrees:

  • Genital pain: penile, testicular, groin, perineal, rectal

  • The sensation of a golf ball in the perineum or rectum

  • Abdominal and/or low back pain

  • Difficulty starting the flow of urine or completing urination

  • Increased urinary urgency or frequency

  • Painful urination and/or defecation

  • Painful erection or ejaculation


Common Causes:

  • Pelvic floor muscle dysfunction

  • Stress

  • Sexual abuse (past or present)

  • Past prostate or urinary tract infection

  • Frequent activities which put pressure on the pelvic floor (like cycling) or involve repetitive muscle contractions (like weight lifting)

  • Food or chemical irritants or sensitivities


What is complete treatment?

Unfortunately, many clients have multiple medical appointments before finding a provider who is familiar with CPPS and is able to guide them to a complete treatment approach. A complete treatment approach should include helpful medications, management of psychosocial components, and physical therapy.


Typical medication(s) prescribed include antibiotics, anti-inflammatories, and sometimes muscle relaxants to ease the bladder and pelvic floor muscles. Natural supplements like quercetin, saw palmetto, or bee pollen may be recommended for inflammation.


Stress and anxiety, which can influence muscle tension and pain, should be addressed as well. Depending on severity and origin, this may benefit from medication or mental health services, or mindfulness and relaxation strategies.


PT is a successful intervention! How does it work?

The pelvic floor and other painful areas can be effectively treated via physical therapy (PT). PT for CPPS uses a variety of techniques to reduce painful muscle tension and spasms, to reduce pressure and strain on the pelvic floor and around the prostate, and to guide return to normal activities.


  1. Manual techniques are used to mobilize and relax soft tissues that can be the source of pain and dysfunction. This is similar to how tight shoulders or a tension headache might be treated with massage. Manual therapy can directly improve the experience of sexual activity and going to the bathroom.

  2. Biofeedback can be used to gain control and awareness of pelvic floor muscle contraction and relaxation.

  3. Visceral mobilization is treatment of internal restrictions and restoration of organ movement related to symptoms.

  4. Determining better postures and movement strategies can prevent or minimize symptoms during normal activities.

  5. Bladder and bowel retraining is used to address habits or patterns that have become dysfunctional, including abnormal urgency and frequency.

  6. Exercises may be programmed to reduce pain by increasing blood flow and nerve mobility to the area, and to work back towards normal levels of exercise.

  7. Autonomic relaxation is used to reduce elevated or chronic sympathetic nervous system activity (fight or flight mode) that contributes to muscle tension and heightened pain perception.


PT typically includes a home program, which may include self-treatment techniques for the pelvic floor, as well as relaxation, posture, exercises, and management of factors that exacerbate symptoms.


Do you need help today?

If you think physical therapy might be helpful for you, schedule a free phone consult, or virtual or clinic appointment with me here. Or use this directory search to find a PT in your local area. You can also try:

  • Limiting potential dietary irritants: sugars, caffeine, alcohol, dairy (to name a few)

  • Diaphragmatic breathing

  • Hot baths with magnesium and epsom salts to relieve muscle tension

  • Taking hourly breaks from sitting (for desk work) and including a daily mobility routine

  • Please consult with your physician or a clinical nutrition professional on the use of any medications or supplements

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NOTE: There are four types of Prostatitis. This article focuses on Type 3 Chronic Prostatitis/Chronic Pelvic Pain Syndrome, for which physical therapy is a highly successful treatment. Physical therapy can also help address symptoms present in the other types of Prostatitis, after or in conjunction with necessary medical care. They are listed here for reference.

Type 1 - Acute bacterial prostatitis

Type 2 - Chronic bacterial prostatitis

Type 3 - Chronic prostatitis / Chronic pelvic pain syndrome

Type 4 - Asymptomatic inflammatory prostatitis

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