Unfortunately, it’s not very well known that Pelvic floor physiotherapy is a great tool to deal with the diagnosis of Chronic Pelvic Pain (CPP) in men.
Chronic pelvic pain is chronic or persistent pain perceived by the patient and clinician in structures related to the pelvis of the patient, such as the perineal area, the inguinal area or the urinary tract. It is often associated with negative cognitive, behavioural, sexual and emotional consequences. It can also be associated with symptoms suggestive of the lower urinary tract (LUT), sexual, bowel, pelvic floor or urological dysfunction. But once the physician starts ruling out tests… there’s nothing found!
Once a man receives the diagnosis of having Chronic Pelvic Pain, lack of information make it difficult to find a solution.
This condition drives crazy a lot of men as many professionals forgot to assess and treat the pelvic. One of the hypotheses is that a past condition may trigger tension in the pelvic floor muscles. For some patients, a past experience that is still creating stress, and this make the pelvic floor tense up. Other patients seem to have the natural tendency to accumulate tension in this area. As other people tense to accumulate area in the jaws or shoulders, patients with pelvic floor muscles tension find physiotherapy a great tool to improve their symptomatology. Certain sports also increase the prevalence of this condition, mainly if there is pressure in the perineal area or if you are constantly tensing up during the activity.
You might be thinking… okay Marina, you are saying that the best way of dealing with Chronic pelvic pain is physiotherapy because this is what pays your rent… Fair point! That’s why I leave you the link to the European Guideline of Chronic pelvic pain:
- http://uroweb.org/guidelines/compilations-of-all-guidelines/.
- https://uroweb.org/guidelines/chronic-pelvic-pain
Along these 86 lovely pages of information, Dr Engelers and a team of professionals explain how to deal with Chronic pelvic pain. Let me summarize in this post my conclusions. Welcome to stay guys!
What is Chronic pelvic pain?
So, First of all, it’s important to understand that the diagnosis of Chronic Pelvic pain IS JUST A NAME. Chronic does not mean that you will be dealing with this forever. “chronic pain is pain that persists or recurs for longer than three months”. It’s important to understand this because the panic that a person may feel after hearing the word “chronic” may affect the symptoms too. Of course, if you believe that you are going to deal with these sensations forever your levels of stress and anxiety will increase. As the guide mention, the psychological status may interfere with symptomatology.
So, the step number one if you have already been visiting a big amount of physicians, is to relax. If no one found a structural problem it does not mean that you are crazy. Pelvic floor muscle tension is something that we can not see with an ultrasound or with an MRI. This tension might be caused by non-adequate stress management, so let’s try to take it easy.
A patient with the diagnosis of chronic pelvic pain may have very different symptoms from another person diagnosed with the same condition.
The pain syndromes are defined by a process of exclusion. In particular, there should be no evidence of infection or inflammation. Which is actually the most important thing!
Investigations should be done to be sure that your pain is not caused by an underlying condition. I know that this is difficult to deal with as this means that you need to go to the urologist, neurologist, gastroenterologist, anaesthesiologist, traumatologist, rheumatologist…
To be a little bit more specific, Chronic pelvic pain means dealing with poorly localised pelvic pain without obvious pathology. Actually, If the pain is in an organ, we should use a specific term, such as rectal pain syndrome or Painful bladder syndrome. If the pain is in multiple organs, we consider it chronic pelvic pain.
What can I do to solve CPP?
There are two options, maybe the doctor that you visit finds that there is an infection or a problem in an organ causing the pain. Then your doctor will prescribe a medication or a procedure to get rid of the symptoms. The option number two is that all the different tests and analyses tell you that the pain that you suffer dont have a physical origin. In this case, you need to FIND A PELVIC FLOOR SPECIALIST.
Some doctors often recommend visiting a physiotherapist to deal with the pain while you are running your test.
As the guide that I shared with you refers, you should find someone who specializes in chronic pain management and pelvic floor physiotherapy. The reason why this recommendation is so specific is that a professional needs to have different tools to deal with your pain and also TEACH YOU how to manage your symptoms. As you hear, you will receive treatment but you will also need to treat yourself.
How can physiotherapy help CPP.
Physiotherapy help when the pelvic foor tension cause symptoms. For example, pleople who accumulate tension in the pelvic floor tend to suffer constipation. If these people consult why they have constipation, all the test will appear clear. Instead if they relax the pelvic floor muscles the constipation will improve.
Physiotherapy also help when the symptoms of other conditions cause tension in the pelvic floor. For example, if the pain is in the rectal area and you have irritable bowel syndrome. Physiotherapy can help you with the muscle spasm caused in the pelvic floor due to the painful bowel movements. Pelvic floor physitoherapy will not solve the irritable bowel syndrom, but will help you with the pain that you may suffer because you tend to hold the stools. You need to find treatment for the bowel condition but the pelvic floor rehabilitation will improve the symptoms.
As mentioned before, there are biological, psychological and social factors that contribute to the pain and also secondary conditions such as cancer, post-surgical, musculoskeletal, visceral, neuropathic…
Team work is key to solve CPP
To find the ideal treatment its necessary teamwork and a proper diagnosis. For example, if the pain is caused by bad stress management you’ll need psychological help to deal with stress. Maybe that stress makes you over-activate the jaw and the pelvic floor, if you don’t get rid of the tension and learn how to relax the musculature the pelvic pain won’t disappear completely or will reappear again. To go a bit further, imagine that the stress caused because of overwork leads to bad eating. This may also cause you bloating and abdominal pain, increasing the muscle tension in the pelvic area. The solution in this case will also need the collaboration of a nutritionist or a gastroenterologist that help you to deal with constipation.
Visits to healthcare professionals for these types of problems are usually made too late, generally due to the taboo they imply and the lack of visibility they are given. This condition often starts with just a burning sensation after intercourse or urination. The sensation persists and it becomes more intense and last longer. Other patients referred to had an infection. Even if they finished the treatment and the test appears clear the pain perseveres.
Men need pelvic floor specialists too.
Men with pain in the perineal area take an average of 6 months to see the indicated professional … If the symptoms appear sporadically, it may take even longer … And when the symptoms are related to sexual function, the waiting time increases exponentially!
Maybe because of the cultural standards of masculinity men tend to “don’t complain”. If there is a problem of erectile dysfunction, burning sensation or heavines “it will go away”
Other times, the patient tries to find help. However, as the physician doesn’t find a physical cause in a test the patient is just recommended: “to relax”. Of course, this increases the pressure! “so am I crazy” “What if I have something really really bad and they can’t find it because it’s hidden?”
Much more frequently than I would like to admit, I attend men with symptoms who have NEVER been to the urologist. Many other times I have met men who after YEARS of palliative treatments discover physiotherapy.
Pelvic floor rehabilitation help to deal with chronic pelvic pain
The objective to prepare this article about chronic pelvic pain is to encourage you to book a consultation. From the first appointment, you will start working by your own. I also expect that the appointment can be useful to help you to organize the medical appointments that you need to make. With physiotherapy, you will also identify the different triggers of your symptoms in order to forget completely about them.
During the session, we will assess externally your muscles with the help of an ultrasound. Depending on this assessment we will assess manually the muscles. It’s perfectly fine to be a little bit concerned about the examination. However, you can decide to postpone the manual part and start working by your own until you feel ready. I can assure you that the most difficult step is the first one, once you start with the treatment everything will go great. You just need to drop me a whatsapp.
Physiotherapist specialized in pelvic floor rehabilitation
Guys, take care!
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Greetings! Very useful advice in this particular article! Its the little changes that will make the biggest changes. Thanks for sharing!