Pelvic floor tightness, pelvic pain, and the associated symptoms can wreak havoc in men, having a severe impact on quality of life, normal functioning, ability to work, sexual activity and day to day activities we take for granted such as sitting. When pelvic pain/tightness is in effect, something as normal as sitting down can become a dreaded activity, as the result is increased pain, seemingly unexplainable symptoms such as problems with urination and defecation and strange sensations in the rectal area that can be very hard to identify or talk about. Some men describe a feeling of a golf ball in their rectum, others experience a feeling of downward pressure, others are unable to quite pinpoint what the sensation is, but it feels “wrong” somehow; uncomfortable at best, and debilitating/overwhelming at worst.
As with pelvic issues in women, there can be a lot of shame and embarrassment attached to pelvic problems in men. There is no clear way to turn, with many men being diagnosed with various sorts of prostatitis, when there is often absolutely no infection or issue with the prostate. Exasperated medical professionals throw antibiotics and other medications at the patients, even if there is no actual evidence of infection, trying to offer some form of relief from misunderstood and seemingly not easily explainable symptom patterns. If medications provide no relief, surgery may be offered, or nerve blocks, or other fairly extreme measures. (PLEASE NOTE: Bacterial prostatitis CAN and should be treated with antibiotics, however many men are treated with medications without doctors checking for evidence of bacteria, therefore leading to long spells on medications that do not help at all. If your doctor has suggested you have any form of prostatitis, please ask them to do a full screening so appropriate treatment can be given.)
Symptoms associated with pelvic floor tightness in men include:
- Discomfort or pain in the rectum or perineum (the area between the scrotum and anus)
- Increased discomfort or pain when sitting
- Discomfort around the pubic bone in and around the area of the bladder
- Discomfort or pain in the groin area
- Discomfort or pain in the testicles and or/penis, often at the penile tip or in the urethra
- Discomfort or pain in or around the coccyx (the tailbone)
- Discomfort or pain in the lower back
- Discomfort or pain in the back, side or front of either/both thighs
- Disturbances in urination; may be pain, discomfort or burning when urinating, reduced urinary stream, increased frequency of urination (having to urinate every half an hour to two hours), urgency of urination (feeling they cannot wait when the urge arises) and/or a need to urinate frequently at night
- Increased discomfort or pain during or after ejaculation, reduced libido, erectile dysfunction (occasional or frequent inability to attain or maintain an erection), reduced ejaculate, softer erections and reduced sexual pleasure
- Reduced interest in participating in life and/or interpersonal relationships
- Low self esteem
These symptom patterns often leave medical professionals not knowing which way to turn, and so men either fall through the cracks of the medical system, or undergo long and arduous rounds of various forms of treatment with little to no long term relief. Various diagnoses are given for pelvic pain in men such as prostatitis, prostadodynia, chronic pelvic pain syndrome (CPPS), orchialgia and/or epididymitis, proctalgia fugax, interstitial cystitis, levator ani syndrome and pupendal nerve entrapment syndrome. A great book entitled Headache In The Pelvis by Dave Wise Ph.D and Rodney U. Anderson Ph.D. describes how all these different names, diagnoses and disorders associated with chronic pelvic pain that has no gross pathology still do not really describe what is actually going on. Often these symptoms that commonly affect urination, defecation and sexual activity are heavily linked with chronic muscle tension, as is the case with a lot of headaches, hence the title of their book. They describe how depending which specialist you are sent to, you may be given very different names for the same set of symptoms. One may say prostatitis whilst another may say chronic genital pain, idiopathic pelvic pain, pelvic floor dysfunction or pelvic floor myalgia. The list is endless. Sadly this attachment to finding a specific name for a condition leads to blindness to stepping back and looking at the bigger picture and the body as a whole.
Chronic tension in any part of the body has an adverse effect on the body as a whole. The fascial system (which is the connective tissue system of the body, literally responsible for connecting everything to everything else), can exert pressures of 2000lbs per square inch on pain sensitive structures such as nerves and blood vessels. This can cause all kinds of symptoms, such as those noted above. When this tension becomes chronic, it is almost like the body forgets how to relax. It is stuck in a constant fight or flight response, unable to soften, except now it is fighting itself.
When this chronic tension is in the pelvic area, or affects the pelvic area, we begin to see the appearance of the symptoms listed above. These tend to worsen over time as not many people seek treatment when they first notice something does not feel right. Usually, especially because of the body shame/embarrassment culture of the West, we allow things to get pretty bad before we ask for help. There is a strong link between body and mind, and this embarrassment/shame can also exacerbate symptoms. Part of the recovery process is about letting go of body shame and embarrassment about certain areas of the body, and moving into seeing our bodies/ourselves as the wonderful beings that we are.
Nothing in the body is linear. Nothing in nature is linear. We are multi-dimensional. We can move up, down, left, right, diagonally, sideways and any and all ways in between. Such is the nature of the fascia. It is an uninterrupted, 3-dimensional web made of micro-tubules of collagenous fibre and a fluid ground substance in between It exists in a state of ordered chaos. Everything affects everything else within the body. If you have a sore hip, it changes how you walk. Maybe you start to feel as if one leg is longer than the other. Then you notice there is a pull in your side, and that you have to adjust your shoulders to appear straight. And then your head seems to be pulled to one side and so you have to make yet more adjustments to compensate. A while later you present at the doctor with a sore neck. You forget that your hip ever hurt, and it doesn’t seem relevant, as this is about your neck. But when we begin to unwind the story (and the body) we start to get back to the cause rather than the symptoms.
Chronic pelvic pain and the associated symptoms are often relieved by treating the pelvic floor and the surrounding structures such as the thighs, lower back, gluteals/piriformis (a polite way of saying the buttocks!) and the psoas complex (often called the hip flexors). Although, as we work and release the fascia, we will likely find other areas of the body that require work as well, all of which helps to create more space within the body as a whole, and relieve the pressures, strains, tensions and symptoms being experienced.
What does treatment for pelvic pain/symptoms involve?
Specific myofascial release (MFR) techniques can be applied directly to the musculature of the pelvic floor to help release restrictions. The pelvic floor is accessed rectally. As with all myofascial release techniques, this is done gently and mindfully, with the patient always in charge. If at any time the patient is uncomfortable, treatment will be immediately ceased and alternatives discussed. Direct pressure is applied to identified areas of restriction and this facilitates the fascia to release the chronic state of tension it has been in. As with all forms of treatment, these procedures will likely need to be performed repeatedly. It takes the body a long time to build up tension, and healing is also a process. However, changes usually start to be felt pretty quickly.
Due to the areas of tissue we are working with and around during pelvic floor work, sometimes you may experience bodily sensations that make you feel uncomfortable. You may feel like your bladder needs to empty, or occasionally feel sensations you may associate with sexual arousal or the need to defecate. Please communicate this to the therapist and know it is nothing to be ashamed or embarrassed about. If you are uncomfortable at any time, as already mentioned, treatment will be immediately ceased and experiences openly discussed. With chronic pelvic floor tightness, a lot of signals and sensations have been restricted for a long time, and as the body works to integrate positive changes, it will sometimes go through waves of seeming chaos before it re-settles into a healthier, stronger and more relaxed state of being. As with all kinds of therapies, there may be a slight exacerbation of symptoms as the body works hard to settle into healthier ways of being. With each treatment, the body has to adjust to the reclaimed space and freedom to function optimally. Any change in symptoms is viewed as good, though sometimes it may not feel like it for a couple of days after a treatment session. These healing waves WILL pass. If there is ever any concern, please do not hesitate to contact the therapist to discuss it. I would always much rather you called and talked about it than suffered in silence. Most people, especially with conditions such as those we are discussing, have suffered in silence long enough. I encourage honest and open dialogue with the people I treat, and I believe this is an important part of the process.
As well as the internal work, external MFR will be performed. The combination of internal and external work can massively improve quality of life, decrease symptoms and help support the body to regain optimum functionality. As previously mentioned, we can have a lot of negative and derogatory belief systems relating to our pelvic areas and so part of the recovery process is you developing a more positive relationship with your body. This can feel very hard when you feel like your body has let you down for years. With MFR, sometimes you may experience waves of emotion such as anger, sadness, frustration, rage.. This is all absolutely normal and natural, and the more we can embrace these emotions and release them, the more our physical body will be able to relax and let go, attaining and maintaining a state of health and relaxation.
Imagine when you get angry about something. Your forehead furrows, your nostrils flare, your jaw tightens, your fists may clench, your shoulders rise, you feel an increase in energy, your muscles go rigid, your heart rate rises.. Your body is in fight mode. With chronic fascial restrictions, often this is the state we are unknowingly living in 24/7. As we enter the recovery/healing process, we have to nurture attitudes and belief systems that feel safe and supportive to encourage our bodies to let go of this fight/flight mode, and to settle into the state which is often called “rest and digest”. This means that as well as the work done with the therapist, there is action you can take yourself to support your recovery process. Suggestions will be made that are relevant for you and your way of life. This can include practices like meditation (including practices such as body scan and yoga nidra which help you to learn to feel into sensation), affirmations, gentle exercise/stretches/self-treatment, self-unwinding, mindfulness practices etc. This may all sounds a little overwhelming at first, but conversely this means there are things YOU can do to support your own recovery that are not dependent on anyone else, that do not have to cost you anything, and that can help empower you on many levels. Building a positive relationship with our bodies and ourselves is one of the most effective ways to improve and maintain good health and well-being.