Chronic Pelvic Pain in Men - Causes and Management

What Is the Pelvis?

The pelvis is a basin-shaped structure that protects the abdominal organs and supports the spinal cord. In the human body, the pelvis consists of the following bones:

• Sacrum - It is a spade-shaped bone formed by the union of sacral vertebrae.

• Coccyx - It is also known as the tail bone and is formed by the union of four coccygeal bones.

• Hip Bones: The following hip bones are normally present in the pelvis -

1. Ilium - It is the broad and flaring portion of the hip bone.

2. Pubis - It is the lower and posterior part of the hip bone.

3. Ischium - It helps in the formation of hips.

What Is Chronic Pelvic Pain?

As the name suggests, chronic pelvic pain denotes a condition when the patient experiences pelvic pain for a prolonged period. It forms an integral part of the wide spectrum of chronic pelvic pain syndrome diseases. The pelvis is a crucial organ of the body and is located between the abdomen and the thighs. The main function of the pelvis is to regulate and support the genitals and abdomen. Males are more likely to experience pelvic pain because of urinary, intestinal, and reproductive problems. The severity and extent of pelvic pain vary from person to person. It can spread to the other body parts like the thighs, buttocks, and lower back. Chronic pelvic pain is commonly associated with chronic prostatitis and has been known to affect 10 to 15 percent of males. Pelvic pain is a medical emergency and requires intensive medical care and attention.

What Are the Different Types of Pelvic Pain?

According to the National Institute of health, pelvic pain can be classified as follows:

A. Chronic Pelvic Pain Syndrome I: It was earlier known as acute bacterial prostatitis (inflammation of the prostate gland due to bacterial infection) and is characterized by acute and sudden pelvic pain. The patient also presents with fever and other signs of bacterial infections.

B. Chronic Pelvic Pain Syndrome II: It was previously known as chronic bacterial prostatitis and is associated with pain and bacterial infection in the urine.

C. Chronic Pelvic Pain Syndrome III: It is also known as prostatodynia (a clinical condition characterized by voiding symptoms and pain in the pelvic region that may be indicative of prostatitis) and is characterized by pelvic pain. However, the pain is not due to bacterial infection.

D. Chronic Pelvic Pain Syndrome IV: The patient experiences pelvic pain due to the presence of inflammatory cells in the urine.

What Are the Causes of Pelvic Pain?

Studies have reported that males tend to experience pelvic pain more frequently than females. The causes of pelvic pain in males are listed below:

1. Urinary Tract Infection (UTI) - As the name suggests, the infection that occurs along the urinary tract is a urinary tract infection. Escherichia coli is the main culprit behind urinary tract infections because it releases virulence factors that infect the urinary system. Pelvic pain is the most common complaint of patients suffering from UTIs. The symptoms of UTI are listed below:

   1. Dysuria (painful urination).

   2. Burning sensation while urinating.

   3. Urinating more than eight to 10 times a day.

   4. Fever, nausea, and vomiting.

   5. Pain in the lower back and abdomen.

2. Cystitis - Cystitis or bladder inflammation might occur due to UTI or the following conditions:

   1. Side effects of medications.

   2. Reactions to chemicals.

   3. Radiation exposure.

   4. Self-catheterization.

3. Prostatitis - The prostate gland is located close to the neck of the urinary bladder. The inflammation of the prostate gland is known as prostatitis. Along with pelvic pain, the patient experiences the following symptoms in prostatitis:

   1. Genital pain.

   2. Pain in the lower back and abdomen.

   3. Perineal pain (area between the anus and the scrotum).

   4. Hematuria (blood in the urine).

   5. Cloudy and foul-smelling urine.

   6. Altered urinary frequency.

   7. Painful ejaculation.

4. Sexually Transmitted Diseases - As the name suggests, a sexually transmitted infection gets transmitted through sexual contact. Chlamydia and gonorrhea are some of the common sexually transmitted diseases. The symptoms of sexually transmitted diseases include the following:

   1. Pelvic pain.

   2. Penile discharge.

   3. Urethritis (inflammation of the urethra).

   4. Dysuria (painful urination).

5. Hernia - Hernia occurs when a part of the tissue protrudes from the weak muscle wall. Inguinal hernia is the most common and mainly occurs due to intestinal protrusion. The common symptoms of hernia include a slow-growing painful bulge in the abdomen or groin and dull pelvic pain.

6. Irritable Bowel Syndrome - Irritable bowel syndrome affects the functioning of the large intestine. The symptoms of irritable bowel syndrome are listed below:

   1. Painful cramps.

   2. Bloating.

   3. Diarrhea.

   4. Constipation and mucus in stools.

7. Kidney Stones - Stones occur due to the precipitation of salts and minerals in the urine. They can form in the kidneys, bladder, and other urinary tract organs. They cause pelvic pain when they move around the urinary system.

8. Urethral Stricture - Urethral stricture or scarring might hinder urine flow and cause pelvic pain. The patient might find it difficult to start the urine stream.

9. Benign Prostate Hyperplasia - It is a non-cancerous enlargement of the prostate gland. As the gland is located close to the urethra, expansion of the gland can compress the bladder and the urethra, resulting in pelvic pain.

10. Pudendal Nerve Entrapment - Pudendal nerve is the principal nerve that supplies the pelvis and the surrounding areas. The patient might experience constant pelvic pain when the pudendal nerve is irritated or trapped.

What Are the Other Signs and Symptoms of Chronic Pelvic Pain?

Chronic pelvic pain might present alone or is accompanied by other urologic conditions. The signs and symptoms seen along with chronic pelvic pain are listed below:

1. Pelvic floor pain or perineal pain without any evidence of urinary tract infection or other medical conditions.

2. Abdominal and lower back pain.

3. Frequent urination.

4. Pain during or after sexual intercourse.

5. Pain in the genitals.

6. Pain after ejaculation and while sitting.

7. Erectile dysfunction.

8. Weakness and tiredness.

How Is Chronic Pelvic Pain Diagnosed?

1. Physical Examination - A physical examination is done to check the organs of the urogenital system like the penis, scrotum, perineum, and prostate. It is also done to rule out other disorders like inguinal hernia, muscle inflammation, and nerve entrapment. Some patients might present with tenderness near the hips and lower abdomen (suprapubic tenderness). The doctor might palpate the pelvic muscles to examine the trigger points that cause muscle pain and inflammation.

2. Digital Rectal Examination - The doctor will insert a lubricated and gloved finger into the rectum during this examination. This examination helps detect the prostate gland's swelling, tenderness, and inflammation.

3. Urinalysis - A urinalysis is mainly done to rule out urinary tract infections and cystitis. During the procedure, the patient must collect the urine in a container and send the sample to the laboratory for investigation. The presence of blood and bacteria in the urine suggests urinary tract infections.

4. Ultrasound - An imaging procedure in which the doctor moves a transducer over the patient’s abdomen to send sound waves into the body. After these waves bounce back, the images of the abdomen, pelvis and other urinary tract organs can be obtained on the computer screen. The doctor uses these images to detect the causes of pelvic pain.

5. Computed Tomography (CT) Scan - CT scan provides three-dimensional images of the body’s internal organs. The patient lies on a table that slides into a device where the X-rays are taken. Finally, the doctor analyzes the images to detect abnormalities.

How to Manage Chronic Pelvic Pain in Males?

It is difficult to treat chronic pelvic pain in males, and doctors require a multimodal approach. Physiotherapy and lifestyle modifications are the best ways to treat chronic pelvic pain. The treatment measures are listed below:

• Biofeedback (a specific form of mind-body strategy employed to regulate some of the body's functions) helps to strengthen and relax the pelvic floor muscles. The patients are taught about the different exercises that regulate muscle tone and relax the pelvic muscles. People have benefited a lot after this therapy, and the results can be seen in six to eight weeks.

• Neuromodulation therapy involves a variety of treatments that target the brain and the spinal cord and is an effective pain-relieving method.

• Therapeutic exercises help to promote mobility and improve muscle strength. People having a sedentary lifestyle must move from their place every 10 to 15 minutes to stay fit.

• Studies have reported that acupuncture or the insertion of needles at certain points in the body helps reduce pelvic pain by 50 percent.

• Some doctors suggest yoga and meditation as they relax the mind and body.

• Manual therapy and compression techniques help to relax the pelvic floor muscles and prevent pain.

Conclusion

Pelvic pain is not a condition but a symptom of other conditions that affect the urinary tract. The biggest misconception is that only women experience pelvic pain, and men do not. Males experience pelvic pain, too, due to several medical conditions. The severity and intensity of pain vary from person to person. The patient need not worry as pelvic pain does not always indicate something serious, but it is important to identify the cause of the pain. Mostly physiotherapy and muscle exercises help relieve pain. Surgical intervention is only required when the pain is due to urinary tract obstruction.