Pelvic Floor PT for Prostatitis

While pelvic floor physical therapy is becoming more well-known, there still is a lack of public awareness of pelvic floor physical therapy for men. This post will touch briefly on pelvic floor physical dysfunction specifically related to prostatitis and pelvic floor physical therapy for men.

Prostatitis

Often times when men go to the doctor with complaints of pelvic pain and/or urinary symptoms and the most common diagnosis they receive is prostatitis. There are different types/categories of prostatitis:

• Category I: acute bacterial prostatitis: an acute infection of the urinary tract
• Category II: chronic bacterial prostatitis: recurrent infection of the prostate
• Category III: chronic prostatitis / chronic pelvic pain syndrome (CPPS): May or may not occur with inflammation. Antibiotics typically DO NOT help with this diagnosis
• Category IV: asymptomatic prostatitis: higher levels of white blood cells typically with no genitourinary symptoms

Categories I and II are due to a bacterial infection of the prostate (accounting for about 8–10% of cases). Typically Categories I and II are treated with traditional antibiotics.

For Category IV, minimal-to-no genitourinary symptoms are present however white blood cells are in the prostatic secretions/tissue. This is an uncommon type of prostatitis in which the prostate may be inflamed but men do not have other symptoms typical of other forms of prostatitis, and usually treatment is not necessary.

Category III is the most common category and makes up 90% of the cases. This category has relevance to pelvic physical therapy in men and is NOT a bacterial infection. Most male patients who present with neurological or myofascial causes/contributions to their symptoms fall in this category and hence would benefit from pelvic physical therapy services.

Symptoms

This type of pelvic dysfunction in men can cause a variety of symptoms such as urinary/bowel complaints, sexual dysfunction, or pain (groin, genital, pelvic, etc.). Symptoms often include but are not limited to:

• Bladder symptoms
  • Urgency, frequency, hesitancy, changes in stream, or pain during urination
• Bowel symptoms
  • Frequency, constipation, difficulty emptying bowels, or pain before/during/after bowel movements
• Sexual Dysfunction
  • Erectile dysfunction, pain with arousal/intercourse, and pain with ejaculation
• Genital pain
  • Such as testicular or penile pain/discomfort
• Anal/Rectal pain
  • Often times people report a feeling of “golf ball in rectum” or “feel like sitting on a rock”
• Other symptoms such as musculoskeletal complaints: hip pain, groin pain, tailbone pain, abdominal pain, or low back pain.

Male Pelvis

The male pelvic floor muscles attach to the front, back, and sides of the pelvis and have several important roles relating to overall body functions. The muscles, tissues, and nerves support the bladder, prostate, bowel, and other pelvic organs and allow for proper urination, defecation, and sexual intercourse. The muscles of the pelvic floor contract and relax just like any other muscles in the body. These pelvic floor muscles can also develop dysfunction like any other muscle in the body (i.e. muscle spasm, tightness, weakness, impaired coordination) which typically lead to symptoms mentioned above. A trained pelvic floor physical therapist can work to help reduce these symptoms and restore normal functioning of the pelvic floor/pelvic girdle region that are causing this dysfunction typically associated with Prostatitis/Chronic Pelvic Pain Syndrome.

Pelvic Floor Physical Therapy for Men

The first visit or PT Evaluation will be detailed and targeted at getting all necessary subjective and objective information that determines the cause and contributing factors to each individual patient’s complaints. By the end of the PT evaluation the physical therapist will discuss the findings of evaluation, work with you to develop a plan of care, and get you started on a beginning home program to work towards reducing your complaints and restoring optimal functioning. Your home program is individualized to you and could consist of exercises, stretches, and behavioral modifications.

Follow up pelvic floor physical therapy visits can involve a number of different therapy techniques such as:

• Myofascial release
• Coordination Exercises/Training
• Therapeutic Exercise
• Manual therapy
• Relaxation Exercises
• Diaphragmatic Breathing
• Behavioral Recommendations
• Postural Education/training
• Biofeedback
• Education/training on home exercise program
• Modalities (e-stim, TENS, ultrasound, etc.)

Compliance with your home exercise plan in combination with treatment with your pelvic floor physical therapist can help you restore proper functioning and diminish symptoms.

For information on how to schedule an evaluation at Restorations Physical Therapy or for specific questions regarding pelvic physical therapy services please call 412-206-9202. Amanda Moe, PT, DPT, PRPC is available for morning and evening appointments.

References

Krieger JN, Nyberg L, Nickel JC (1999) Consensus definition and classification of prostatitis Journal of American Medical Association 283 (3) 236-237

Schaeffer, A. Chronic Prostatitis and the Chronic Pelvic Pain Syndrome N Engl J Med 2006; 355:1690-1698 October 19, 2006

Schaeffer AJ: Prostatitis: US perspective. Int J Antimicrob Agents 1998, 10:153–159.

Roberts RO, Lieber MN, Bostwick DG, et al.: A review of clinical and pathological prostatitis syndromes. Urology 1997, 49:809

Dorey, G. (2006). Pelvic dysfunction in men. 2nd ed. Chichester, England: John Wiley & Sons, pp.44-64.