CPPS and the Pelvic Floor: Why It's Often a Muscle Problem
For many men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), the prostate isn't the main source of the pain at all. Tight, tender muscles in the pelvic floor are. Understanding that can change which treatments make sense.
What the pelvic floor is
The pelvic floor is a sling of muscles across the bottom of the pelvis. It supports the bladder and bowel, controls urination and bowel movements, and is involved in erections and ejaculation. Like any muscle, it can become overactive: held tight for long periods, unable to relax fully, and sore.
How it causes CP/CPPS symptoms
An overactive pelvic floor can develop tender spots, often called trigger points, that refer pain to other places: the tip of the penis, the testicles, the perineum, the lower abdomen or the tailbone. That's why pain can feel like it's coming from the prostate or bladder when the muscles are the real source. Tight pelvic floor muscles can also cause urinary symptoms such as a slow or hesitant stream, a feeling of not emptying, and pain during or after ejaculation.
When urologists Shoskes and Nickel created the UPOINT system for CP/CPPS, they gave muscle tenderness its own category, T, because so many men have it. In their studies it was one of the most common features of all.
What tends to make it worse
- stress and anxiety, which many people unconsciously hold in the pelvic floor
- long periods of sitting, especially on hard seats
- straining with constipation
- repeatedly tightening the pelvic floor, including pelvic floor strengthening exercises, which can make an already tight pelvic floor worse
How it's treated
The main treatment is physiotherapy from a pelvic health physiotherapist experienced with male pelvic pain. The aim is the opposite of what most people expect: relaxing the pelvic floor rather than strengthening it. Physiotherapists use techniques such as myofascial release and trigger point therapy, and teach ways to notice and let go of pelvic tension. In a 2009 pilot trial led by Mary FitzGerald, which included men with CP/CPPS, people who had this kind of targeted physiotherapy were much more likely to improve than those who had general massage.
Because stress and pelvic tension feed each other, many people also benefit from support with stress, sleep or anxiety alongside physiotherapy. Medication may help other parts of CP/CPPS, but on its own it rarely loosens a tight pelvic floor.
Getting assessed
If you have CP/CPPS, it's worth asking your urologist or GP whether pelvic floor tenderness has been checked and whether a referral to a pelvic health physiotherapist is possible. Not every physiotherapist works with men's pelvic pain, so it's worth asking for someone who does.
See what eases your pelvic pain
Cypps tracks pelvic pain, urinary symptoms, triggers and treatments over time, including UPOINT, so you can see whether things like physiotherapy are making a difference.
Coming to the App Store soon.
This article is for general information and isn't a substitute for medical advice. Talk to a doctor about your own symptoms, tests and treatment.