MALE PELVIC PAIN “PROSTATITIS AND

LEVATOR ANI SYNDROME

JENNIFER SHIFFERD, MSPT, CLT, WCS

MALE PELVIC FLOOR DYSFUNCTIONS

• Levator Ani Syndrome- spasm of deepest muscle layer

• Symptoms include pain, pressure or ache in vagina and rectum
• Referred pain to thigh, coccyx, sacrum, lower abdomen and to tip of penis,
urethra
• Repeated straining during defecation can promote pain/throbbing

• Men often misdiagnosed with prostatitis

• Can lead to erectile, urinary dysfunction and bowel dysfunction
MALE PELVIC FLOOR DYSFUNCTION

• Prostatitis
• 95 percent of cases of chronic prostatitis in men is nonbacterial1, and could indeed have a
musculoskeletal origin.

• Dysfunction and spasm of the pelvic floor muscles can cause symptoms that mimic prostatitis by
causing pain and urinary symptoms.

http://physical-therapy.advanceweb.com/Features/Article-1/A-Male-Malady.aspx
1. Nickel, J.C. et al. Prevalence of prostatitis-like symptoms in a population based study using the
national Institutes of Health chronic prostatitis symptom index.  J Urol, (2001)165: 842.
CHRONIC PROSTATITIS

• NIH classified prostatitis into four categories:

• Category I: Acute Bacterial Prostatitis
• Category II: Chronic Bacterial Prostatitis
• Category III: Chronic Prostatitis / Chronic Pelvic Pain Syndrome
• Category IV: Asymptomatic Prostatitis
CHRONIC PROSTATITIS / CHRONIC PELVIC PAIN SYNDROME

• Chronic Pelvic Pain Syndrome is a nonbacterial infection but is often treated as

such.
• Primary symptoms; discomfort and pain
• Pain locations: pelvic floor, perineum, rectum, coccyx (tail bone), prostate,
penis, testicles/scrotum, groin, thighs, lower abdomen, and low back
CHRONIC PROSTATITIS / CHRONIC PELVIC PAIN SYNDROME

• Sexual dysfunction can include painful ejaculation, premature ejaculation, erectile

dysfunction, and decreased libido
• Erectile dysfunction reported in 43% of patients, with 45% of patients reporting
exacerbation of pain during or after intercourse
• 62 patients with pelvic pain syndrome, 52 were found to have tenderness and
spasm in pelvic muscles around prostate and anterior pelvis per digital rectal exam
CHRONIC PROSTATITIS / CHRONIC PELVIC PAIN SYNDROME

• Erectile function; adequate amount of blood must flow into penis and must be
trapped to maintain rigidity
• Bulbospongiosus and ischiocavernosus muscles are involved
• Bulbospongiosus blocks blood from escaping by pressing on the deep dorsal vein of
the penis
• Need adequate contraction of muscles to maintain erection
• Erectile Dysfunction; can result from muscle spasm and weakness
CHRONIC PROSTATITIS / CHRONIC PELVIC PAIN SYNDROME

• Painful ejaculation; levator ani muscle trigger points can refer pain to tip of penis
and urethra
• Chronic pelvic pain can lead to decreased libido
• Goal for patient- to learn how to relax their pelvic floor musculature
CHRONIC PROSTATITIS / CHRONIC PELVIC PAIN SYNDROME

• Premature ejaculation; can be result of pelvic floor muscle weakness

• Increasing awareness of the pelvic floor musculature through physical therapy is
a start
• Strengthening is a key component to success
CHRONIC PROSTATITIS / CHRONIC PELVIC PAIN SYNDROME

• Urinary Dysfunction; voiding dysfunctions such as dysuria, urgency and frequency

• Chronic pelvic floor muscle tension can compromise urine flow by constricting
urethral sphincters, resulting in weak stream and difficulty initiating voiding
• Urgency- straining to void to fully empty further aggravates a tight pelvic floor
leading to a perpetuating cycle
CHRONIC PROSTATITIS / CHRONIC PELVIC PAIN SYNDROME

• Bowel Dsyfunction; repetitive straining to empty bowels can further aggravate pelvic
floor muscle spasm, if prolonged can disrupt normal defecation mechanics and lead
to pelvic organ prolapse
CHRONIC PROSTATITIS / CHRONIC PELVIC PAIN SYNDROME

• ASSESSMENT:
• Pelvic floor examination- to assess for trigger points of the levator ani and
ischiocavernosus musculature, ability to isolate and contract pelvic floor, pelvic
floor muscle strength
• Muscle coordination; check for good relaxation and perineal descent with
simulated defecation to rule out dyssynergia
CHRONIC PROSTATITIS / CHRONIC PELVIC PAIN SYNDROME

• TREATMENT:
• If infection is ruled out then referral to physical therapy is recommended
• Physical Therapy will help to teach patient how to relax their pelvic floor and better isolate
once strengthening is indicated
• Initial treatment is manual therapy; trigger point releases, prolonged gentle stretching
• Modalities for pain, inflammation reduction
• SEMG to assist with pelvic floor isolation, recruitment, relaxation
• Core strengthening once pelvic floor muscle spasm has reduced and no pain with
contraction
• Home program for symptom management