Pelvic pain in men is common… you’ve had pain in your pelvis, groin, or genitals for months – maybe longer. You’ve been to the GP. Perhaps you’ve been to a urologist. You might have had a course of antibiotics, possibly more than one. The tests came back normal. The antibiotics didn’t help. And you’re still in pain.
If this sounds familiar, you’re not alone – and there’s a very good chance the real cause of your pain has been missed.
The prostatitis problem
Chronic prostatitis is one of the most common diagnoses given to men with pelvic pain. But here’s the thing: in the majority of cases, the prostate isn’t actually the problem.
Chronic Pelvic Pain Syndrome (CPPS) – sometimes still called chronic prostatitis – affects up to 10% of men at some point in their lives. It can cause persistent pain in the lower abdomen, perineum, genitals, inner thighs, or rectum, often accompanied by urinary symptoms and changes in sexual function. Yet research consistently shows that in most cases, there is no bacterial infection present. The prostate is not inflamed. The antibiotics were never going to work.
What is often missed is the pelvic floor.
The pelvic floor as a source of pain
The pelvic floor is a group of muscles at the base of your pelvis. In men, these muscles support the bladder, bowel and prostate, play a role in sexual function, and are part of your core stability system. Like any muscle group, the pelvic floor can develop tension, tightness, and trigger points – and when it does, it can refer pain in ways that mimic other conditions.
An overactive or hypertonic / high tone pelvic floor can cause:
- Pain in the perineum (the area between your scrotum and anus)
- Testicular or groin pain with no identifiable cause
- Pain during or after ejaculation
- Problems getting or maintaining erections
- Pain that is worse after sitting for long periods
- A sense of heaviness or pressure in the pelvis
- Urinary urgency, frequency, or incomplete emptying
- Pain with bowel movements
Many men with these symptoms have spent years being investigated for conditions that were never there – kidney stones, hernias, STIs, prostate infection – while the pelvic floor was never assessed.
Why does the pelvic floor become overactive?
There are a number of reasons the pelvic floor can develop excessive tension. Prolonged sitting (desk jobs, long commutes, cycling) is a common contributing factor. So is ongoing stress – the pelvic floor is particularly responsive to emotional and psychological tension and often holds tightness that the rest of the body doesn’t show.
Previous injury to the pelvis, hips, or lower back can also change the way the pelvic floor muscles work. Some men develop overactivity following a urinary tract infection, a period of constipation, or after pelvic surgery. For others, there is no single clear cause – the pattern simply develops over time.
Whatever the origin, an overactive pelvic floor is a physical problem that responds to physical treatment.
What does assessment involve?
A pelvic health physiotherapist will take a detailed history of your symptoms – how and when they started, what makes them better or worse, and what impact they’re having on your quality of life. We will then assess the pelvic floor muscles, which for men involves both an external assessment and, with your consent, an internal rectal examination. This allows us to feel directly whether the muscles are tight, tender, or have areas of heightened sensitivity.
This might sound daunting, but it is a standard clinical assessment carried out with care, explanation, and full respect for your comfort. Most men tell us it was far less uncomfortable than they expected – and that finally having a clear explanation for their pain is an enormous relief.
What does treatment involve?
- Manual therapy – hands-on techniques to reduce muscle tension and desensitise trigger points
- Breathing and relaxation techniques – learning to down-regulate an overactive nervous system, which plays a significant role in pelvic pain
- Specific exercise – gentle movement to restore normal pelvic floor function and coordination, not kegel exercises (tightening an already tight muscle is counterproductive)
- Postural and lifestyle advice – addressing contributing factors such as sitting posture, exercise habits, and stress management
- Education – understanding why you have pain and what is maintaining it is a crucial part of recovery
Recovery from chronic pelvic pain syndrome is not always quick, but it is very achievable. Most men see meaningful improvement within six to twelve weeks of consistent treatment, and many achieve complete resolution of symptoms.
You’ve probably been patient for long enough
Living with unexplained pelvic pain is exhausting – physically, emotionally, and socially. It affects relationships, work, and the simple ability to sit comfortably or enjoy physical activity. Many men put up with it for years because they don’t know that an effective treatment exists.
If you’ve been told it’s prostatitis, or been given a shrug and normal test results, please don’t give up. A thorough pelvic floor assessment may give you the answers – and the path forward – that you’ve been looking for. Pelvic pain in men is treatable.
We see men with pelvic pain regularly at Pelvic Health Physiotherapy in Wellington, and we understand how to approach these conversations with sensitivity and without judgement.
You’re welcome to get in touch to discuss whether this sounds like what you’re experiencing, or simply to make an appointment. You don’t need a referral. Continence NZ also has helpful information and resources if you’d like to read more. You might also find our blogs on bladder leakage and ED after prostate surgery and men’s pelvic floor problems helpful.
Frequently asked questions
What is chronic pelvic pain syndrome in men?
Chronic Pelvic Pain Syndrome (CPPS) is persistent pain in the pelvis, genitals, perineum, or lower abdomen that lasts three months or more. It often comes with urinary symptoms and changes in sexual function. It’s one of the most common urological conditions in men under 50 – and one of the most frequently misdiagnosed.
How do I know if my pelvic pain is a pelvic floor problem?
Some clues that the pelvic floor is involved: pain that worsens after sitting for long periods, pain during or after ejaculation, testicular or groin pain with no identifiable cause, urinary urgency or frequency, and pain that hasn’t responded to antibiotics. A pelvic health physiotherapist can assess your pelvic floor directly and give you a clear answer.
Why didn’t the antibiotics work for my prostatitis?
Because in most cases of chronic pelvic pain in men, there is no bacterial infection present. The prostate is not inflamed. Antibiotics treat infection – they have no effect on tight or overactive pelvic floor muscles, which is what’s actually causing the pain in the majority of cases. If your symptoms persist after antibiotics, a pelvic floor assessment is a logical next step.
Can stress cause pelvic floor tension in men?
Yes – the pelvic floor is highly responsive to stress and anxiety. Many men carry tension in their pelvic floor without realising it, in the same way others carry it in their shoulders or jaw. Prolonged stress, a demanding job, or a period of emotional difficulty can all contribute to pelvic floor overactivity and pain.
What does treatment for male pelvic pain involve?
Treatment is tailored to you, but typically includes manual therapy to release muscle tension, breathing and relaxation techniques to calm an overactive nervous system, specific exercises to restore normal pelvic floor function, and advice on posture, activity, and contributing lifestyle factors. We take a whole-body approach – because pelvic pain rarely has just one cause.
How long does it take to recover from chronic pelvic pain syndrome?
Most men see meaningful improvement within six to twelve weeks of consistent treatment. Many achieve complete resolution of symptoms. Recovery isn’t always linear – there may be better and worse periods – but with the right treatment most men make significant progress. The sooner you start, the better.
Do I need a referral to be seen for pelvic pain?
No – you can book directly without a GP or specialist referral. If further investigation is needed, we’ll let you know and can work alongside your GP or urologist. Many men come to us after years of investigations elsewhere and find that a pelvic floor assessment finally gives them the answers they’ve been looking for.
Pelvic Health Physiotherapy Wellington specialises in pelvic health for people of all genders. Our clinicians have postgraduate training in assessing and treating male pelvic pain. Book online or call us – pelvicphysio.co.nz.
