Why Men Experience Lower Abdominal Pain After Vasectomy?

Why Men Experience Lower Abdominal Pain After Vasectomy?

A man may opt for a vasectomy if he does not want to impregnate someone in his lifetime. However, most of them experience lower abdominal pain after vasectomy as a response to their body’s fast healing, resulting in inflammation and secondary pain. But what is it really like after a vasectomy procedure? Is the pain bearable? Is there relief?

Continue reading to find out.

Overview of Post-Vasectomy Pain Syndrome

Post-vasectomy pain syndrome (PVPS) is a continuous or intermittent testicular pain lasting more than three months. About 1–2% of men who undergo a vasectomy experience this discomfort, which leads to some form of medical treatment.

In some cases, the pain may begin within one month following the procedure and continue for years following the surgery. Pain can be ongoing and short-lived and resolved with anti-inflammatory tablets, but can also become chronic. It can be mild to moderate chronic pain, and in rare cases, patients may experience debilitating pain. But do not worry because there are treatments used for PVPS.

The experience of lower abdominal pain after a vasectomy is only indicative of your body’s response to the healing process, which includes some inflammation and secondary pain. Typically, it is mild discomfort for 5-10 days and occurs in the scrotum area, but can also affect the groin or lower abdomen.

What Symptoms Should You Watch for After a Vasectomy?

If you’ve had a vasectomy and you’re still dealing with pain months later, you might be wondering what’s going on. You could be experiencing something called Post-Vasectomy Pain Syndrome (PVPS)—and while it’s rare, it’s real. The symptoms can range from mildly annoying to seriously disruptive, so it’s important to pay attention to what your body’s telling you.

Here are some common PVPS symptoms to look out for:

  • Ongoing testicular or scrotal pain: If the ache just won’t go away and it’s been more than a few months, it’s worth getting checked.
  • Lower abdominal pain: That dull, nagging pain in your lower belly or groin area could be related.
  • Pain during physical activity: Whether you’re working out, lifting something heavy, or just on your feet for too long—if it hurts, take note.
  • Discomfort during sex: Painful erections or discomfort during intimacy are common red flags.
  • Pain after ejaculation: Some men describe a sharp or lingering pain after climax, which can affect their quality of life.
  • Erectile dysfunction: Chronic pain can take both a physical and mental toll, making it harder to get or maintain an erection.

If any of these sound familiar, you’re not alone—and you’re not imagining things. It’s a good idea to reach out to a urologist who understands PVPS and can help you explore your treatment options. Catching it early can make a big difference.

Factors causing PVPS

In terms of the symptoms exhibited and the treatment required, there are a few main causes for testicular pain following vasectomy:

Neurogenic: Some chronic pain is caused by sperm build-up in the vas deferens, trapped in fibrous tissue. This can cause intense pain during activities that agitate your scrotum, such as running or cycling.

Granuloma: Sometimes sperm leakage occurs during or shortly after a vasectomy, causing a lump and swelling.

Epididymitis: Epididymitis results from an increase in pressure inside the epididymis, which is a tube that transports sperm from the testes to the urethra. Normally, men continue to produce sperm after a vasectomy, and the cells are reabsorbed by the body. However, they can develop a buildup of sperm in their vas deferen,s which can cause the epididymis to burst under pressure.

Testicular Torsion: If left untreated, PVPS can twist the spermatic cord that carries blood to the scrotum and cut off the blood supply.

Why Do Men Experience Lower Abdominal Pain After a Vasectomy?

It’s not uncommon for men to experience lower abdominal pain after a vasectomy, and there are a few reasons why this can happen. In most cases, the discomfort is temporary and part of the normal healing process—but for some, it may signal a more persistent issue like Post-Vasectomy Pain Syndrome (PVPS).

Common Causes of Lower Abdominal Pain After Vasectomy:

  1. Post-surgical inflammation: After a vasectomy, your body initiates a healing response. Mild swelling or irritation can sometimes radiate to the lower abdomen or groin area, causing discomfort.
  2. Nerve irritation or injury: Small nerves in the spermatic cord or pelvic region can become irritated during the procedure. It can lead to pain that may be felt higher up in the lower abdomen.
  3. Congestion pain: After the vas deferens is sealed, sperm may continue to build up, causing pressure or congestion in the epididymis. This can lead to a dull ache that radiates to the abdominal area.
  4. Referred pain: Sometimes, pain originating in the testicles or scrotum is “referred” or felt in the lower abdomen due to how nerves are interconnected in that area of the body.
  5. Infection or hematoma (rare): In some cases, post-operative complications like infection or internal bleeding (hematoma) can lead to localized pain that spreads toward the lower belly.

When to Seek Help

If the pain is sharp, increasing, or lasts more than a few weeks, it’s a good idea to check in with your urologist. Especially if it’s affecting your daily life, sex drive, or causing concern—early intervention can prevent chronic issues.

Diagnosis of PVPS

PVPS is different from acute postoperative pain. Most PVPS patients suffer from persistent orchalgia for greater than three months after surgery. However, some patients experience pain while ejaculating, having intercourse, or erection. 

The diagnosis of PVPS must be an exclusion diagnosis. A three-month follow-up history and physical are recommended after surgery. A scrotal ultrasound using color-flow Doppler is administered to every patient suffering from chronic testicular pain. It is recommended to obtain a routine urinalysis, a urine culture, and a semen culture to determine whether there is an infection.

Treatment Options for Post-Vasectomy Pain Syndrome (PVPS)

Post-Vasectomy Pain Syndrome (PVPS) is a long-term complication that affects a small percentage of men following a vasectomy. Characterized by chronic testicular pain lasting longer than three months, PVPS can significantly impact quality of life. The good news is that there are several effective treatment options for PVPS, ranging from conservative approaches to advanced surgical procedures.

1. Non-Surgical and Conservative Treatments

Many men with mild to moderate PVPS find relief through conservative, non-invasive methods:

  • Over-the-counter pain relief: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen help reduce swelling and manage pain.
  • Scrotal support: Wearing supportive underwear minimizes movement and pressure, which can ease discomfort.
  • Physical therapy: Specialized pelvic floor physical therapy can address muscle tension and nerve irritation.
  • Nerve blocks: Local anesthetic or corticosteroid injections into the spermatic cord can reduce nerve-related pain and serve as a diagnostic tool.

These methods are often the first line of treatment for chronic testicular pain after vasectomy.

2. Medication-Based Treatments

When conservative measures aren’t sufficient, doctors may prescribe medications targeted at nerve-related pain:

  • Neuropathic pain medications: Drugs like gabapentin, pregabalin, or tricyclic antidepressants (e.g., amitriptyline) help manage chronic nerve pain.
  • Hormonal therapy: In select cases, medications that reduce testosterone may be used to decrease testicular activity and reduce pain.

These treatments are particularly useful when pain is thought to be neuropathic or hormonal in nature.

3. Surgical Treatment for PVPS

For persistent, severe pain, surgical intervention may be necessary:

  • Microsurgical denervation of the spermatic cord (MDSC): A precise procedure that targets and severs specific nerves to stop the pain signal.
  • Vasectomy reversal: In cases where pressure buildup or sperm congestion is suspected, reversing the vasectomy may relieve symptoms.
  • Epididymectomy or orchiectomy: As a last resort, surgical removal of the epididymis or testicle may be considered, especially when all other options have failed.

Surgical options are typically recommended only after conservative and medication-based therapies have been exhausted.

4. Mental Health and Supportive Care

Living with chronic post-vasectomy pain can take a toll on mental health. Psychological counseling, pain management therapy, and support groups can be essential parts of a holistic treatment plan.

Physical Therapy as a non-surgical treatment for PVPS

Pelvic floor physical therapy can also be beneficial in the treatment of PVPS. People who undergo a vasectomy may experience significant pelvic pain. Due to the abnormal testicular pain they are experiencing, their pelvic muscles tend to tighten up. A physical therapist can teach them pelvic floor exercises to relax those muscles and take the strain off of other areas, such as the scrotum and testicles.

Pelvic floor therapy relieves pelvic pain and discomfort associated with testicular pain by relaxing the scrotum and testicle muscles. By using this therapy, you may be able to increase blood flow and relieve some symptoms.

At PELVIS NYC, we have successful treatments for post-vasectomy pain. By alleviating their symptoms, we enable them to carry on with their daily lives. We listened carefully to identify the source of their pain and formulate the best possible treatment.

Pelvis NYC Team for people experiencing Why Men Experience Lower Abdominal Pain After Vasectomy?

If you have more questions, visit www.pelvis.nyc and have your free 15-minute teleconsultation.


You might get interested in reading: Do You Still Ejaculate After a Vasectomy?

Related Blog: Real Story of How We Help Our Patient Recover from Lower Abdominal Pain

Ease Epididymitis Symptoms: A Proven Approach

Ease Epididymitis Symptoms: A Proven Approach

Introduction to the Male Reproductive System

The male reproductive system is a sophisticated network designed for the production, storage, and transport of sperm. Key components include the testes, epididymis, vas deferens, prostate gland, urethra, and bladder. The epididymis, a tightly coiled tube located at the back of each testicle, is essential for storing and maturing sperm before they travel through the vas deferens during ejaculation.

This system is closely linked to the urinary tract, making it susceptible to various infections. Urinary tract infections and sexually transmitted infections are among the most common causes of inflammation in the male reproductive system, including epididymitis. Because the epididymis connects directly to both the urinary tract and the vas deferens, infections can easily spread, leading to symptoms such as pain, swelling, and discomfort. Understanding how these organs work together is crucial for diagnosing and effectively treating conditions like epididymitis.

Male Reproductive System- epididymitis symptoms

Understanding Epididymitis

Epididymitis is a common condition involving inflammation of the epididymis—the coiled tube located behind each testicle that stores and transports sperm. Epididymitis is characterized by an inflammatory process affecting the epididymis, which leads to pain and swelling.

It’s one of the leading causes of testicular pain in men under 50, yet it often goes undiagnosed or misdiagnosed.

According to a 2023 study published in the Journal of Urology, approximately 600,000 cases of epididymitis are reported annually in the U.S. Early detection and treatment are key to avoiding complications like epididymo-orchitis, infertility, and chronic pelvic pain.

Epididymitis Symptoms

Recognizing the symptoms early helps prevent progression and complications. Common signs include:

  • Pain in the scrotum
  • One-sided scrotal pain or swelling
  • Redness or warmth in the scrotum
  • Painful urination or frequent urge to urinate
  • Penile discharge (white, yellow, or green)
  • Fever and chills (in acute cases)
  • Discomfort during intercourse or ejaculation
  • Fluid buildup around the testicle (hydrocele)

In some cases, pain may radiate to the lower abdomen, which can help differentiate between various acute scrotal conditions.

In chronic epididymitis, symptoms may persist for over six weeks, usually as dull, aching pain in the testicle or groin.

⚠️ Testicular torsion may mimic epididymitis but is a medical emergency. Immediate evaluation is essential for sudden, severe testicle pain.

Types of Epididymitis

Acute Epididymitis

  • Lasts < 6 weeks
  • Often caused by bacterial infections, including those caused by sexually transmitted pathogens such as Chlamydia trachomatis and gonococcal infection (Neisseria gonorrhoeae), or by urinary tract infections (UTIs)
  • May present with fever, scrotal tenderness, and swelling

Presumptive treatment is often initiated based on the most likely causative organisms before laboratory confirmation.

Chronic Epididymitis

  • Lasts >6 weeks
  • May result from prior infections, trauma, or autoimmune reactions
  • Symptoms are less intense but persistent

📌 A 2024 study in European Urology Open Science found that chronic cases respond better to anti-inflammatories, pelvic floor therapy, and lifestyle adjustments than antibiotics alone.

Causes and Risk Factors

Common Causes of Epididymitis

Understanding the underlying causes of epididymitis is key to preventing recurrence and tailoring effective treatment. While the causes can vary by age, lifestyle, and health history, here are the most common culprits:

1. Sexually Transmitted Infections (STIs)

In sexually active men under 35, Chlamydia trachomatis and Neisseria gonorrhoeae are the most frequent infectious agents. These bacteria ascend through the urethra, prostate, and vas deferens to infect the epididymis.

  • Often linked to unprotected sex or multiple sexual partners.
  • STIs may be asymptomatic, so routine screening is essential.

2. Urinary Tract Infections (UTIs)

Escherichia coli (E. coli) and other non-sexually transmitted bacteria can cause epididymitis, particularly in older men or those with urinary tract problems.

  • These bacteria can migrate from the bladder or urethra, especially when urination is obstructed or incomplete.

3. Tuberculosis (TB)

Though rare, tuberculous epididymitis can occur when Mycobacterium tuberculosis spreads from another site of infection (commonly the lungs).

  • Often seen in individuals with weakened immune systems or from TB-endemic areas.
  • Can cause chronic inflammation and granuloma formation in the epididymis.

4. Epididymo-Orchitis

In more severe infections, the inflammation can spread from the epididymis to the testicle, a condition known as epididymo-orchitis.

  • Often presents with more intense scrotal pain, swelling, and fever.
  • Can lead to testicular damage or infertility if untreated.

5. Chemical Epididymitis

This non-infectious form occurs when urine flows backward into the epididymis, often due to heavy lifting, straining, or trauma.

  • Associated with conditions like reflux of sterile urine from the bladder into the vas deferens.

Risk Factors of Epididymitis

Several factors can increase a man’s risk of developing epididymitis. Awareness and prevention can significantly reduce the chances of infection or recurrence.

1. Unprotected Sex or Multiple Partners

  • Engaging in unprotected sexual activity increases exposure to STIs like chlamydia and gonorrhea, which are leading causes of epididymitis in younger men.
  • Regular STI screening and condom use significantly reduce this risk.

2. Use of Urinary Catheters or Medical Devices

  • Indwelling catheters or intermittent self-catheterization can introduce bacteria into the urinary tract, especially in hospitalized or elderly patients.
  • Any foreign object in the urinary system increases infection risk.

3. Recent Pelvic or Urological Surgery

  • Procedures such as prostate surgery, vasectomy, or cystoscopy may disrupt normal urinary flow or introduce pathogens.
  • Post-operative inflammation can also mimic or trigger epididymitis.

4. Urinary Tract Structural Abnormalities

  • Conditions like urethral strictures, prostatic hypertrophy, or congenital malformations may impair urine flow and increase the chance of retrograde bacterial ascent.
  • Chronic retention or incomplete bladder emptying compounds the risk.

5. Use of Certain Medications (e.g., Amiodarone)

  • The antiarrhythmic drug amiodarone has been associated with a rare side effect of chemical epididymitis, especially at doses >200 mg/day.
  • Typically non-infectious and resolves upon discontinuation.

6. History of Prostatitis or Tuberculosis

  • Chronic or recurrent prostatitis (inflammation of the prostate) can serve as a reservoir for bacteria that spread to the epididymis.
  • Past or latent tuberculosis infections should raise suspicion in persistent or unusual cases.

7. High-Impact Physical Activities

  • Activities like long-distance cycling, heavy lifting, or motorcycling can irritate or traumatize the perineal and scrotal area, leading to inflammation or increased susceptibility to infection.
  • Wearing protective gear and taking regular breaks can help reduce the risk.

Diagnosing Epididymitis: How Is It Identified

Physical Examination

Your doctor may assess:

  • Swelling, tenderness, or lumps in the scrotum
  • Penile discharge
  • Enlarged or tender prostate (via rectal exam)

Diagnostic Tests

  • Urinalysis and urine culture: To identify bacterial causes
  • STI screening: To test for chlamydia or gonorrhea
  • Scrotal ultrasound: To distinguish epididymitis from testicular torsion or tumors
  • Blood tests: To assess for infection or inflammation

Differential Diagnosis: Ruling Out Other Conditions

Diagnosing epididymitis requires careful consideration, as its symptoms can overlap with several other serious conditions. One of the most critical distinctions is between epididymitis and testicular torsion—a surgical emergency that can threaten testicular viability if not treated promptly. Both conditions can present with acute scrotal pain, but testicular torsion typically involves sudden, severe pain and requires immediate intervention.

Other conditions that may mimic the symptoms of epididymitis include orchitis (inflammation of the testicle), testicular cancer, testicular infarction (loss of blood supply to the testicle), and mumps orchitis, especially in younger males. A thorough medical history, including recent sexual activity, number of sexual partners, and any previous urinary tract infections, helps identify risk factors and guide the diagnostic process.

A comprehensive physical examination is essential, often followed by diagnostic tests such as urinalysis, urine culture, and scrotal ultrasound. These steps help rule out other causes of scrotal pain and confirm the diagnosis of epididymitis. Considering all possible differential diagnoses ensures that patients receive the correct treatment and avoid complications from missed or delayed diagnoses.

Epididymitis Diagnosed: What to Expect Next

Once epididymitis is diagnosed, the primary goal is to treat the underlying bacterial infection and manage symptoms. Most patients will begin a course of antibiotic treatment tailored to the specific bacteria identified, which is crucial for resolving the infection and preventing complications. In addition to antibiotics, doctors often recommend supportive measures to relieve discomfort, such as resting, applying ice packs to the scrotum, and elevating the scrotum to reduce swelling.

For those experiencing severe pain, pain medications or anti-inflammatory drugs may be prescribed. It’s important to complete the entire course of antibiotics, even if symptoms improve, to ensure the infection is fully eradicated. Patients should also monitor for signs of complications, such as epididymo-orchitis, and seek medical attention if symptoms worsen or fail to improve. Regular follow-up appointments help ensure that the infection has cleared and that no further treatment is needed.

Bacterial Epididymitis: Treating the Root Cause

When caused by bacteria, especially in younger men, prompt antibiotic treatment is essential to prevent progression to severe infection and to support overall disease control. Supportive measures such as scrotal elevation, cold packs, and activity limitation are also recommended to reduce pain and swelling.

Standard Treatment Includes:

  • Antibiotics: Ciprofloxacin, doxycycline, or ceftriaxone depending on the pathogen
  • NSAIDs: To reduce inflammation and pain
  • Scrotal support: Elevation and cold packs for symptom relief
  • Sexual partner treatment: To prevent reinfection if STI is confirmed

The Role of Pelvic Floor Physical Therapy

While antibiotics remain the first line of treatment, pelvic floor physical therapy has shown promise in speeding up recovery, particularly in chronic or treatment-resistant cases.

Benefits of Physical Therapy:

  • Improves pelvic blood flow
  • Relieves pressure and muscular tension in the groin
  • Helps with urination and ejaculation-related pain
  • Reduces inflammation without side effects

💡 Clinical evidence suggests pelvic floor therapy improves outcomes when combined with medication for both acute and chronic cases.

how to improve epididymitis symptoms

How to Maintain a Healthy Male Reproductive System

Preventing epididymitis starts with proactive care of the male reproductive and urinary systems:

  • Practice safe sex and limit sexual partners
  • Stay hydrated and urinate regularly
  • Avoid prolonged sitting or repetitive groin trauma
  • Seek care for urinary symptoms early
  • Incorporate pelvic floor exercises under professional supervision

Maintaining a healthy male genitourinary tract is essential to reduce the risk of infections and inflammation that can lead to conditions like epididymitis.

Complications of Untreated Epididymitis

If not addressed, epididymitis can lead to:

  • Testicular torsion
  • Infertility: Due to scarring or blocked sperm flow
  • Chronic pain
  • Abscess formation
  • Increased risk of testicular cancer (in rare cases)

Severe or untreated cases may also result in complications involving the spermatic cord, such as abscess formation or impaired blood flow.

Prognosis: What’s the Outlook?

The outlook for most men diagnosed with epididymitis is positive, especially when treatment is started early. With appropriate antibiotic therapy and supportive care, symptoms typically resolve within a few weeks. However, if left untreated, epididymitis can lead to more serious complications, including epididymo-orchitis, testicular infarction, and even infertility due to scarring or damage to the reproductive tract.

Certain individuals, such as those with chronic epididymitis or underlying conditions like human immunodeficiency virus (HIV), may be at increased risk for persistent symptoms or complications. In these cases, ongoing management and lifestyle modifications may be necessary to control symptoms and prevent recurrence. Regular follow-up with a healthcare provider is essential to monitor recovery, address any lingering issues, and reduce the risk of long-term damage to the male reproductive system. Practicing safe sex and seeking prompt medical care for urinary or reproductive symptoms are key steps in maintaining reproductive health and preventing future episodes.

When to Seek Medical Help

Seek immediate care if you experience:

  • Sudden, severe testicular pain
  • Fever, chills, or nausea with groin pain
  • Discharge from the penis
  • Swelling that doesn’t improve in 48 hours
  • Difficulty urinating

Your Next Step: Expert Help Is Available

At Pelvis NYC, we specialize in helping men manage and recover from epididymitis through science-backed pelvic floor therapy. We’ve helped countless patients ease their symptoms, restore function, and prevent recurrence.

epididymitis symptoms: who can help

👉 Schedule your FREE 15-minute teleconsultation with one of our pelvic health experts today.

✅ Summary: Key Takeaways

Pudendal Nerve Entrapment: How Physical Therapy Can Help?

Pudendal Nerve Entrapment: How Physical Therapy Can Help?

If you’re a man experiencing unexplained pelvic discomfort, pain during sitting, or persistent urinary or sexual issues, you might be dealing with a little-known condition called pudendal nerve entrapment (PNE). PNE occurs when an entrapped pudendal nerve leads to nerve compression, resulting in chronic pelvic pain. It’s often misunderstood, misdiagnosed, and—worst of all—left untreated.

This blog will walk you through what pudendal nerve entrapment is, what causes it, how to identify it, and most importantly, how physical therapy can play a major role in recovery.

What Is Pudendal Nerve Entrapment?

The pudendal nerve is one of the main nerves in the pelvis. It runs from the lower back through a small canal in the pelvis (called Alcock’s canal) and branches out to serve the genitals, anus, and perineum (the area between the genitals and anus).

The pudendal nerve supplies motor and sensory innervation to the perineal region. It ncludes the external genitalia and anal sphincter, playing a crucial role in continence, sensation, and sexual function. It controls sensation and some muscle movements in that region, including the pelvic floor.

“The main branches of the pudendal nerve include the perineal branch, dorsal nerve, and inferior anal nerve. The perineal branch innervates the perineal muscles and skin, the dorsal nerve provides sensation to the penis in males and the clitoris in females, and the inferior anal nerve supplies motor innervation to the external anal sphincter and sensory innervation to the anal canal.”

When this nerve becomes compressed, irritated, or entrapped—often between ligaments or by tight muscles in the pelvis—it can lead to a painful condition called pudendal neuralgia. Pudendal nerve compression is a common cause of these symptoms. The resulting nerve pain can feel like burning, stabbing, aching, or numbness in the genitals, perineum, or rectum.

After passing through Alcock’s canal, the pudendal nerve is susceptible to entrapment, which can result in pudendal canal syndrome—a specific form of nerve entrapment within the pudendal canal.

Though it’s not widely recognized, pudendal nerve entrapment can affect both men and women. Symptoms of pudendal neuralgia may include genital numbness, sexual dysfunction, and bladder or bowel issues. Men, however, often report symptoms like:

  • A dull or sharp ache in the perineum or lower pelvis
  • A feeling of “sitting on a golf ball” or lump in the groin
  • Erectile dysfunction that doesn’t respond to typical treatments
  • Urinary urgency, frequency, or incomplete emptying
  • Pain that worsens while sitting and improves when standing or lying down

Understanding Pudendal Nerve Pain (Pudendal Neuralgia)

Pudendal neuralgia is a type of chronic pain that stems from irritation or damage to the pudendal nerve. Chronic pudendal neuralgia is a long-term condition that can be associated with chronic perineal pain, pelvic and perineal pain, and other chronic pain syndromes. It may come and go—or it might persist and affect your quality of life significantly. Because symptoms vary and mimic other conditions, it’s frequently misdiagnosed as prostatitis, pelvic floor dysfunction, or even psychological distress.

The pain may be:

  • Sharp, burning, or electric-shock-like
  • Localized to the penis, scrotum, perineum, anus, or inner thighs, with pelvic and perineal pain being common manifestations
  • Made worse by activities like cycling, squatting, or even sitting

If left untreated, it can contribute to anxiety, depression, and withdrawal from physical or intimate activities. Some patients experience persistent pain despite treatment, which can significantly affect daily activities.

Symptoms of Pudendal Nerve Entrapment

Pudendal nerve entrapment can present with a wide range of symptoms, often making daily life challenging. The most common sign is persistent pelvic pain, which may feel like a burning pain or numbness in the genital and anal regions.

Many people notice that their discomfort worsens when sitting and eases when they stand or lie down. This nerve entrapment can also lead to urinary frequency, constipation, or even painful bowel movements, making routine activities uncomfortable.

Sexual dysfunction is another frequent concern, with some individuals experiencing erectile dysfunction, painful ejaculation, or a decrease in sexual sensation. Others may describe a sensation of having a foreign object in the rectum or vagina, which can be both distressing and confusing. Because these symptoms can significantly impact quality of life. It’s important to seek an accurate diagnosis and appropriate treatment for pudendal nerve entrapment as soon as possible.

Causes of Pudendal Neuralgia?

Pudendal nerve entrapment typically results from nerve compression, which occurs when the pudendal nerve is pinched or irritated along its path through the pelvis. This compression may happen between ligaments, within tight spaces like Alcock’s canal, or from overactive pelvic floor muscles.

Pudendal neuralgia caused by nerve entrapment is often due to compression of nerve fibers at specific anatomical sites, leading to neuropathic pain that can worsen with sitting. The nerve fibers transmit pain signals, and their compression results in the characteristic symptoms of pudendal nerve entrapment syndrome. Prolonged sitting—especially on hard surfaces—can lead to chronic compression of the perineal region, placing constant stress on the nerve. Activities such as cycling or horseback riding can produce similar effects through repetitive pressure and friction.

Trauma, including falls or accidents that impact the lower back or pelvis, may also lead to pudendal nerve entrapment syndrome, especially when there is bruising or misalignment in the pelvic structures. Pelvic trauma is a recognized cause, as it can damage or entrap the pudendal nerve and its fibers, resulting in pain and dysfunction.

Surgical procedures in the pelvic or perineal region can leave behind scar tissue, creating adhesions that further compress the nerve. Chronic straining due to constipation or heavy lifting may also contribute to gradual injury. In some individuals, the nerve may be compressed by benign or malignant tumors, cysts, or anatomical abnormalities, although these cases are rarer. Identifying and treating the root source of nerve compression—whether muscular, structural, or surgical—is key to relieving symptoms.

When Is Decompression Surgery Considered?

When conservative treatments like physical therapy, nerve blocks, and medication do not provide adequate relief, pudendal nerve decompression surgery may be recommended. This surgical procedure involves carefully releasing the pudendal nerve from the tissues or ligaments compressing it—most commonly between the sacrospinous and sacrotuberous ligaments or within Alcock’s canal. Surgical decompression, including minimally invasive approaches like laparoscopic pudendal nerve decompression, aims to relieve nerve compression and provide pain relief.

Decompression surgery is typically reserved for individuals who meet specific diagnostic criteria, such as a positive response to a diagnostic pudendal nerve block and persistent pain or symptoms that have not improved with non-invasive care. Persistent pain despite conservative treatment is a key reason for considering surgical intervention. Because this is a complex and delicate procedure, it should be performed by surgeons who specialize in pelvic neuropathies. While not everyone is a candidate, those who undergo successful decompression may experience significant relief from pain and a better quality of life. However, surgery is not a guaranteed solution and some patients may continue to experience persistent pain even after intervention, so it should be considered only after thorough evaluation and exploration of other options.

How Do You Diagnose Pudendal Nerve Entrapment?

The diagnosis of pudendal nerve entrapment is a structured process that involves clinical evaluation based on established criteria, neurophysiological testing, and advanced imaging techniques.

Diagnosing pudendal nerve entrapment can be tricky. It’s not something you can see on a typical X-ray or even a standard MRI. Instead, diagnosis relies on a combination of clinical symptoms, physical examination, and sometimes specialized tests. Pudendal nerve entrapment syndrome is recognized as a clinical entity with specific diagnostic criteria, including history, physical examination, nerve blocks, and imaging such as MRI or ultrasonography to confirm nerve entrapment and rule out other causes.

When considering what conditions to rule out, sacroiliac joint dysfunction and chronic pelvic pain syndrome should be included in the differential diagnosis, along with other causes of pelvic or perineal pain.

Here’s how the process typically goes:

1. Clinical Evaluation

A thorough history of your symptoms, especially their relation to sitting and whether they change with movement, gives the first clues. Pudendal neuropathy is a broader term that refers to nerve injury or damage from various causes, such as trauma, childbirth, or compression, and may or may not involve entrapment. Pudendal neuralgia caused by pudendal nerve entrapment is a specific subset, where nerve compression leads to chronic pain, and is diagnosed using established criteria. Doctors will often follow a set of diagnostic criteria, including:

  • Pain in the pudendal nerve area
  • Worsening pain when sitting
  • No pain when lying down or at night
  • No loss of sensation or motor function
  • Temporary relief from a diagnostic pudendal nerve block

2. Diagnostic Pudendal Nerve Block

A local anesthetic is injected near the pudendal nerve in a procedure known as pudendal nerve block injections, which serve as both a diagnostic and therapeutic tool. If your pain improves for a few hours or days afterward, it confirms the pudendal nerve is involved.

Pain medication, such as local anesthetics or corticosteroids, may be used in conjunction with these nerve block injections to provide temporary relief and reduce inflammation. This procedure also helps guide treatment options.

3. Imaging and Nerve Tests

High-resolution MRI, CT scans, or pelvic floor EMG may be used to rule out structural problems. These are less about seeing the nerve directly and more about excluding other conditions.

Can It Be Treated Without Surgery? Yes. Here’s How.

While decompression surgery is an option in more severe cases, non-surgical treatment is highly effective for many people—especially when started early. This is where pelvic floor physical therapy plays a central role.

Nerve Compression: How It Affects the Pudendal Nerve

Nerve compression is a key factor in the development of pudendal neuralgia and chronic pelvic pain. The pudendal nerve runs through the pelvic floor muscles and passes close to several structures, including the ischial spine, sacrospinous ligament, and the pudendal canal.

When these surrounding tissues—such as tight muscles, ligaments, or tendons—press on the nerve, it can lead to symptoms like numbness, tingling, and neuropathic pain in the pelvic area.

Prolonged or repeated compression can cause lasting nerve damage, resulting in chronic neuropathic pain that is often difficult to manage without targeted treatment. Understanding exactly where and how the pudendal nerve is being compressed is vital for choosing the right therapy. Whether that involves physical therapy to relax the pelvic floor, nerve blocks, or, in some cases, surgical intervention. By addressing nerve compression early, it’s possible to reduce pain and prevent long-term complications.

How Physical Therapy Helps Pudendal Neuralgia

pudendal nerve entrapment

In some cases, muscle relaxants may be prescribed alongside physical therapy to help reduce pelvic floor spasm and improve the effectiveness of treatment.

A specially trained pelvic health physical therapist can:

  • Teach you how to relax and lengthen the pelvic floor muscles
  • Guide you through exercises to strengthen weak muscles and improve coordination
  • Use manual therapy techniques to release tight or tender areas
  • Provide education on posture, body mechanics, and lifestyle modifications

✅ Release Pelvic Floor Tension

Overactive or tight pelvic floor muscles can compress the pudendal nerve. Therapy focuses on relaxing these muscles through manual techniques and guided exercises.

pudendal nerve entrapment

✅ Correct Postural Imbalances

Poor posture or spinal alignment may strain nerves in the pelvis. PT helps you improve posture to reduce unnecessary pressure on the nerve.

✅ Identify Aggravating Movements

A trained eye can spot which activities or movements irritate your nerve—and help you adjust or eliminate them safely.

✅ Teach Safe Stretching & Mobility

Stretches that target hip rotators, hamstrings, and the lower back can open up tight areas that may be indirectly affecting your nerve.

✅ Support Bladder and Bowel Function

Therapists can help you develop habits that prevent straining, such as healthy bathroom posture, breathing techniques, and dietary changes.

✅ Incorporate Pain Management Tools

Devices like TENS units can help block pain signals from the pudendal nerve. Therapists guide proper use for maximum benefit. In cases where pain is refractory to conservative treatments, advanced neuromodulation techniques such as sacral nerve stimulation and spinal cord stimulation may be considered. This can use for complex or persistent neuropathic pain conditions.

Physical therapy is especially helpful when nerve entrapment is caused by muscle compression, not a structural defect. It is something quite common in active men or those who sit for long periods. Persistent genital arousal disorder, which can be associated with pudendal nerve compression, may also benefit from similar pain management strategies.

Lifestyle Changes for Managing Pudendal Neuralgia

Making thoughtful lifestyle changes can have a significant impact on managing pudendal neuralgia symptoms and improving overall quality of life. One of the most effective strategies is to avoid activities that trigger or worsen pain. Examples are prolonged sitting or cycling. Using ergonomic cushions, taking frequent breaks, and adjusting your daily routine can help minimize discomfort.

Maintaining a healthy weight and engaging in regular, gentle exercise can support pelvic health. It can reduce pressure on the pudendal nerve. Practicing good posture and incorporating pelvic floor physical therapy into your routine can strengthen pelvic muscles. Additionally, it can improve bladder and bowel function. Stress management techniques, like meditation and deep breathing, are also valuable tools for coping with chronic pain and reducing symptom flare-ups.

By adopting these lifestyle changes and working closely with a physical therapist, individuals with pudendal neuralgia can take proactive steps to manage their symptoms, regain control, and enhance their quality of life.

When Is Surgery Necessary?

If conservative treatments fail to relieve symptoms over several months, pudendal nerve decompression surgery may be considered. This involves surgically releasing the nerve from surrounding tissues to reduce compression. It’s a complex procedure and should be done by a surgeon experienced in pelvic nerve disorders. Pre-surgical nerve blocks are often used to predict whether surgery will help.

Managing Chronic Pudendal Pain

Living with chronic pudendal pain can be both physically draining and emotionally overwhelming. Especially when the symptoms persist without a clear explanation or diagnosis. Fortunately, there is a range of treatment options available that can help patients manage pain and improve their quality of life.

A comprehensive approach typically includes pelvic floor physical therapy as the foundation. It aimed at releasing muscle tension, restoring mobility, and reducing nerve irritation. Alongside therapy, patients often benefit from pain management techniques. Examples are the use of TENS (transcutaneous electrical nerve stimulation) units, which deliver low-level electrical currents to disrupt pain signals.

Medications for nerve-related pain—such as gabapentin, amitriptyline, or duloxetine—can also be prescribed to help calm nerve activity and reduce discomfort. For some, pudendal nerve blocks or pulsed radiofrequency treatments may be used to target the source of the pain more directly.

Additionally, psychological support, particularly cognitive behavioral therapy (CBT), can be an important part of pain management. It helps patients develop better coping mechanisms and address the emotional strain that often accompanies chronic pain.

Lifestyle modifications are equally important in reducing symptom flare-ups. This may involve adjusting exercise routines, using ergonomic cushions when sitting, avoiding activities that aggravate the nerve, and improving bowel and bladder habits to avoid straining. With the right combination of interventions—and the support of a skilled care team—many patients are able to manage their symptoms effectively and regain a sense of normalcy in their daily lives.

Take the First Step Toward Relief

At PELIVS NYC, we understand how difficult pudendal nerve pain can be, both physically and emotionally. That’s why we offer expert evaluation and individualized pelvic floor therapy to help you regain control over your health.

We also offer a FREE 15-minute teleconsultation so you can speak to a professional, ask questions, and explore whether therapy might be right for you.

You don’t have to live in pain. Get the right diagnosis, the right treatment, and your life back.

Related Blog: Pudendal Neuralgia: PT Is Your Treatment

How Do You Get Rid of Hard Flaccid Syndrome?

HOW TO GET RID OF HARD FLACCID SYNDROME

What is Hard Flaccid Syndrome?

Hard Flaccid is a newly coined term that describes a symptom of pelvic floor dysfunction/CPPS. But before we dive deep into how to get rid of your hard flaccid syndrome, let us understand first what could be the cause and risk factors.

Similarly, patients describe their symptoms to be a nuisance throughout the day and in the bedroom. Men will often describe that their penis doesn’t hang as low as it did in a flaccid state and seems somewhat retracted. Men will describe that their penis can feel cold, takes more physical stimulation to get aroused, feels rubbery during an erect state, the penis doesn’t get as much blood flow/maintain an erection, and a weak stream of urine.

What are the psychological effects of hard flaccid in men?

As for why this happens? We don’t understand the full mechanism behind it. In fact, the majority of medical professionals will deny that this diagnosis even exists and will say “it’s all in your head” and probably prescribe you some sort of PDE5 inhibitor (Viagra/Cialis) to get rid of your “anxiety”. The dangerous part of using the word anxiety is that you may have developed or worsened your anxiety due to this issue as it would any male going through this, but anxiety isn’t causing this issue.

Prior to feeling these symptoms, we men never had to think about our penis. In fact, we only used it for the 2 P’s; Pee and Pleasure. So the fact that now you are constantly thinking of “how much urine is coming out”, “will I be able to maintain and keep a rigid erection” induces anxiety and further takes the SEX out of SEXY. All you are left with is a Y (see what I did there?). This constant feedback loop causes anxiety and further increases sympathetic tone which is the antithesis of getting an erection.

So this blog post is for those that have been searching for some answer, for those who are looking for options, doable options to get rid of a hard flaccid syndrome. This is written for you!

It is equally important to know that these symptoms are real and they are very much treatable. Furthermore, in Pelvis NYC, we do have a working hypothesis that hypertonic/weak pelvic floor muscles may be causing the issue. The majority of men seen with this condition have very tight lower abdominals, their perineum is weak and cannot sustain a contraction longer than 10 seconds.

Who can help in getting rid of hard flaccid syndrome?

First thing is, always get yourself to a primary care physician or urologist to get medically cleared for anything serious. High blood pressure, diabetes, obesity, as well as High cholesterol are one of the few conditions that will start as erectile dysfunction.

Second, get yourself to a pelvic floor physical therapist who can help evaluate and treat you. Remember not all medical professionals are equal, just because you saw one should not mean that you have exhausted your options.

Third, start to take matters into your own hands. Do your best to control the variables in your life that are easily controllable.  Start by evaluating your diet, sleep, stress, and movement. The second you start to see improvements in some areas you will notice improvements within others as well.

What are the pelvic floor exercises I can do now to get me on the path of getting rid of hard flaccid?

1)    Ease the tension around the lower abdominals. Try these:

a.     Cobra stretch ( 2 minutes min with exhalation at the top to let your belly go)

b.     Couch stretch ( 2 minutes- inhale and exhale into the stretch)

c.     Foam/Lacrosse ball – Find a tender area and gently breathe through it This is a nice soft tissue release.

2)    Decrease tension around perineum

a.     Deep Squat stretch – This will help stretch your adductors and your perineum (2 min). If you have a bathtub you can use the buoyancy to help decrease the strain on your knees

b.     Happy Baby – 2 mins

At Pelvis NYC we want you to know that we understand what you are going through. We truly care about your well-being. Now that you know these symptoms are real and that it is treatable….BREATHE!

The next step is to follow some of the recommendations here, see what works for you, and let us know how we can help. Contact us now!

The Male Physiotherapist: An Interview with Dr. Adam Gvili, PT, DPT

Pelvic floor dysfunction affects more women than men, but MEN ARE AFFECTED TOO. Since most physiotherapists are focused on treating women, a lot of men are silently suffering, left untreated, misdiagnosed, and experiencing depression and anxiety. That is why a need with a Male Physiotherapist is essential.

In this interview between Simon Edward Smith of The Medical Journo on Youtube entitled Interview With Male Pelvic Specialist Dr. Adam Gvili, they have discussed below topics:

00:15​ Can you explain a bit about what you do?

Dr. Adam Gvili: I’m a physiotherapist as you know, in the States, right I’m here in New York City & my specialty is the male pelvic floor. I hope to treat females one day, but I’d like to focus solely on males for now.  I also treat orthopedically and treat a lot of athletes and I really enjoy treating in full spectrum. And the only population I don’t treat is pediatrics. Coz I think there are much better people out there that can focus on pediatrics than men.

So I treat a lot of females for orthopedic issues but I won’t treat them for the pelvic floor. Obviously, I’ll treat men for any issue. 

Simon Edward Smith: “Right and this is based out of New York, you’ve got a clinic there?

Adam: Yeah right in Manhattan.

Simon: How long have you had that for?

Adam: About two years now.

01:40​ Dr. Gvili’s experience with pelvic floor dysfunction 

Adam: I don’t know how much you know about me. I myself went through pelvic floor dysfunction a couple of years back. Maybe ten years ago, at that time there was nobody out there to treat it. Really, in terms of men treating men. Right there were females treating it, but having a conversation like ‘hey you know when you pee at the urinal and you get this weird feeling, oh wait you don’t pee at the urinal right?’. And you can probably relate to this topic.

It’s like a weird dead end that I couldn’t complete a plan of care. But luckily I did meet a woman who is really familiar with male anatomy. I can give her a lot of kudos and I did learn from her. One of the reasons I started on my own, was because I was like there are no males treating males and guys don’t like to talk about their penis that much and that is the truth.

Simon: Yeah so what are your experiences in pelvic pain?

Adam: So luckily I only had some pain like an occasional shooting pain. Sometimes into the rectum maybe two seconds and it goes away. It was just a hypertonic pelvic floor. So as a patient, I had some issues like weird erectile dysfunction, premature ejaculation. Muscles are so tight that it is constantly contracting around my prostate. And it’s almost a borderline persistent general arousal disorder.

And I remember the third physical therapy session got better. It pushes the right buttons so I think that was what it was.

03:18​ Dr. Gvili’s treatment of his pelvic pain 

Simon: What would you do in a physiotherapy session to recover so quickly?

Adam: So we didn’t do much movement base stuff which is kinda I think what is needed to speed up the process but what I did appreciate was this certain individual did a lot of internal and that’s part of my practice as well. I do a lot of internal. I’m gonna kick that taboo on the side. Guys treating guys.

I think even orthopedic clients need that therapy with touch to get that therapeutic effect right. I need to tone down your system. If that is the case, most of my guys have had a hypertonic pelvic floor. I treat mostly an average of 20 to 40, we had the outliers but I used it to tone down the system first before trying to get you engaged or to believe that this is gonna work. Because by the time you’ve gotten to me, you’ve seen so many practitioners that have run you down some rabbit hole. Googling and thinking that you have a terminal disease so I have to calm you down a bit and the way to do that is by internal.

04:31​ The taboo over male-treating-male treatment 

Simon: You said that there was a taboo with men treating men. Do you find that in the US then?

Adam: Totally! And it’s funny! Because when you speak to practitioners in the UK and Australia who are light years ahead of the US. We’re practitioners and we’re here to get people better and that’s our goal. And that has nothing to do with gender. But for some reason when you speak to people coming out of school or people that might be interested in specialties. They hear what you do and ‘oh I can never do that’ those were the usual answers that follow and you do get that a lot.

05:15​ The influence of A Headache In The Pelvis

Simon: You’ve heard of a headache in the pelvis? Well, that’s all internal. Not all of it actually no that’s wrong but some of it is internal isn’t it. And that was crazy in the US. I was quite surprised that it is such a big book within the physiotherapy world. I’m surprised it’s not just common being accepted into the practice.

Adam: It’s such a big one in the physiotherapy practice.

Simon: It’s such a big-known book that I’m surprised that there is a bit of an issue around men treating men.

Adam:  So it’s interesting I do give Dr. Wise a huge kudos because they kind of got this whole movement started. If you really think about it, especially for males. I’ve had a wand and I used it. I’m not the biggest fan of it. But I mean internals out there for some reasons it’s still a taboo right.

Like when I took my first men’s pelvic floor course. I remember it was a two or three-day course either way we spent a good two hours or an hour and a half talking about what you do in a situation where a guy gets an erection. So it was more geared towards women feeling comfortable treating men as opposed to just how do we diagnose and treat men. Even within the female kind of sector, there was a taboo here like oh what do we do right.

06:59​ What name would you give to this condition?

Simon: What name would you give to this coz there’s a lot of debate of groups over what terminology people should use. But you know coming from actually from the field what would you call it?

Adam: Yeah it’s tricky because have you heard of sciatica?

Simon: Yeah that’s the nerve down the thigh.

Adam: Yeah it’s actually at the back of the leg.

Adam: Sciatica or it can be in your spine it could be coming along that pathway. Like pelvic pain, we have an umbrella term, we kinda branch out from there. So I don’t necessarily know if I would rename it because it depends on someone’s symptoms and it depends on it being a multi-fast issue we don’t know what’s going on. I think the biggest disservice we have done so far is diagnosing people with stuff we’re not sure they have.

Simon: Right, such as an inflamed prostate.

Adam: What the h*** does it even mean?

Adam: No seriously I’m a little more animated than your average physical therapist. But what the h*** does that even mean. I have a leading urologist in New York City referring me to clients. Thankfully, I’m very thankful for that. But how can I feel an inflamed prostate? You can’t feel if it’s baggy but can I tell if it’s really inflamed. I’ve touched many prostates. I don’t know if that’s necessarily true. Can I be honest? It could be wrong.  Maybe I’m feeling but I’m telling you what I think. or I mean I have this theory that specifically in the US but I don’t know it is in the UK but we over medicalize here. We definitely over medicalize. We diagnose, the reason why we have to diagnose is so we get paid by the insurance 

I never walk out of a doctor’s office saying we’re not really sure what it is just do this, and this. And we’re always looking for an answer for some reason. How do we know it’s necessarily the pelvic floor and it’s a hip issue? How do we know it’s not a low back issue? So many things can cause the said symptoms. That I think we do some disservice, let’s say it’s for sure like this when we don’t have enough research. Majority of those diagnoses that you’ve heard 

09:42​ The problem with giving it a name 

Simon: Yeah! Cole Monahan mentions that giving a diagnosis can be a bit definitive and not really help the situation. Like you said that there are so many different symptoms coming from different places and it’s hard to classify them.

Adam: Totally! And then I’ve had people who have had a one-night stand and said it happens after that. I never had sex before and they tell me they have these symptoms. So when that happened the first time. That person came to me and said I’m actually a virgin. I’ve never had oral sex either. But I have these symptoms. That was like someone shot me in the head. Because I was like we thought to believe that this could potentially be something that changed your urethral or bladder flora.

Whoa, so I’m always at the question mark and I think that it’s the exciting part about treating the pelvic floor that constantly comes up.

10:44​ Issues around internal treatment and trigger points 

Simon:  So I really want to ask what this internal treatment is? Do you say you’re not a massive fan of the wand? Is that because there are few different types? Is that the easy one, the magic wand?

Adam: It’s kind of like an S-shape. Like a small S shape. I’m not the biggest fan because… to go and search for trigger points, I don’t know how helpful that is. Also unless you’re sort of a Marvel DC Comic character when you have a long arm, or you actually can make it to put it in your butt. You might have a problem kind of relaxing certain muscles because you’re utilizing them in order to contract them to a certain position right.

Well that being said I’ll never tell someone not to do something. In most cases, I won’t say no to do something. So if that makes you feel better, do it.

Simon: So you’re using your finger then?

Adam: Yeah we use gloves.

Simon: You’re using your finger like a wand basically?

Adam: So am I looking for a trigger point or not? I have people that seem that don’t have that much tension in their pelvic floor but they go through all the gamma symptoms and everyone who does, has a high torn pelvic floor. So I’m not necessarily looking for trigger points. But something that says that I’m in the right area right. Especially the first session which is evaluation. I go around and try different things and I’ll tell my clients to text me the next two or three days and then I have a log two-three days and another two-three days until they come in. and we’ll see if that did work and we’ll stick with that a little bit and then when we are at the point where we’re stagnating then maybe we’ll switch to something else.

12:47​ Individual treatment for clients 

Simon: So what are these? Are you telling them to stretch? Or do they do the massage and set the internal massage themselves? What is it? Or just a combination of different methods?

Adam: Yeah, I don’t have cookie-cutter treatment. If it takes someone with a really high tone pelvic floor that kinda sits all day, and doesn’t move much. They would do really well, just kind of going out for a walk starting slow, deep squats. My favorite is deep squatting in your bathtub. I don’t know in the UK if you have traditional bathtubs, not sure if you do. Curve the edges on the side. 

 So you can deep squat with your back with supported heels down that curved the edges will further push you to the hip flexion. So what you’ll get is the opening of that perineum and adductor fascia. That’s my favorite kind of talk of almost everyone on their first visit just to see if we get a change because that is what we are looking for right. An active change.

Simon: It’s funny you say that. Because that is the position that I would do. The wand, that’s the exact position that is really helpful. That deep squat just pulls everything open. You can feel like releasing… come open… so I can certainly associate with that.

Based on the above conversations, we can feel how passionate Dr. Adam Gvili is in treating male pelvic floor disorders and how he works with them closely to improve their symptoms and normalize their pelvic floor.

Do you want to know more about a male physiotherapist and how Dr. Gvili treats his patients? Want to learn more tips and advice from an expert who experienced pelvic floor disorder himself? Watch out for our next blog.

Related Blogs: Physical Therapy for Men: FAQs Answered and Guide to Physical Therapy: What You Need to Know

Confessions of a Pelvic Floor Physiotherapist

pelvic health

I was in deep sadness, because of an unhealthy pelvic floor. Past tense because it was all in the past. Have you been searching for ways how to regain your pelvic health?

If YOU or you know ANYONE who has been suffering from pelvic floor dysfunction over the years. Please let them read this. Please share this with them.

Because they need to know what I’ve been through. And how my story can HELP them regain their pelvic health back for GOOD.

Here it is…

My pelvic pain issues made me a pelvic floor physiotherapist.

When I was going through my symptoms of a pelvic floor disorder, I remember feeling very bad for myself. I have experienced all the embarrassing signs of pelvic floor dysfunction.

  • Weak pelvic floor
  • Urinary incontinence
  • Fecal incontinence
  • Painful urination or defecation
  • Erectile dysfunction
  • Pain in the bladder or groin area

I tried to rationalize why someone like me who is a good person, would get such a terrible disease. And I also tried to play out every scenario in my head and think of what I could have done over so that I would not feel the pain and discomfort I was feeling. Weird things like my masculinity kept being called into question, I would second guess myself on routine tasks and I would feel less confident around familiar people. I remember crossing the street and thinking to myself “I bet you, he doesn’t have pelvic pain”. This all drove me mad!

Physicians I consulted with thought I was crazy. Every test they examined me for came back NEGATIVE!

Examinations include:

  • Digital rectal exam
  • Urinalysis
  • Blood tests
  • Radiology tests
  • Cystoscopy

They all concluded that it must be psychological, and I started to believe them. The issue with men’s pelvic pain is that it’s not tangible; no one can prove that you are feeling pain, neither can you. At some point in your journey, you start to ask yourself is my anxiety causing this? What came first, my anxiety or the pain? Did I even have anxiety prior to this? The truth is, it’s a double-edged sword if you are constantly trying to make sense of something in your head and you are feeling symptoms of that which you cannot make sense of, that is anxiety by mere definition. 

It wasn’t until I finally met a pelvic physical therapist focused on men’s pelvic health, who could finally validate my symptoms. And help me get out of pain and discomfort that I started to see the light at the end of the tunnel.

It took me 6.5 long years to finally get someone to listen to me and let me know that my symptoms are real and actually very much treatable.

I remember breaking down and crying at how happy I was.

This was now the beginning of a great journey and all my efforts up until this point have not been wasted. So many men have been through hell and back and have lost hope.

There are so many reasons as to why you haven’t gotten relief yet. In many cases I see clients that haven’t been pointed in the right direction for care. Sometimes it’s a urologist, gastroenterologist, colorectal specialist or even a PCP that didn’t know how to screen for pelvic pain. Other times it’s another pelvic floor therapist that didn’t know how to properly treat the cause of the symptoms. Whatever it is, know that it takes time to get help for a diagnosis with little to no research. Only now are we starting to see leading practitioners research this issue.

So don’t lose hope, remind yourself that you are doing everything in your power to get better and there is absolutely nothing you can do beyond that. Control the factors in your life that you can control.  Getting rid of pelvic pain is multifactorial, look at the whole picture.

  • Check your sleep cycle;
  • Water intake
  • Stress level
  • Activity level
  • Check your diet and vices

My only MISSION is to pay it forward.

Be that SOMEONE who listens. That SOMEONE who pays attention to your pain. And we are making it possible by creating a judgment-free community of MEN that support MEN, aiming to be free from pain and live their best life.

Feel free to join our EXCLUSIVE GROUP here CHRONIC PROSTATITIS, PELVIC PAIN & ALL THINGS MEN.

If you need someone to talk to, I am here to listen. I am here to tell you that it will GET BETTER.

I am also providing 15-minutes teleconsultation for FREE.

You can also hear my full story on how I overcome PELVIC FLOOR DISORDER here.

Weak Pelvic Floor: Do You Know The Signs?

signs of weak pelvic floor

WEAK PELVIC FLOOR is synonymous with a TIGHT PELVIC FLOOR. These words are common terms in the world of pelvic health but are usually misunderstood. To give everyone clarity, a weakened pelvic floor is a state of the pelvic floor muscles where your pelvic organs lack the support it needs to function normally. That may stop you from being able to control urine, feces, or gas. 

Symptoms of a WEAK/TIGHT PELVIC FLOOR MUSCLES

  • Leaking urine or flow of urine when coughing or sneezing
  • Passing wind/gas when bending or lifting
  • Reduced sensation in the sexual organ
  • Unable to control bowel movements or passing the stool
  • Pain in the tailbone (coccyx pain)
  • Sudden urge to pee (urinary urgency)
  • Unable to poop (constipation)
  • Painful sex (dyspareunia)

WHAT ARE THE COMMON CAUSES OF WEAK PELVIC FLOOR IN MEN?

Men’s pelvic floor can be weakened by:

  • Obesity (as defined by the World Health Organization, obesity is the abnormal or excessive fat accumulation that presents a risk to health.)
  • Type-A Personality ( People with Type A personalities are often high-achieving “workaholics” )
  • Chronic constipation (Constipation that lasts for several months)
  • Post-Op Prostate Recovery (People who underwent prostatectomy which is a surgery that removes part or all of the prostate gland)
  • Straining to urinate or defecate (An intense exertion to pass the urine or stool)
  • Minimal Ejaculation (Ejaculating little to no semen)

WHAT ARE THE COMPLICATIONS OF WEAK PELVIC FLOOR?

Have you tried riding a roller coaster and felt like your internal organs are shuffled? And it felt like there is a strong gravitational force pulling you down there? It may be a little exaggerated, but one of the major complications of a weak pelvic floor is PROLAPSE. Prolapse is the bulging or dropping of your rectum or bladder. It is more common in females but may occur in men as well.

Symptoms of PROLAPSE:

  • Pressure in the pelvic region
  • A feeling that something is falling out
  • Protrusion of the rectum or anus
  • Trapped stool or difficult bowel movements
  • Urine leakage and difficulty in urinating
  • Lower back pain

HOW TO REDUCE SYMPTOMS OF PELVIC FLOOR WEAKNESS?

If your pelvic floor muscles are weak, there are lifestyle changes and pelvic floor muscle training that can reduce the symptoms of pelvic floor weakness. It may include the following:

  • Pelvic Floor Physical Therapy –  Pelvic floor exercise (especially integrated with a strong core) can help with the symptoms of a weak or tightened pelvic floor. Your pelvic floor therapist can help strengthen the muscles of your pelvic floor and core. 
  • High-fiber diet
  • Water intake
  • Weight loss
  • Exercise/Movement
  • Yoga

WHERE TO GET HELP?

Having a weakened pelvic floor is not a medical emergency, but it is EMBARRASSING and UNCOMFORTABLE. Pelvis NYC is on a mission to help men get proper treatment and proper care. If any of the above signs and symptoms are bothering you, please consult your specialist. Or you can book a 15-minute teleconsultation totally FREE OF CHARGE. We are here to listen. We are here to help.

Other Related Blog:

PELVIC PAIN IN MEN: KNOW HOW CAN PELVIC FLOOR THERAPY SET YOU FREE

Pelvic Floor Specialist NYC: Know How Pelvic Floor Physical Therapy Can Set You Free

man free from chronic pelvic pain

Are you a prisoner of pelvic pain? Are you experiencing chronic pelvic pain for the past 6 months? Do you feel hopeless and frustrated over unlimited doctor visits? And no progress on the prognosis? Or worse, no clear diagnosis? Have you ever thought that you may feel this pain for the rest of your life? If your answer is YES, on any of the queries above, you came to the right place. Here we will explain how PELVIC FLOOR THERAPY can help you move well, feel better, and live your best life.

Here are the few testimonials from our clients who have been pain-free from pelvic pain and living their best life.

“Low back pain encompassed my life and now not only am I pain-free, but I have the tools to get out of the pain in the future.” – Amelia H

“I was diagnosed with Chronic Prostatitis, Hard Flaccid, Interstitial Cystitis, and overactive bladder. I am now symptom-free for about 2 months and am living a life without pain.” – Kevin Miller

“He is a healer in every sense of the word. I owe him my life. I have no pain anymore.” – Katie M

 

PELVIC PAIN IN MEN

WHAT CAUSES PELVIC PAIN IN MEN?

Male pelvic pain – is a discomfort or localized pain to the pelvis, groin, or genital area. There are a lot of other symptoms that can accompany pelvic pain including burning sensation when you pee, urinary frequency (the urge to urinate multiple times a day), urinary urgency (the urge to urinate immediately), painful urination, painful sex, and constipation. There are many possible causes of pelvic pain, such as infection or neoplasm but the most common cause of pelvic pain in men are the following conditions:

URINARY TRACT INFECTION (UTI) – is a type of infection that happens when pathogenic bacteria enters the urethra or urinary tract causing a burning or painful sensation when you urinate.

CYSTITIS – is an infection of the lower urinary tract or the urinary bladder.

PROSTATITIS – is an inflammation of the prostate or the areas around the prostate that may be bacterial or non-bacteria. Scientists have identified four types of prostatitis:

  • Chronic Prostatitis Or Chronic Pelvic Pain Syndrome (CP/CPPS)
  • Acute Bacterial Prostatitis
  • Chronic Bacterial Prostatitis
  • Asymptomatic Inflammatory Prostatitis

BENIGN PROSTATIC HYPERPLASIA – a benign or nan-cancerous enlargement of the prostate that can cause bladder problems.

PUDENDAL NEURALGIA – a condition that happens when a nerve in your lower body is damaged or irritated that causes pain, numbness and discomfort.

Other conditions that may cause pelvic pain in men could be a hernia, Irritable Bowel Syndrome (IBS), Sexually Transmitted Infection (STI), kidney stones, or post-vasectomy. These are a few of the most common causes of pelvic pain in men and these should be properly diagnosed to be properly treated. And in most cases, these conditions need to be ruled out to identify if it is a PELVIC FLOOR DYSFUNCTION.

In the absence of bacteria and an enlarged prostate, pelvic pain in men is most likely due to a musculoskeletal origin. We can say that posture, connective tissue, and trigger points cause pelvic pain. But the truth is, there is no one answer to what causes pelvic pain. We must look at the entire individual. What are their daily habits like? What are their triggers? How much movement do they incorporate in their day? What is their diet like? Are they constipated? All of the information is gathered and only then can a doctor make an educated decision on what is going on.

HOW TO PROPERLY DIAGNOSE PELVIC PAIN IN MEN?

PELVIC PAIN is an umbrella term used to diagnose a host of symptoms that cause discomfort and pain pertaining to your abdomen and pelvic contents. It is said that 1 in 6 men will experience pelvic pain in their lifetime. The two most mentioned diagnoses are Chronic Pelvic Pain Syndrome (CPPS) & Chronic Prostatitis (CP). Both these diagnoses can have the same symptoms of shooting pain/numbness, erectile dysfunction, premature ejaculation, hard flaccid, constipation, urinary hesitancy/burning/frequency, erectile pain, post-ejaculate pain and the list goes on. That is why sometimes these two can be used interchangeably and at times can really confuse your specialist.

If your pelvic pain won’t go away, it is always a must to see your doctor or specialist and they will perform the following to diagnose the cause of your pelvic pain:

  • Medical History – This includes the patient’s past surgical history, family medical history, social history, allergies, and medications
  • Diagnostic Tests – urinalysis (analysis or test of the urine)  is one of the most common diagnostic tests to rule out or identify the presence of any infection
  • Diagnostic Imaging – cystoscopy or ultrasound can help your specialist visualize your pelvic organs
  • Physical Exam – your healthcare provider may also do a physical exam using their hands to check for spasms, knots, and muscle weakness

The most common urological diagnosis of men under the age of 50 is CPPS/CP. Generally urological tests such as urine & semen cultures, cystoscopies, urine flow tests, bladder ultrasounds come back negative for bacteria, yet you are still feeling pain & discomfort. Once you are medically cleared and have gone through these tests by your urologist, you should be seen by a Male Pelvic Pain Physiotherapist so that they can properly diagnose you.

There is no one-size fits all to treating pelvic pain and it is important to take an individualistic approach to treatment. If you are feeling any of the above symptoms, PLEASE DO NOT TRY AND DIAGNOSE YOURSELF. Understand that HELP DOES EXIST and that at the end of the day we just have to find out what message your body is trying to send you. To say that pelvic pain is caused by one thing is just not true. Pelvic pain is multi-faceted and no one “cure” will get it better.

WHEN SHOULD YOU WORRY ABOUT PELVIC PAIN?

If you stumbled on this article and you are searching for ways to relieve your pain and the pain you are experiencing lasts longer than you think, this is one of the indication that you should seek help from a specialist.

Pain is a general term that means an uncomfortable sensation, a physical suffering or a discomfort caused by illness or injury. Your clinician will assess your pain based on the following:

  • How it feels like?
  • How often you experience the pain?
  • Where do you feel the pelvic pain?
  • In a scale of 0-10, how much does it hurt?
  • How it is triggered?

Everyone will have their own pain tolerance but regardless of the onset and severity of your pelvic pain, it is always advisable to seek medical advice. They’ll be able to investigate the cause and prescribe treatments required for your condition.

PELVIC FLOOR THERAPY FOR MEN

CAN PELVIC FLOOR DYSFUNCTION GO AWAY ON ITS OWN?

Pelvic floor disorders are very common in American men. If you are diagnosed with pelvic floor dysfunction it may not go away on its own, but fortunately, with pelvic floor therapy and prescribed treatment, it can be reversed. There is nothing to lose if you will not engage in pelvic floor therapy… but sure it will consume your time, energy and the quality of life you deserve.

HOW DOES PELVIC FLOOR THERAPY TREAT PELVIC PAIN?

Physical therapists are experts not only in treating pain, but also identifies the trigger causing muscle tension and dysfunction. Some of the common causes of pelvic floor dysfunctions are stress, lack of activity, accidental injury or infections. Pelvic floor therapist will prescribe certain exercises to ease pain and help you move better. Manual release of your pelvic floor muscles will help relieve the tension and pelvic floor tightness. Lifestyle changes including your diet, the way you move and your daily activities may also be modified to address the cause of pelvic pain.

In a pelvic floor therapy session, you may do a mix of:

  • Strengthening exercises – such as Kegels to improve the way you relax and contract your pelvic floor muscles
  • Biofeedback – a non-surgical way to monitor your pelvic floor muscles while you relax or contract them
  • Relaxation techniques – your pelvic floor therapist may prescribe exercises to relax your muscles

WHAT DOES PELVIC PAIN TREATMENT LOOK LIKE?

Depending on the severity and aggravation of symptoms treatment can vary from twice a week, weekly and bi-weekly. During treatment a full evaluation of subjective & objective history will take place. I always tell my clients, there is absolutely NOTHING you can’t tell me. If you want to tell me how far you used to ejaculate compared to now, that is fine and actually very helpful for me creating a treatment plan. Treatment for pelvic pain consists of trigger point release, soft-tissue mobilization, education and movement. Both therapist and client should have active roles throughout the plan of care.

HOW WILL I KNOW IF PELVIC FLOOR THERAPY IS RIGHT FOR ME?

If you have chronic pelvic pain, if your doctor keeps requesting for urine culture or urinalysis and keeps giving you antibiotics and telling you that you may have a urinary tract infection or prostatitis—if you keep going back, and you keep getting the same answer without any pain relief—and if you are at the edge of a cliff and still trying to google about your symptoms and its telling you that the excruciating pain you are experiencing could be the big C or cancer – then it’s worth consulting a pelvic floor physical therapist. Save yourself from all the anxiety of over diagnosis and save yourself from the despair of suffering needlessly for the rest of your life. Consult a PELVIC FLOOR THERAPIST now!

PELVIC PAIN MANAGEMENT AT PELVIS.NYC

I usually tell my clients that pelvic pain treatment is like 2 steps forward and 1 step back. You will have times where you are getting better and others where you might feel you are regressing. But at the end of the day, it is still 1 net step forward. You are the only person that will know if they are getting better.  To help you better make that decision, at Pelvis NYC we discuss all goals and desired outcomes so all expectations are set at the beginning of the plan of care.

WHO ARE THE EXPERTS IN PELVIC FLOOR THERAPY?

If you are experiencing pain that won’t go away, call us for a telehealth advice or book an appointment with our pelvic floor therapist.