Finding a Physical Therapist for Chronic Prostatitis/Chronic Pelvic Pain (CPPS)

Community Member

Some time ago there was a post entitled "Why Choose a Women's Health Physical Therapist?"

There were many reasons listed for this and I agreed with most or all of them.

However men with pelvic floor dysfunction (or in my case, pelvic/voiding pain), have difficulty finding a physical therapist (PT) that's even willing to try, much less have some success.

Many men suffer from Chronic Prostatitis/Chronic Pelvic Pain (CPPS).   It can come in various forms, and often times no cause can be found. It has been estimated that as many as 10 percent of men have experienced, or will experience, some form of CP/CPPS.

CP/CPPS is usually defined as chronic pain in the male pelvic region that has lasted at least three months. The pain is usually accompanied by difficulties with voiding and sexual activity, usually painful ejaculation ("e-pain"). There are three recognized classifications:

  • Type I: Acute bacterial prostatitis
  • Type II: Chronic bacterial prostatitis
  • Type III: Chronic non-bacterial prostatitis

Types I and II are usually treatable with antibiotics, but sometimes for the long term. However, Type III is very difficult to diagnose and treat.

CPPS obviously can cause bladder issues leading to incontinence, which is why I am discussing it here.

In my case (now diagnosed as CPPS type III), the cause was due to prostate surgery for infection with left me with severe bladder spasms and voiding pain.

Men have a difficult time getting treatment for pelvic pain, due partly to the following:

  • The "embarrassment factor." As with women, most men don't like having this region of their body probed and tested.
  • Most will attempt to initially see an urologist, but many urologists are not trained to deal with the problem. After an initial office visit, some may, at most prescribe medication to alleviate the symptoms. If the symptoms don't respond, the urologist will probably assume "it's in the patient's head" and not attempt any more treatment.
  • The tests involved in determining if the patient has prostatitis and not CPPS can be very painful.

I had a very difficult time getting help with this issue. The only PTs I could find with expertise in this area and that were willing to try were women that are experience with female pelvic issues. While most of their experience is with women, they have been somewhat successful in treating men with pelvic pain.

I won't go into the details of what they did, but it did involve trying to stretch my internal muscles that support my pelvic floor and prostate. Most of the time the therapy was pretty uncomfortable. At one point one therapist was working "internally" while her partner was working externally. Unfortunately, while I did get some temporary relief, it did not last, and so there was no point in continuing therapy. Even working internally, they just could not reach the muscles that probably needed stretching and treatment.

As Ms. Mulligan can probably attest, this therapy can be very difficult for the therapist, not just the embarrassment factor, but it takes a lot of physical strength and endurance. Many times the therapist would have to stop and give her hands a rest. I saw two different PTs, and only one could work internally. The other PT I saw could not work internally; her hands just would not tolerate it.

There are other treatments CPPS, some of which may hold some promise. I have not given up on my quest to alleviate my voiding and e-pain, and with luck I may find either a doctor or PT that can help