Causes of Male Pelvic Pain and Treatment Options

For men, pelvic pain—that which is centered around the lower abdomen or buttocks—can be a sign of several different conditions. Pelvic pain may begin suddenly, as with a kidney stone or a pulled muscle, or it can come on gradually, as with prostatitis or a urinary tract infection (UTI). Other possible causes include, but are not limited to, an inguinal hernia, prostatitis, a bladder infection, digestive problems.

Male pelvic pain can have other varying characteristics depending on the cause and its severity. Pain may be very localized or spread throughout a large area. Some may describe the pain as dull or sharp, feeling more like pressure, constant or circumstantial, or having other qualities.

If you are experiencing pelvic pain, its important that you see your doctor promptly. While the cause may not be serious, there are other cases when pain can rapidly worsen and even cause long-term complications (such as infertility) without appropriate treatment.

Some causes of pelvic pain only affect men, while others can affect both sexes.

Prostatitis is inflammation of the prostate gland. An infection can cause acute cases. Chronic prostatitis, on the other hand, is usually caused by inflammation, often without an infection.

In addition to pelvic pain, prostatitis may cause urinary problems or problems with ejaculation.

The prostate can enlarge due to benign prostate hyperplasia (BPH), prostate cancer, or prostatitis. A large prostate can cause pelvic pain, bladder issues, or it might not cause any symptoms at all.

A number of different hernia types affect men, such as inguinal hernia, femoral hernia, umbilical hernia, and hiatal hernia.

An inguinal hernia is a protrusion of the intestines into the inguinal canal, which is a "tunnel" where the testes descend, and it only affects men.

This pain syndrome may be associated with prostatitis or BPH, but the pain can last longer than expected with these conditions. It can even occur without an identifiable cause.

Male chronic pelvic pain syndrome is a diagnosis of exclusion, meaning that your doctor will attempt to identify other causes of pelvic pain before concluding that your symptoms are attributable to this pain syndrome.

Testicular torsion can cause severe pelvic pain. While uncommon, it is a medical emergency. Surgical treatment is necessary, and a delay could cause loss of the affected testicle.

Pelvic pain can also be caused by health issues that affect both men and women, including:

• Muscle strain
• Gastrointestinal problems, such as irritable bowel syndrome (IBS)
• Sexually transmitted infections (STIs)
• Urinary tract infections (UTIs)
• Appendicitis
• Kidney stones
• Cancer in the pelvis or the pelvic bones

If you have a chronic condition, such as IBS or recurrent constipation, pelvic pain can recur when your condition acts up. In this type of situation, your doctor may have already prescribed medication for you to use whenever this happens.

But if you develop new pelvic pain, you should see a doctor.

Associated issues that signal that your pelvic pain could be caused by a serious issue include:

• Fever
• Frequent urination, particularly at night (nocturia)
• An urgent need to urinate
• Pain or burning sensation when urinating (dysuria)
• A bulge of the pelvis, groin, testicles, or lower abdomen
• A rash or discharge
• Difficulty urinating, such as dribbling or urinary hesitation
• Abdominal pain or tenderness
• Difficulty having a bowel movement
• Blood in the stool (can appear bright red or dark and tarry)

Your medical evaluation will include a history and physical examination. You may also need a blood test, urinalysis (U/A), and/or imaging.

During your medical history, your doctor will ask about the severity of your pain, if you have had this type of pain in the past, whether it is constant or comes and goes, whether anything makes it better or worse, and if you have any associated symptoms.

As part of your physical examination, your doctor will look at and around the area where you have pain. Your physical examination will include palpation (touching and gentle pressure) in the area of your pain. A hernia can usually be identified on a physical examination.

Depending on your symptoms, you might also have a prostate examination, which involves a digital rectal examination (DRE).

If there is a concern that you could have a bladder infection or inflammation of the bladder, your doctor may order a U/A to evaluate your urine for evidence of infection (bacteria and/or white blood cells) or a tumor (abnormal bladder cells or red blood cells).

You might also need to have a blood test to see if there are signs of an infection, especially if there is concern about appendicitis. A blood test can also be used to detect prostate-specific antigen (PSA), which may indicate prostate cancer. However, the results of a PSA test do not necessarily rule prostate cancer in or out.

Imaging tests can include pelvic and/or abdominal X-ray, computerized tomography (CT), ultrasound, or magnetic resonance imaging (MRI). These tests may detect signs of appendicitis, pelvic infection, kidney stones, tumors, gastrointestinal disease, an enlarged prostate, or testicular torsion.

Your treatment depends on the cause of your pelvic pain. You might need pain control as well as management of your underlying medical issue.

Each cause of pelvic pain requires its own approach. For example, antibiotics are needed if you have a bacterial infection. Kidney stones may be treated by drinking lots of fluids, or with lithotripsy or surgical removal if necessary. And tumors may require surgery, chemotherapy, or radiation.

Physical therapy has been used to manage different causes of male pelvic pain, including chronic pelvic pain syndrome and pelvic pain after a prostatectomy.

Common treatments used for managing pelvic pain include:

• Short-acting pain medications, such as acetaminophen or non-steroidal anti-inflammatories (NSAIDs)
• Antidepressants that are used off- label for pain management, such as selective serotonin reuptake inhibitors (SSRIs)
• Treatment of prostate hypertrophy, such as Flomax (tamsulosin), an alpha-adrenergic blocker
• Oral muscle relaxants or Botulinum toxin A injections for treatment of bladder muscle spasticity

Other treatments used in the management of chronic pelvic pain syndrome include acupuncture, prostatic massage, and impulse wave therapy.

Sometimes it is not possible to avoid pelvic pain, but there are some approaches that can help reduce your chances of developing it.

• Practice safe sex: Because STIs are among the causes of male pelvic pain, protecting yourself can prevent pain and other symptoms. Barrier protection is the most effective way to avoid becoming infected.
• Manage digestive issues: Constipation and intestinal irritability can contribute to pelvic pain. If you are prone to digestive problems, follow your doctor's instructions regarding medication and/or diet.
• Drink adequate fluids: Dehydration can increase the risk of kidney stones and bladder infections. Both conditions can often be prevented by drinking enough water, and getting enough fluids can even help in recovery if you have been diagnosed with either condition.
• Get recommended health screenings: Be sure to have your recommended screenings for colon cancer and prostate cancer. These serious diseases can cause pelvic pain and may be life-threatening, but the sooner they are identified, the better your chance of a cure.

Male pelvic pain can limit your activity and be a sign of an underlying medical condition that needs to be treated. It is not always easy to distinguish pelvic pain from groin pain (between your lower abdomen and upper thigh) or rectal pain. If you experience pain in these areas, it is important that you don't ignore it or attempt to manage it on your own.