Pelvic Pain in Men

Pelvic pain in men 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, or digestive problems.

If you are man experiencing pelvic pain, it's important that you see your healthcare provider 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.

This article looks at some of the most common causes of pelvic pain in men. It also discusses how pelvic pain is diagnosed and treated, and when you should see a healthcare provider.

Causes of Male Pelvic Pain

Pelvic pain affects the lower abdomen or buttocks. Some causes of pelvic pain only affect people with male genitourinary organs and anatomy, while others can affect any person.

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

Prostatitis

Prostatitis is inflammation of the prostate gland. An infection can cause sudden, or 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.

Prostatic Hyperplasia (Enlargement)

The prostate can enlarge due to:

• Benign prostate hyperplasia (BPH)
• Prostate cancer
• Prostatitis

A large prostate can cause pelvic pain, bladder issues, or it might not cause any symptoms at all.

Hernia

A hernia occurs when a body part pushes through the muscle or tissue that normally keeps it in its place. A number of different hernia types affect people with male anatomy, such as:

• Inguinal hernia (protrusion into the inguinal canal, a tunnel where the testes descend)
• Femoral hernia (protrusion through the groin)
• Umbilical hernia (protrusion near your bellybutton)
• Hiatal hernia (protrusion through your diaphragm, the muscle between your abdomen and chest)

Male Chronic Pelvic Pain Syndrome

Male chronic pelvic 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.

This is a diagnosis of exclusion, meaning that your healthcare provider will attempt to identify other causes of your symptoms before concluding that they are attributable to male chronic pelvic pain syndrome.

Testicular Torsion

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.

Other Causes of Pelvic Pain in Men

Pelvic pain can also be caused by health issues that affect people of any sex, 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

When to See a Healthcare Provider

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 healthcare provider may have already prescribed medication for you to use whenever this happens.

But if you develop new or worsening pelvic pain, you should see a healthcare provider. 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)

Diagnosing Pelvic Pain

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

Intake and Exam

During your medical history, your healthcare provider will ask for details about your pain, including:

• The severity and exact location(s) of your pain
• If you have had this type of pain in the past
• If the pain is constant or comes and goes
• Whether anything makes it better or worse
• If you have any associated symptoms

As part of your physical examination, your healthcare provider will look at and around the area(s) 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).

Labs and Tests

If there is a concern that you could have a bladder infection or inflammation of the bladder, your healthcare provider may order a urinalysis to evaluate your urine for evidence of infection or a tumor.

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

Imaging tests can include:

• Pelvic and/or abdominal X-ray
• Computerized tomography (CT)
• Ultrasound
• Magnetic resonance imaging (MRI)

These tests may detect signs of:

• Appendicitis
• Pelvic infection
• Kidney stones
• Tumors
• Gastrointestinal disease
• Enlarged prostate
• Testicular torsion

How Pelvic Pain in Men Is Treated

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. 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 used off- label for pain management, such as selective serotonin reuptake inhibitors (SSRIs)
• Treatment of prostate hypertrophy, such as with Flomax (tamsulosin), an alpha-adrenergic blocker
• Oral muscle relaxants or Botulinum toxin A (Botox) 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.

Prevention

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 healthcare provider's instructions regarding medication and/or diet.
• Drink adequate fluids. Dehydration can increase the risk of kidney stones and infections of the urinary tract and bladder. 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.

Summary

Male pelvic pain can have many possible causes. Some common causes of pelvic pain in men include prostatitis, enlarged prostate, and hernias. Less common causes include testicular torsion and certain kinds of cancer.

See a healthcare provider any time you have new pelvic pain. Lab tests and imaging tests can help your healthcare provider confirm a diagnosis.