Taking Control of Pelvic Pain: How Physiotherapy Can Help Men with Prostatitis/CPPS

It’s a topic that many men find difficult to discuss, but if you’re experiencing persistent pelvic pain, know that you are far from alone. Conditions like non-bacterial prostatitis and Chronic Pelvic Pain Syndrome (CPPS) are surprisingly common, and they can be a frustrating and often painful ordeal. My goal today is to shed some light on what’s happening in your body and, most importantly, to show you that there is a clear, effective path forward with physiotherapy.

Many men I see in the clinic have been down a long road of tests and treatments with little to no relief, often leaving them feeling disheartened. The missing piece of the puzzle for many is understanding that prostatitis and CPPS are often not an issue with the prostate gland itself, but rather a problem with the muscles and nerves surrounding it – the pelvic floor.

Understanding the "Why": It’s Often About an Overly Tight Pelvic Floor

Think of your pelvic floor as a muscular hammock stretching from your tailbone to your pubic bone. These muscles support your bladder and bowel, and they play a crucial role in sexual function. Just like any other muscle in your body, they can become overworked, tight, and painful.

When we are stressed, injured, or have been in pain for a while, these pelvic floor muscles can go into a state of constant high alert, a bit like a clenched fist that just won’t relax. In the world of physiotherapy, we call this a "hypertonic" pelvic floor. This constant tension can lead to a whole host of symptoms that you might be all too familiar with:

• Pain in the perineum (the area between your scrotum and back passage), testicles, penis, or lower abdomen.

• A feeling of needing to urinate frequently or urgently.

• Pain during or after ejaculation.

• Lower back pain that doesn’t seem to have another cause.

The key takeaway here is that the pain is very real, but its source is often muscular and nerve-related, not necessarily a problem with the prostate gland itself. This is fantastic news because it means there are tangible, physical steps you can take to find relief.

Your Physiotherapy Toolkit: The Best Exercises for Relief

In physiotherapy, our first goal is not to strengthen, but to release and relax. It's about teaching that "clenched fist" how to open up. Here are some of the most effective exercises we use in the clinic. Remember to approach these gently; the goal is relaxation, not strain.

1. Diaphragmatic Breathing (Belly Breathing)

This is the cornerstone of pelvic floor physiotherapy. When you breathe deeply into your belly, your diaphragm (your main breathing muscle) descends, which in turn gently lowers and relaxes your pelvic floor. It’s a powerful tool for calming your entire nervous system.

• How to do it: Lie on your back with your knees bent and feet flat on the floor. Place one hand on your chest and the other on your belly.

• The Action: Breathe in slowly and deeply through your nose. Feel the hand on your belly rise, while the hand on your chest stays relatively still.

• The Release: Breathe out slowly through your mouth, letting your belly gently fall. As you exhale, imagine your pelvic floor muscles softening and melting away.

• The Routine: Practice this for 5 minutes, once or twice a day. It’s especially helpful before sleep or during a flare-up of your symptoms.

2. Pelvic Floor Drops (or "Reverse Kegels")

You’ve likely heard of Kegels, which involve tightening the pelvic floor. For CPPS, we do the opposite. We want to consciously lengthen and relax those tight muscles.

• How to do it: Get into a comfortable position, either lying down or sitting.

• The Action: Take a gentle diaphragmatic breath in. As you breathe out, imagine the area between your sitting bones widening. Gently bulge or bear down, as if you were trying to pass wind. You should feel a subtle lowering or dropping of the pelvic floor.

• The Key: The movement is very subtle. It is a gentle release, not a forceful push. Link this movement with your out-breath.

• The Routine: Repeat this for 10-15 repetitions, focusing on the feeling of letting go.

3. Child’s Pose Stretch

This is a wonderful, gentle stretch for your lower back and the pelvic floor muscles.

• How to do it: Start on your hands and knees.

• The Action: Sit your hips back towards your heels, allowing your knees to go wide. You can rest your forehead on the floor or on a cushion.

• The Feeling: You should feel a gentle stretch in your lower back and around your hips and groin. Breathe deeply into your belly and with each exhalation, try to sink deeper into the stretch, releasing any tension.

• The Routine: Hold this position for 30-60 seconds, focusing on your breathing.

4. Happy Baby Pose

This pose helps to open up the hips and release tension in the inner thighs and pelvic floor.

• How to do it: Lie on your back.

• The Action: Bend your knees towards your chest and grab the outsides of your feet (or your ankles if that’s more comfortable). Gently pull your knees down towards your armpits, keeping your lower back on the floor.

• The Feeling: You should feel a good stretch along your inner thighs and groin. You can gently rock from side to side if it feels good.

• The Routine: Hold for 30 seconds, breathing deeply throughout.

A Final Reassuring Word

Living with prostatitis or CPPS can be a challenging journey, but it is one you do not have to walk alone. The pain and frustration you are feeling are valid, but they do not have to be your new normal. By understanding the true cause of your symptoms and working with a men’s health physiotherapist, you can learn to release the tension, calm your nervous system, and take back control of your body.

If any of this resonates with you, I encourage you to reach out to a qualified men's health physiotherapist. We are here to listen, to educate, and to guide you on the path to recovery.