What Can Cause Pelvic Pain in Men?

What is pelvic pain?

Causes of pelvic pain in men include bicycle riding, past prostatitis infections, chemical irritation, sexual abuse, pelvic floor muscle problems, prostate irritation from urine backup, bacteria that are not common, and psychological stress.

There are a few different forms of male pelvic pain. Prostatitis (prostate inflammation), chronic pelvic pain syndrome (CPPS), and pain from problems in your internal organs or bones are the most common causes. Of the three likely reasons, prostatitis is the most common source of pelvic pain in men under the age of 50, while CPPS accounts for 90% of the pelvic pain in outpatient cases.

Since there are many causes of pelvic pain in men, it helps to understand what can cause it and what the treatments are for the conditions so you can get help if you experience pain in your pelvic region.

Symptoms of pelvic pain

Pelvic pain, as the name implies, is a pain in the pelvic region. If you're experiencing pain there, it might be accompanied by other symptoms. These symptoms can include:

Difficult, painful, or frequent urination
Pain in the bladder, groin, and anus areas
Pain in the abdominal area
Pain during ejaculation
Problems obtaining an erection
Chills, fever, body aches, and fatigue
Pain in the lower back area
No symptoms (with type IV)
Blood in semen
Blood in urine

Types of pelvic pain

There are four types of chronic pelvic pain syndrome accepted by medical professionals. These four are:

Chronic pelvic pain syndrome I – Acute bacterial prostatitis
Chronic pelvic pain syndrome II – Chronic bacterial prostatitis
Chronic pelvic pain syndrome III – Non-bacterial prostatitis
Chronic pelvic pain syndrome IV – inflamed cells in urine or prostate secretions without any other symptoms

Acute bacterial prostatitis is an infection of your prostate gland accompanied by chills, fever, and pain in the lower back and groin. You might also feel fatigued and have problems urinating or with sexual activity. The second syndrome is chronic bacterial prostatitis, which is a recurring infection of the prostate. It usually has the same symptoms as acute bacterial prostatitis, but they are less intense.

If you have non-bacterial prostatitis, you won't have any of the symptoms associated with a bacterial form, such as a fever or chills. Instead, you might feel an urgency to urinate, which might be painful or burn, and experience lower back and groin pain. You may also have painful ejaculations or experience difficulties getting an erection.

Asymptomatic inflammatory prostatitis is inflammation of the prostate that doesn't have any symptoms. It is usually found when your doctor is running tests for other medical conditions.

Pain in the pelvic region can also result from many other types of conditions, such as:

Urinary tract infections
Intestinal problems
Lower abdominal hernia
Bone problems

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Causes of pelvic pain

Bacteria is commonly the cause of acute bacterial prostatitis. The non-bacterial condition causes are generally unknown but are attributed to multiple events that can cause sensitivity in the nervous system around the pelvic region. Some conditions that might contribute to the sensitivity of the pelvic area are:

Bicycle riding
Past prostatitis infections
Chemical irritation
Sexual abuse
Pelvic floor muscle problems
Prostate irritation from urine backup
Bacteria that are not common
Psychological stress

Other causes of pelvic pain can be:

Pain from kidney stone movement
Infection in the urinary tract or bladder
Problems with the lower intestines, rectum, muscles, or pelvic bones

When to see the doctor for pelvic pain

It isn't normal to experience pelvic pain unless you have done something to cause it, such as falling on your hip. If you experience any of the symptoms of chronic pelvic pain, call your doctor immediately. You should go to the emergency room immediately if you experience any of the following symptoms:

Inability to urinate
Fever and chills with frequent and painful urination
Blood in urine
Intense pain in the lower abdomen

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Diagnosing pelvic pain

Your doctor will conduct a physical exam to assess any of the symptoms you describe. They will likely perform a prostate exam for inflammation through the rectum and will check your testicles and scrotum for tenderness and swelling. They will also check for any discharge from your urethra. Additionally, your doctor may want to perform some or all of the following tests:

Prostate-specific antigen test (blood test)
Urodynamic test
Cystoscopy
Abdominal ultrasound
Transrectal ultrasound with a biopsy
MRI or CT scan

Treatments for pelvic pain

Your doctor may refer you to a urologist specializing in the urinary tract and male reproductive organs for diagnosis and treatment. Bacterial prostatitis is treated with antibiotics, nonsteroidal anti-inflammatory drugs (aspirin, etc.), and muscle relaxers.

Nonbacterial prostatitis might be treated for a short time with antibiotics to rule out bacterial prostatitis. These would then be followed by muscle relaxers, NSAIDs, glycosaminoglycan, or neuromodulators to reduce pain in your pelvic region Your doctor may also prescribe warm baths, heat therapy, or physical therapy to strengthen the muscles in your pelvic region.

Psychologically, pain can create devastating effects such as depression or a sense of hopelessness. Your doctor may also refer you to a pain management team to help you cope with the psychological and physical effects of chronic pelvic pain.

If your doctor finds other causes of pain, treatment varies with the condition. Kidney stones are usually treated with muscle relaxers and pain killers until the pain subsides. If the stones are too large to pass, the doctor might prescribe shock wave therapy to break them up. Infections are treated with antibiotics, while other pain sources have to be diagnosed with labs, imaging, or other tests to determine the cause.