What causes pelvic floor sensitivity in men and how is it treated?

Causes and Treatment of Pelvic Floor Sensitivity in Men

Pelvic floor physical therapy is the first-line treatment for men with pelvic floor sensitivity, which can manifest as pain, urinary symptoms, and sexual dysfunction. 1, 2

Causes of Pelvic Floor Sensitivity in Men

Primary Causes

• Pelvic floor muscle hypertonicity/spasm
  • Non-relaxing pelvic floor or hypertonicity 3
  • Abdominophrenic dyssynergia (improper coordination between abdominal and diaphragmatic muscles) 4

Secondary Causes

• Medical conditions

  • Prostatitis/chronic pelvic pain syndrome 1
  • Lichen sclerosus (can cause meatal stenosis and penile dysesthesia) 4
  • Fecal incontinence with pelvic floor dysfunction 4
  • Post-surgical complications (particularly after prostate cancer treatment) 4

• Functional disorders

  • Voiding dysfunction 3
  • Defecatory disorders 4
  • Sexual dysfunction (erectile dysfunction, ejaculatory disorders) 1, 2

Diagnostic Approach

Clinical Assessment

• Evaluate for urinary symptoms (stream issues, frequency, urgency, nocturia) 4
• Assess for sexual dysfunction (erectile function, ejaculatory issues) 4, 1
• Screen for defecatory dysfunction and fecal incontinence 4
• Evaluate for pain patterns and triggers 5

Specialized Testing (when indicated)

• Pelvic floor assessment
  • Anorectal manometry to identify anal weakness or altered rectal sensation 4
  • Pelvic floor MRI or ultrasound for global assessment of pelvic compartments 4
  • Urodynamic studies for suspected bladder outlet obstruction 4

Treatment Algorithm

1. First-Line Treatments

• Pelvic floor physical therapy

  • Manual therapy techniques to normalize muscle tone 2
  • Pelvic floor muscle training with biofeedback 6
  • Diaphragmatic breathing exercises 4

• Behavioral modifications

  • Scheduled toileting and bowel training program 4
  • Lifestyle changes (hydration, dietary modifications) 4

2. Second-Line Treatments

• Pharmacological interventions

  • Alpha-blockers (e.g., tamsulosin) for slow urinary stream 4
  • Anticholinergic medications (e.g., oxybutynin) for urinary frequency/urgency 4
  • Topical lidocaine for persistent pain 7, 4

• Psychological approaches

  • Cognitive behavioral therapy 4, 7
  • Brain-gut behavioral therapy for associated bowel symptoms 4

3. Advanced Interventions (for refractory cases)

• Specialized procedures

  • Trigger point injections for persistent pain 3
  • Botulinum toxin A injections for severe muscle spasm 3
  • Sacral neuromodulation for persistent symptoms 3

• Surgical options (rarely needed)

  • Only considered after failure of conservative measures
  • Referral to urologist for evaluation of anatomical issues 4

Special Considerations

Sexual Dysfunction

• For erectile dysfunction
  • Pelvic floor exercises have shown significant improvement in erectile function 6
  • Consider PDE5 inhibitors (sildenafil, vardenafil, tadalafil) in conjunction with pelvic floor therapy 4
  • For non-responders, consider vacuum erectile devices or other interventions 4

Urinary Symptoms

• For incontinence
  • Pelvic floor rehabilitation with Kegel exercises 4
  • Timed voiding techniques 4
  • For persistent leakage, referral to urologist for consideration of surgical options 4

Common Pitfalls to Avoid

1. Overlooking psychological factors - Anxiety often accompanies and exacerbates pelvic floor dysfunction 5
2. Financial barriers to treatment - Insurance coverage for pelvic floor physical therapy is often limited 5
3. Inadequate patient education - Many patients don't understand the rationale for physical therapy 5
4. Focusing only on one symptom - Pelvic floor dysfunction often affects multiple systems simultaneously 4
5. Overtraining pelvic floor muscles - In cases of hypertonicity, strengthening exercises may worsen symptoms 2

Monitoring and Follow-up

• Regular reassessment of symptoms using validated tools (e.g., Sexual Health Inventory for Men) 4
• Adjustment of treatment plan based on response
• Long-term maintenance exercises after symptom improvement

By addressing the underlying pelvic floor dysfunction through a structured approach beginning with physical therapy, most men can experience significant improvement in pelvic floor sensitivity and associated symptoms.