Chronic pelvic pain syndrome

Synonyms for chronic pelvic pain syndrome

• Chronic nonbacterial prostatitis
• SDPC
• CP/CPPS (Chronic Prostatitis/Chronic Pelvic Pain Syndrome)

What is chronic pelvic pain syndrome?

Chronic pelvic pain syndrome is persistent pain in the pelvic region in men, with no detectable infection. This condition affects urinary, bowel, and sexual functions. Despite its former name of chronic prostatitis, the prostate is not usually involved.

In 90% of cases, there is no infection or inflammation to treat. That's why antibiotics rarely work. The problem is more likely to be excessive tension in the pelvic floor muscles and a nervous system that has become overly sensitive.

Chronic pelvic pain syndrome mainly affects men between the ages of 35 and 50. It is the fourth most common urological diagnosis in men. The good news? This condition can be effectively treated with the right approach.

What are the symptoms of chronic pelvic pain syndrome?

Symptoms include pain in the perineum, pubic area, anus, or penis. Urinary problems such as urgency or frequency are common. Pain can also affect ejaculation and sexual function.

Pelvic pain

Pain is the main symptom. It can be constant or intermittent. You may feel it in several places:

• The perineum (the area between the scrotum and the anus)
• The pubic area and lower abdomen
• The anus and rectum
• The penis, especially the glans
• The testicles
• The lower back and coccyx

The pain often worsens when you sit for long periods of time. It may also increase after a bowel movement or after ejaculation.

Urinary symptoms

• Frequent need to urinate during the day and night
• Urgent need to use the restroom
• Feeling of not completely emptying the bladder
• Occasional pain or burning sensation when urinating

Sexual symptoms

• Pain during or after ejaculation
• Decreased sexual desire
• Possible erectile dysfunction

Pain during ejaculation is a clear indicator of pelvic floor muscle tension. If you experience this symptom, perineal physiotherapy can be very helpful.

What causes chronic pelvic pain syndrome?

The exact causes remain poorly understood. Pelvic floor muscle tension plays a major role. Stress, pelvic trauma, and certain lifestyle habits contribute to the development of the syndrome.

Pelvic floor muscle tension

The muscles in your pelvic floor can become overly tense. This chronic tension creates trigger points (painful muscle knots). These trigger points can refer pain to several areas of the pelvis.

It's as if your pelvic muscles are constantly contracted, even when you're resting. This excessive tension compresses the surrounding nerves and tissues. This causes pain and functional problems.

Contributing factors

Several factors can increase your risk:

Central awareness

After months of pain, your nervous system can become overly sensitive. It amplifies normal signals and interprets them as dangerous. It's like a home alarm that goes off for no reason. This central sensitization explains why pain persists even when the tissues have healed.

How is chronic pelvic pain syndrome diagnosed?

The diagnosis is based on your symptoms and a physical examination. Medical tests can rule out infection or other conditions. An examination of the pelvic floor by a specialized physical therapist completes the assessment.

Medical evaluation

Your doctor will first rule out treatable causes such as a urinary tract infection or bacterial prostatitis. This usually includes:

• A urine test
• Sometimes a bacteriological culture
• A physical examination including a rectal exam

If these tests are normal and your symptoms have lasted for more than three months, a diagnosis of chronic pelvic pain syndrome becomes likely.

Physical therapy assessment

Your physical therapist specializing in perineal rehabilitation will conduct a comprehensive assessment:

• Your lifestyle habits and stress factors
• Your posture and breathing
• The condition of your pelvic floor muscles (tension, trigger points)
• The mobility of your back and hips

This assessment helps identify the specific causes of YOUR symptoms and create a personalized treatment plan.

How does physical therapy help chronic pelvic pain syndrome?

Perineal physical therapy is a first-line treatment for chronic pelvic pain syndrome. Your physical therapist uses manual techniques to relax tense muscles and teaches you specific relaxation exercises.

The American Urological Association guidelines (2025) recommend manual physical therapy for men with pelvic floor tension. Studies show significant improvement after 6 to 8 sessions.

Treatment techniques

What you will learn

• Pelvic floor relaxation exercises (not Kegels!)
• Breathing techniques to reduce tension
• How to manage stress and aggravating factors
• Tips for your lifestyle habits and posture

When should you seek physical therapy for chronic pelvic pain syndrome?

Consult a doctor if you have had pelvic pain for more than three months with urinary or sexual symptoms. You do not need a referral. Perineal physiotherapy is often the first recommended treatment.

Signs that you should seek medical attention

• Pelvic pain that has lasted for more than three months
• Urinary problems (frequency, urgency, pain)
• Pain during ejaculation or intercourse
• Your symptoms affect your quality of life
• The drug treatments did not work.

You do not need to see a doctor before consulting a physical therapist. If your condition requires medical evaluation, your physical therapist will be able to tell you and refer you.

Red flags: when to seek emergency medical attention

Some symptoms require urgent medical attention. They are rare, but you should be aware of them:

• Blood in urine or semen
• Fever accompanied by pelvic pain
• Complete inability to urinate
• Sudden and very intense pain

What can you do at home for chronic pelvic pain syndrome?

Stress management is essential because tension increases symptoms. Stay active, change positions frequently, and avoid sitting for long periods of time. Certain foods and beverages may aggravate your symptoms.

Managing stress

Chronic stress keeps your pelvic muscles tense. Find activities that help you relax:

• Mindfulness meditation
• Gentle yoga (avoid poses that create pressure)
• Daily walk
• Enjoyable activities that take your mind off things

Adapt your habits

• Vary your positions: Do not remain seated for more than an hour without getting up and moving around.
• Use a cushion: A contoured cushion can reduce pressure on the perineum.
• Adjust your bike: If you ride a bike, use an ergonomic saddle with a central cutout.

Diet: what can cause irritation

What to avoid

• Kegel exercises: They strengthen muscles that are already too tense.
• Straining to urinate or have a bowel movement: This increases pelvic pressure.
• Ignoring the urge to urinate: Go to the bathroom when you feel the urge.

To learn more

You can listen to the podcast created by one of our physical therapists, Alexis Gougeon. Episode #23 specifically discusses perineal rehabilitation.

Find the episode on YouTube, Spotify, or Apple Podcasts.

Sources

• Shoskes DA, Nickel JC, Dolber O, et al. Management of chronic prostatitis/chronic pelvic pain syndrome. Prostate Cancer and Prostatic Diseases. 2009;12:177-183.

• American Urological Association. Diagnosis and Management of Male Chronic Pelvic Pain: AUA Guideline. 2025.