I’ve been wanting to talk about male pelvic pain. Men have pelvises and get pelvic pain. Why does it remain a taboo? This one is for both patients and clinicians.
Karl and I have been friends for a while. He’s a wonderful human, therapist, pain expert, collaborator… he generally defies labels. From a background in sports and advanced clinical massage therapy and specialist training in Arvigo Techniques of Maya Abdominal Therapy (ATMAT) he’s built a wonderfully holistic clinic and practice that serves men with pelvic pain. You can find out about Karl here and his clinic here.
It speaks volumes that only in the last few years have we made the transition from “Women’s Health” physiotherapy (with physios who also treat men) to “Pelvic health physiotherapy” – a much more apt name for the treatment of pelvises, regardless of gender identity nor anatomy. It’s a pelvis, we treat the inside and outside.
We sat down after a recent conference to highlight male pelvic pain and provide some insight into the treatment that is available. We had to film in the hotel lobby, it’s very pretty but at times busy so please bear with us.
Talking about pelvic pain can be very difficult.
So lets get the conversation started for you. Karl has a specific viewpoint with pelvic pain, he’s had it. We cover his treatment, or lack of, fertility worries, and how he got better. We also talk about how to access treatment now and what that might look like.
Pain is part of normal ‘homeostasis’ – our body’s way of keeping everything in balance. Pain is useful and needed, but sometimes an excess of pain exists where our system has got a bit stuck protecting us. It’s doing a great job, but doing it too much when it doesn’t need to. But the decision to give us a painful experience is logical to our body. If you can create safety in your/ your patient’s neuroimmune system then it’s less likely to need to tell you to protect something from a perceived threat.
You’re more likely to have flare ups when your glass is full. If you’re doing too much, taking on too much, or don’t have enough moments of joy/relaxation/rest in your life your glass with overflow. Tackling that is one of the easiest things to start with. Get the basics right – find a way to get 8 hours of sleep, eat well and regularly, spend time with friends, family and outdoors in nature.
Looking at a truly holistic biopsychosocial (BPS) approach to treatment encompasses asking patients about the whole of their lives, belief systems and experiences. This shouldn’t be shied away from, but form the crux of your treatment. The BPS approach is often used to excuse symptoms, e.g. “He had an infection, now he’s stressed with work/his relationship and catastrophizing about his pain so that’s making it worse” – this false statement relies on a biological cause of pain (the infection) and psychosocial sensitisers (relationships/fear and anxiety re: pain). Whereas the BPS approach means you can Omit the biological and still have pain – as Morten Høgh said recently “I don’t know what anatomy has to do with pain”. But this doesn’t mean we think the pain is In your head or you’re making it up, we just understand that life factors have a role in the expression of your pain.
Karl’s top tips for men in pain:
Go get tested, see your GP as there may be acute medical issues that can be treated simply. Many men are worried about prostate cancer, but this rarely presents with pain down there. Your GP will be able to guide you through the tests you need. And if you get the all clear don’t despair..
Know there is help out there, you’re not alone. There are physios and therapists all over the world to help you
Find a pelvic health physio or therapist (link below). Work in collaboration with your therapist – you know your body better than anyone and you know the answers to get your body out of pain. Seek a therapist who will collaborate and empower you to lead your own recovery.
Here’s the links we talk about:
Remember the internet is a great place to anonymously vent your fear and hurt, but it doesn’t tend to attract people who have recovered and are living their lives, so a lot of things you’ll read about pelvic pain are negative. Click here to read stories about people who have recovered from pelvic pain.
Here are some links to help you understand where we are with pain:
Why things hurt – Prof Lorimer Moseley
Predictive Processing in Pain - Prof Mick Thacker
These books can be helpful:
Explain Pain Supercharged – Prof. G.Lorimer Moseley, Dr. David S Butler
Explain Pain Handbook Protectometer – Prof. G.Lorimer Moseley, Dr. David S Butler
Teach us to sit still – Tim Parks
Now it’s your turn to get talking. Get help. It’s out there.