THE ULTIMATE BEGINNER'S GUIDE TO MALE PELVIC FLOOR DYSFUNCTION/CPPS

Written By: Michael Hodge

Medically Reviewed By: Dr. Brianne Grogan, PT, DPT

This may be a guide that you probably never wanted to have to read — but new knowledge leads to a new experience, and my goal is to help you discover something here that will shift you out of your current pain and dysfunction. In this guide, I will take you through what it means to be experiencing pelvic floor dysfunction/CPPS, basic anatomy to better understand your privates, potential root causes, and a few simple steps to begin your recovery back to vibrant pelvic health.

MY STORY OF PELVIC PAIN

I know a little bit about this subject, as I lived it for five years. When I was 22, I had an odd experience with pelvic discomfort after ejaculating, which led me to visit my general practitioner. Over time, the pain got worse, including tension in my perineum along with a growing varicocele (poor blood flow around the testicle). I was sent from one urologist to another, to specialists, I did all of the diagnostics (MRI, ultrasound, blood tests, and others), but to no avail. The pain became a mainstay of every day, making it hard to exercise, stand for very long, sit down (sitting was not fun), and just live life.

I would make a little bit of progress and then have a major regression… It was so frustrating. I spent hundreds of hours (and thousands of dollars) on natural healing modalities, visiting acupuncturists, doing yoga, tai chi, changing my diet, physical therapy, and more.

After years of chronic pain, I began to see changes when I shifted my mindset internally from an intense, anxious state of “I’ll do whatever it takes to be 100% better” to a more relaxed state of “I am healthy, I am grateful for today, my pelvic floor is strong.” Instead of obsessing about specific timelines, I shifted into complete belief and faith in my body’s ability to heal while allowing it to occur on its own timeline, and simultaneously living in joy. Combined with good movement routines (which is how I learned of Dr. Bri originally), a diet that was more appropriate for my body at the time, and some hands-on support from a natural practitioner, I recovered.

I have since dedicated my life to helping other men to heal with the intention of creating the most effective pelvic health programs in the world. Dr. Bri and I teamed up to create Overcome Pelvic Pain, which is an intelligently designed 12-week program that integrates all of the important components for your recovery back to strength. It is ridiculously gratifying to see someone get back to health in a handful of months, instead of living through this for half-a-decade like I did.

WHAT IS MALE PELVIC FLOOR DYSFUNCTION/CPPS?

Chronic Pelvic Pain Syndrome (CPPS) is a broad term used to describe persistent pain in the pelvic region that may be attributed to a variety of root causes. Unfortunately, there are still a lot of unknowns around CPPS, and the diagnosis that many men receive is “chronic prostatitis” even though the prostate may or may not be involved. Interestingly, 90-95% of persistent pelvic pain cases are classified as chronic non-bacterial prostatitis, meaning that there’s no bacterial infection present (and therefore, antibiotics won’t work).

CPPS is usually accompanied by tension in the pelvic muscles and often goes hand-in-hand with digestive issues, bladder concerns (like frequency or urinary hesitancy), and sexual difficulties.

COMMON SYMPTOMS

Pelvic Floor Dysfunction or CPPS (Chronic Pelvic Pain Syndrome) are blanket terms that describe lack of normal functioning in your pelvic floor muscles and organs. There are a wide range of possible symptoms, and these symptoms can shift over time. In my case, it started with discomfort in the testicle, a varicocele, and then tightness/pain in the middle of my perineum. It shifted to tightness around the rectum, as well as in the perineum.

I experienced urinary hesitancy (having to wait several minutes to start the flow of urine, or having to sit down to be able to pee without pain), urinary urgency (having to pee more often, especially overnight), weak erections, weak ejaculation, pain and elevated symptoms after ejaculation, and numerous mental and emotional challenges.

There are many other possible symptoms, too. Now that I have worked with hundreds of men in the Overcome Pelvic Pain program that Dr. Bri and I created together, we have seen this more exhaustive list:

• Tightness in perineum
• Spasms in pelvic floor muscles
• Pudendal neuralgia
• Hard-flaccid
• Frequent urination
• Painful urination
• Erectile dysfunction
• Painful anal intercourse
• Pain during or after ejaculation
• Pain during or after bowel movements
• Testicular pain
• Pain while sitting
• Pain in pelvic floor while exercising
• Premature ejaculation
• Lower abdominal pain
• Low back pain

The emotional and mental symptoms associated with CPPS cannot be overstated. Depression and anxiety go hand-in-hand with CPPS, and may contribute to its onset as well as perpetuate it (make it continue, and make it feel more intense).

ANATOMY OF YOUR PELVIC FLOOR

The pelvic floor muscles are found at the base of your pelvis. They create a “hammock” of support that slings from the pubic bone in the front, to the tailbone in the back, and between the sitting bones from side-to-side.

To keep things simple, there are layers to your pelvic floor: a deep inner layer with a group of muscles that collectively make up the levator ani (which literally means “anus lifter”), and an outer layer of smaller, more superficial muscles that surround your anus and penis. Together, the pelvic floor muscles help support your internal organs, provide core stability, and contract and relax to help with bowel and bladder function, and sex.

You can see a diagram of the male pelvic floor muscles below:

A note about the penis and sexual function: The penis is not muscular tissue, it's a soft erectile tissue and consists of spongy chambers that fill with blood to get hard.

Penis erectile tissues have attachments to your pelvis and share connections with the pelvic floor muscles. When the penis fills, the bulbospongiosus and ischiocavernosus (outer pelvic floor muscles) squeeze around the base of the penis to help increase pressure within the chambers.

During an erection, the bulbospongiosus puts pressure on the deep dorsal vein. This keeps blood inside the penis (thus, keeping it hard). During orgasm, the bulbospongiosus and the levator ani muscles contract. This gets the ejaculate out, and is perceived by the brain as a pleasant sensory experience.

In summary: Your pelvic floor muscles help you get an erection, keep an erection, and ejaculate IN ADDITION TO helping with stability and bowel and bladder control. Your pelvic floor can help you experience pleasure, and they can also contribute to pain. Let’s talk a little bit more about pain.

POTENTIAL ROOT CAUSES

There is not just one root cause, but many factors that can contribute to pelvic floor dysfunction. In this section, I will cover some potential root causes to take into consideration. This is not intended to be a substitute for medical evaluation or treatment, and is certainly not a diagnosis, but it can help open your mind to the possibilities of what could be causing your pain. Awareness is the first step to relief.

An Upregulated Nervous System (Stress, Anxiety, Fear, Overwhelm)

The first potential root cause to bring to light is nervous system dysregulation; specifically, upregulation and over-activation of the stress response. This is rarely discussed when it comes to traditional medical management of pelvic pain, but we see it time and again with the men in Overcome.

Our mind and emotions are intimately connected to what’s physically happening in the body. There is constant two-way communication between our brain and body, and we unconsciously, automatically, and reflexively create tension in our tissues simply by the thoughts we think (whether or not we’re even aware of these thoughts).

Your body is designed to activate the protective fight/flight/freeze response whenever you encounter danger. In this modern day, we often confuse fear with danger. Danger is an immediate threat to your body whereas fear is a psychophysiological experience, caused by a thought.

Chronically thinking fearful thoughts, reacting with a stress response, and worrying too much about the future or attempting to control it (anxiety) will throw your nervous system into an upregulated state. Your pelvic floor is a part of your body and goes into “brace mode” in response to the fear and uncertainty of everyday life – including what’s going on in the news, what’s happening at work, your relationship status, financial concerns, etc. It tenses up and holds this tension, as your body prepares to fight, flee, or freeze. This is what your body is designed to do, to protect you! But when we maintain this state for too long, without being aware of it (which can happen in this super-fast paced, pressure-filled modern life), then problems such as CPPS can arise.

With CPPS, a tension-pain cycle develops which looks something like this: pelvic tension causes stress, fear, embarrassment, and uncertainty. This sends danger messages to your brain, increasing your internal “alarm bells” and pain sensing mechanisms. Your brain’s response to the “danger alarm” is to create pain, which causes more tension in the body (including the pelvic floor), and more pain. Over time, with repeated input, these stress responses become overly sensitive and this cycle happens faster and faster, with smaller and smaller inputs needed to make the alarm bells sound.

It’s important to know that you haven’t done anything wrong… your body is only trying to protect you by “turning up the volume” on the alarm system! Pain pathways are created over time, and they can be CHANGED over time as well. Awareness of the tension-pain cycle is the first step to interrupting it by down-regulating, or calming, your nervous system.

Body Misalignment

The tension-pain cycle discussed above can cause poor postural alignment, sitting habits, and lack of movement which can “feed” the cycle and just make things worse! But even aside from the pain-tension cycle, chronic alignment issues cause patterns of restriction and holding in your tissues. If you spend most of your day slumped in front of the computer at work, sit in your car to drive to the gym, spend 30 minutes at the gym working out, but then slump on the couch scrolling on your device after dinner, then you’re spending most of your day in an unhealthy position that tightens certain muscles and lengthens others. Overly tight muscles aren’t strong. Overly-lengthened muscles aren’t strong. These imbalances lead to weakness, and ultimately pain and dysfunction.

Overtaxing Your Pelvic Floor

Again, we must realize that everything is connected. If you constantly push yourself at the gym, or regularly masturbate/have sex when already in an up-regulated nervous system state, this can contribute to the buildup of tension in your pelvic floor. Although it might feel like a desired release, it could amplify your symptoms. It’s important to find a balanced approach, and realize that extreme working out, or excessive masturbation/sex – especially when the rest of your mind and body are out of balance – could exacerbate symptomology.

Improper Nutrition and Constipation

A diet that lacks balance can lead to inflammation, digestive tract issues, and constipation. Constipation and an unhealthy gut can cause tension which pulls and impacts your pelvic floor functionality, including pain with bowel movements.

Furthermore, constipation and straining to “go” can contribute to hemorrhoids (piles) and has been connected to erectile dysfunction and soft penis syndrome. Repetitive straining puts excessive pressure on the blood vessels that supply the penis making it difficult to achieve or maintain an erection. The remedy? Eat more plants and drink more water!

Direct Injury

A direct injury to your coccyx, or perineum, testicle, penis, or somewhere in this area can contribute to acute inflammation (which can cause pain and patterns of muscular holding). Ultimately, if the direct causes nerve damage or a wound, then longer-term challenges might arise such as weakness or scar tissue resulting in soft tissue restriction and/or patterns of misalignment.

Medical Concern

As mentioned earlier in this article, 90-95% of persistent pelvic pain cases are classified as chronic non-bacterial prostatitis; however, some cases of pelvic pain are, in fact, caused by a bacterial infection, a sexually transmitted infection, or a significant medical concern such as cancer. This is not to induce fear, it’s simply to say that while a holistic mind-body approach and conservative treatment options (such as stretching and/or physical therapy) can be helpful for most cases of CPPS and pelvic floor dysfunction, it’s VERY IMPORTANT to rule out a medical concern that may require more aggressive treatment. Talk to your doctor, get testing, and be sure they rule out any red flags such as warmth or redness that may indicate infection, burning pain, radiating numbness or tingling, sudden changes in bowel or bladder habits, sudden changes in weight or appetite, and changes in balance or ability to walk.

SIMPLE STEPS TO RETURNING TO STRENGTH

Slow Down

The first step to recovery is slowing down your life, at least some, and at least for now. This doesn’t mean you have to retreat completely, but if you have been go-go-go with new projects, work, family, pressure, pushing, and making things happen — take your foot off of the gas for a while. Love yourself enough to do this. Your body needs time and space and reclaimed energy to come back into balance and harmony.

Daily Movement to Relax and Release Your Pelvic Floor

It is important that you integrate daily movements which are designed to release and relax your pelvic floor muscles and the surrounding muscle groups. The Overcome Pelvic Pain for Men program has a scientifically designed routine for 12 weeks in a row, taking the guesswork out of this.

Whether you are following a set of individualized routines from your physical therapist or following the Overcome Pelvic Pain program, make sure to stay consistent with your daily exercises. Initially, it is important to downtrain your pelvic floor muscles, which means to bring them to a place of neutrality, without constant tension. Later on, you will want to begin restrengthening the surrounding muscles groups, and ultimately regain coordination and control within the pelvic floor itself — which is what our 12 week build-up does in the Overcome program.

Do NOT begin with kegels or strengthening moves! It is important to focus on releasing and opening movements at first. You might feel some soreness and discomfort for the first few days or even weeks, as you begin to unclench these chronically tight muscles. This is a relatively common occurrence, as you are waking up muscles that haven’t been moved in such a way in perhaps a very long time, and your body is fighting to “stay in the past.” Don’t let your body take over your mind. Bring them back into balance by breathing deeply, releasing fears, going slow, and being consistent with your daily movement routine.

A Clean Diet

Your nutritional intake is significantly more important when it comes to pelvic tension than you might have realized. Your gut health influences your entire body’s chemistry, and has a lot to do with the regulation of your nervous system. Not to mention, that an overly worked, stopped up, and constipated digestive tract can lead to exacerbated pelvic floor tension and symptoms.

Chemical addictions and imbalances can lead to elevated diuretic symptoms (urination) along with internal build up of toxins that can create inflammation within your pelvic floor.

Consider greatly reducing your intake of sugar, alcohol, caffeine, and other stimulants while doing the Overcome program or your own recovery program.

Crowd out unhealthy, greasy foods with more whole foods. The more you can eat real food, that is not coming out of a box or can or bag (yes, even if those containers say organic on them), the more vibrancy and digestibility you will bring into your diet. Leaning into lean meat, vegetables, fruit, legumes, nuts, and some grains works well for most people. Every BODY is different, so you will need to discover your own bio-individuality regarding nutrition intake. The Overcome Pelvic Pain program includes nutritional guidance for each month of your recovery program, to make this easy to understand and follow.

The Importance of Mind-Body Practices

Now onto the most important aspect of your recovery — the mind-body connection. Everything is connected. Your thoughts and emotions have a tremendous (and measurable) effect on your physiology. The emerging science of psychoneuroimmunology is showing us the unbelievable power of the human mind. Your mind can and does influence your body. What does this mean? If cyclical, negative thoughts and emotions can make you sick, that means that conscious, positive thoughts can make you healthy (along with the other mechanical and chemical changes in unison).

It is important that you begin retraining your brain, wiring and firing new neural networks together. You have been walking down the same (neural) path over and over again, which is that which leads to the experience of chronic pain. The path has become a multi-lane highway! You will need to wire and fire new neurons together; thoughts and emotions of health, wholeness, and function. This neurologically reprograms your nervous system back into health.

How is this done? There are many ways. One is new information. Reading, listening to, and experiencing knowledge and possibility, which creates a new belief (if you did not already know that this was possible). Then, doing practices such as meditations, self-hypnosis, and mindful breathing, with specific intentions. All of this is integrated into the Overcome Pelvic Pain program for you. The program includes a guide on how the mind-body practices change your brain and body, in harmony, with a library of custom designed meditations and mind workshops, which are for subconscious reprogramming.

A Support System

You don’t have to do this alone. Other men, such as myself, have already walked this path to the end of the tunnel (yes, there really is light there!), and have made it out on the other side. I have so much gratitude for experiencing pelvic floor dysfunction. I am grateful for every day that I live, knowing that I made the choice to stay alive. I am grateful to have learned how to guide my own healing, and to discover the power of the mind and spirit (if you believe in such a thing — I do). I’m also grateful that I have the understanding and skills to help others like yourself to recover, in ideally a much shorter period of time than it took for me; phew, what a blessing!

–Family and Friends

You don’t want to be a broken record about your chronic pain, but let others know what you are doing to actively help your health. Especially when you choose to draw a line in the sand, and state that you are choosing health for your pelvic floor and that you are stepping into a new life. Make this known. Set boundaries when needed. Advocate for help, if required, so that you can complete your daily stretches and self-care practices. Others will begin seeing the NEW YOU, and not the past you, which appeared frail and lifeless, stricken with chronic pain.

–Community

Joining an online or local community of men who are recovering together can be super-supportive. In the Overcome Pelvic Pain program, we have a private online community for the men in the program, where Dr. Bri and I also assist by answering questions and giving powerful support.

Hearing that other men have similar symptoms to you, and also seeing others go forth, as they share their victories and transformation, is really motivational and comforting. Don’t be afraid to speak up and ask for help and to share your own wisdom with those around you; everyone has a gift to give.

Practitioner/Coach/Guide

Finding an experiencing practitioner, such as a physical therapist, physiotherapist, or other related professional can be very helpful. You can also enlist a coach or guide to be there for you along the way, giving you support on your beautiful journey or recovery back to strength. I’d love to be that guide for you. It energizes me to help men overcome their pain and get back to living a vibrant life, and beyond. This is my life purpose!

Shifting Your Mindset

Your mindset can keep you stuck or it can liberate you. One shift is moving into gratitude. Even if you feel pain, even if it looks as though things are not changing, what can you find gratitude for right now, in your life? True gratitude opens your heart. A coherent brain and heart leads to harmonious function throughout your entire body.

Another shift is living in the present moment. When we are experiencing unexpected pain, it can be really hard not to think all of those daunting thoughts and what-ifs and whys; however, mindfulness has been studied for years and has proven to be effective at managing chronic pain. When we stop thinking about the past and the future, and we engage in the now, we are fully present. This is healing. It allows you to appreciate the now, which is truly all we ever have. You will not be able to experience anxiety and stress when you are fully present in the “now,” which is highly beneficial for down regulating your nervous system.

Another thing to watch for is self talk. How do you talk to yourself? And what do you tell others? Do you make victim statements: “I’ve been stuck with this pain for two years.” Or, do you say, “I try everything and nothing works, I hate this.” Or, “I can’t believe I just did that again, now I’m going to make my pain worse, you stupid ******.”

When we shift our words in a way that speaks our future into existence, in a way that we are already owning our health and wholeness, and in a way that is so loving to us, then our body responds in a beautiful way. The Overcome Pelvic Pain For Men program includes detailed Mindset lessons to help you make the most important shifts, in an approachable way.

Finding Joy in the Now - You’re More than Your Pelvic Floor

It is so easy to forget about having fun when you are experiencing CPPS. A little-known secret is finding joy everyday. Even while you are recovering, what can you do today that will bring you joy? Maybe you are not able to do some of your favorite movement activities, but can you read an adventurous book? What about playing a game with your kids? Or painting? Or going for a walk or any other small act? When you lean into joy, and you take your mind off of the problem, your body and mind have the space they need in order to “do their thing.” Joy is a powerful choice that you can make, today. Don’t wait until you are healed to be joyful. This ironically keeps you from your goal.

You made it through this guide. There is light at the end of the tunnel. You CAN do this. I can help. Love yourself and commit to vibrant pelvic health. I'd love to support you on your journey, let's do this! The best next step is to do the FREE 7 Day Overcome Pelvic Pain Kickstart. I will see you in there. :)

Final Words of Advice:

Just like every person is different, so too is every HEALTHCARE PROVIDER. If you are not satisfied with the evaluation or examination you receive from one provider, then don't be afraid to seek a second opinion.

Advocate for yourself! If you feel like something is "off" in your body, then LISTEN. If you feel blown off by a provider who says your prolapse is "normal" and just something you have to live with, then find someone else who can help.

This guide is not a substitute for individualized medical treatment; contact a physician and/or physical therapist in your area for one-on-one evaluation and a personalized treatment plan.

Sending light and love… and don’t forget to begin the 7 Day Free Kickstart to Recovery!