What is Pudendal Neuralgia? Signs, Causes, and Proven Treatment Options

Physical Therapy: Treatment for Pudendal Neuralgia

Living with persistent pelvic pain can be frustrating, confusing, and sometimes even life-altering. For some people, the source of this discomfort isn’t well known or often misunderstood. One such condition is pudendal neuralgia—a type of nerve-related pelvic pain that’s frequently underdiagnosed yet has a major impact on quality of life.

Pain is the main symptom of pudendal neuralgia. The good news? Pudendal neuralgia is treatable. With approaches like physical therapy, pain management strategies, nerve blocks, and lifestyle changes, many people can reduce their symptoms and regain control of their lives.

This comprehensive guide will walk you through everything you need to know: what pudendal neuralgia is, why it happens, how to recognize it, and how specialists like the team at Pelvis NYC can help.

What is Pudendal Neuralgia?

The pudendal nerve is one of the most important nerves in your pelvic region. It runs through the pelvic floor and carries both sensation and motor function to areas including the anus, perineum, genitals, clitoris, and penis. The perineal branch of the pudendal nerve provides sensory innervation to the perineal region. It plays a vital role in urinary control, bowel function, and sexual health. The pudendal nerve also controls the sphincter muscles responsible for opening and closing the urethra and anus.

Pudendal neuralgia occurs when this nerve becomes irritated, compressed, or damaged. This can lead to nerve pain described as burning, stabbing, tingling, or shooting sensations. Because the nerve supplies such sensitive areas, including the rectum as part of its sensory distribution, the pain can be intense and disruptive.

Unlike muscle pain, pudendal neuralgia often worsens with sitting and may improve when standing or lying down. Many patients report that the discomfort feels worse throughout the day, especially after long periods of sitting.

Unfortunately, pudendal neuralgia is often misdiagnosed as a bladder problem, prostatitis, or gynecological condition, which delays proper treatment. That’s why awareness is crucial.

Pelvic Floor Muscles and Pudendal Neuralgia

The pelvic floor muscles form a supportive sling across the base of your pelvis. They hold your bladder, bowel, and reproductive organs in place. The pudendal nerve runs directly through this muscular region, making it vulnerable to compression.

When these muscles are too tight, weak, or imbalanced, they can place extra pressure on the pudendal nerve. This is why pelvic floor dysfunction and pudendal neuralgia often go hand in hand.

For example:

  • Overly tight pelvic floor muscles may trap or irritate the nerve.
  • Weak or imbalanced muscles may cause structural shifts that increase nerve compression.
  • Scar tissue from surgery or childbirth can also contribute to pudendal nerve entrapment.

The obturator internus muscle, which is located on the lateral wall of the pelvis, can also contribute to pelvic and perineal pain when it is tight or in spasm. Entrapment or spasms of this muscle may cause tenderness and should be considered during physical examination to help differentiate pelvic pain syndromes.

Understanding the relationship between muscles and nerves is key to finding the right treatment—especially since many people assume pelvic pain is purely muscular when in fact the nerve is involved.

Recognizing Nerve Pain and Chronic Pain

Not all pain feels the same. Muscle soreness after a workout is very different from nerve pain. With pudendal neuralgia, people often describe sensations like:

  • Burning or stinging
  • Electric shock–like jolts
  • Numbness or tingling
  • Stabbing pain deep in the pelvis

These are typical symptoms of pudendal neuralgia, which may affect the sensory distribution of the pudendal nerve and significantly impact quality of life.

Pudendal neuralgia is a form of neuropathic pain, and if untreated, this pain can become chronic neuropathic pain, meaning it lasts for months or even years. Chronic pudendal neuralgia can interfere with sitting at work, driving, using the restroom, and sexual activity. Patients suffering from chronic neuropathic pain may also experience emotional distress, such as depression and frustration, especially when earlier interventions have failed to provide relief.

The longer nerve pain persists, the harder it can be to treat, which is why early pain management strategies are so important.

Pelvic Pain Symptoms

Pudendal neuralgia symptoms can vary, but some of the most common include:

  • Pain in the genitals, anus, or perineum
  • Perineal pain, often chronic and neuropathic in nature
  • Discomfort that worsens when in the sitting position but improves when standing or lying down
  • Burning or tingling sensations in the pelvic region
  • Changes in skin sensation, such as numbness or sensitivity, in the pelvic area between the genitals and anus
  • Numbness or sensitivity in the buttocks or thighs
  • Sexual dysfunction and sexual problems, including pain during sex, erectile dysfunction, or difficulty reaching orgasm
  • Frequent urge to urinate or discomfort with bowel movements

Both men and women can experience pudendal neuralgia, though the triggers may differ. For example, men may notice symptoms after cycling or prolonged sitting, while women may develop it after childbirth or pelvic surgery.

Why is Pudendal Neuralgia Underdiagnosed?

One of the biggest challenges with pudendal neuralgia is that it’s often mistaken for other conditions. Because the symptoms overlap with urinary tract infections, prostatitis, gynecological problems, or even lower back issues, many patients see multiple doctors before receiving a proper diagnosis. Clinicians must consider other causes of pelvic pain and review all possible diagnoses to ensure accurate assessment and treatment.

The lack of awareness among healthcare providers contributes to delays in treatment. The diagnostic process involves ruling out other diagnoses and applying specific diagnostic criteria, such as the Nantes criteria, to confirm pudendal neuralgia. Patients often feel frustrated, unheard, or dismissed, which can worsen their overall mental health. Raising awareness about pudendal neuralgia helps ensure that more people get the care they deserve.

Physical Examination for Pudendal Neuralgia

Diagnosing pudendal neuralgia usually involves a thorough physical examination and medical history review. A pelvic health specialist may check for:

  • Tenderness along the pudendal nerve pathway
  • Muscle tension in the pelvic floor
  • Postural or structural issues contributing to nerve irritation
  • Rectal and vaginal examinations to assess for nerve involvement and exclude other diagnoses

During the anatomical assessment, the examiner may trace the path where the pudendal nerve travels through the pelvis, noting areas where the nerve travels through tight anatomical spaces that could lead to irritation or compression.

In some cases, imaging tests (like MRI) or a diagnostic nerve block are used to confirm the diagnosis. Early and accurate diagnosis can make treatment more effective and prevent chronic pain from worsening.

How Can Physical Therapy Help Pudendal Neuralgia?

One of the most effective conservative approaches to treating pudendal neuralgia is physical therapy. At Pelvis NYC, we specialize in pelvic floor physical therapy, which focuses on restoring balance, mobility, and function to the pelvic region.

Here’s how physical therapy can help:

  1. Pelvic Floor Muscle Release
    Tight pelvic floor muscles can compress the pudendal nerve. Through manual therapy and targeted relaxation techniques, a therapist can release tension and reduce nerve pressure.
  2. Posture and Alignment Correction
    Poor posture, especially when sitting, can worsen pudendal nerve pain. Physical therapy includes strategies to improve spinal and pelvic alignment, which reduces daily stress on the nerve.
  3. Tailored Exercises
    Gentle strengthening and stretching exercises help rebalance the pelvic floor and surrounding muscles. Over time, this improves circulation, reduces inflammation, and prevents recurring pain.
  4. Nerve Mobilization Techniques
    Some therapists use techniques designed to “free up” nerves that may be restricted by tight tissues. This helps restore natural nerve mobility.
  5. Education and Self-Management
    Patients learn strategies for sitting more comfortably, modifying activities like cycling, and avoiding positions that trigger pain.

The beauty of physical therapy is that it’s non-invasive and focuses on long-term healing rather than temporary fixes. Many patients find significant relief within weeks of starting treatment.

Nerve Block for Pudendal Neuralgia

When pain is severe or persistent, a pudendal nerve block may be recommended. This is a specific type of injection used for both diagnosis and treatment of pudendal neuralgia. The procedure involves injecting an anesthetic (sometimes combined with steroids) around the pudendal nerve, often using image-guided techniques. Injections are frequently performed in anatomical areas such as Alcock’s canal to accurately target the nerve.

Benefits of a pudendal nerve block include:

  • Immediate pain relief in many cases
  • Diagnostic value (if the pain disappears temporarily, pudendal neuralgia is confirmed)
  • Breaking the cycle of chronic pain, making physical therapy more effective
  • Potential for repeated pudendal nerve blocks to provide ongoing pain relief

While pudendal nerve blocks aren’t a cure, they can provide a window of relief that allows other treatments to work better.

Pain Management Options

Managing pudendal neuralgia often requires a multifaceted approach. Beyond physical therapy and nerve blocks, other pain management strategies may include:

  • Medications such as nerve pain drugs (gabapentin or pregabalin), muscle relaxants to help relax pelvic floor muscles, and topical creams for localized relief and to calm nervous system sensitivity
  • Nerve stimulation (such as TENS or neuromodulation) as a non-invasive treatment option
  • Acupuncture or biofeedback for relaxation and pain reduction
  • Counseling or therapy to address the emotional toll of chronic pain

The goal is to reduce pain to a manageable level while improving quality of life.

Management of Pudendal Neuralgia

The best management of pudendal neuralgia is a personalized, step-by-step plan. Treatment usually begins with conservative approaches like physical therapy and lifestyle changes. If these don’t fully relieve symptoms, nerve blocks or medications may be added.

For the small percentage of people who don’t improve with non-invasive methods, surgical decompression of the pudendal nerve may be considered—but this is rare and reserved for severe cases. In such situations, decompression surgery, specifically pudendal nerve decompression, is an important option. Various surgeries may be considered to relieve nerve compression, especially when scarring, congenital issues, or trauma are involved.

Lifestyle Changes

Certain lifestyle changes can make daily life easier and reduce flare-ups:

  • Use cushions designed to reduce pressure on the perineum when sitting.
  • Take breaks from sitting to stand, stretch, or walk.
  • Modify activities like cycling or horseback riding that increase nerve irritation.
  • Stay hydrated and eat a fiber-rich diet to avoid constipation, which can worsen symptoms.
  • Practice relaxation techniques like yoga or meditation to reduce pelvic floor tension.

These small changes can add up to major improvements over time.

Other Conditions to Rule Out

Because pudendal neuralgia symptoms mimic other issues, it’s important to rule out other conditions, including:

  • Interstitial cystitis (bladder pain syndrome)
  • Prostatitis (inflammation of the prostate in men)
  • Endometriosis (in women)
  • Sciatica or herniated discs
  • Infections or hernias

A thorough evaluation ensures the right treatment is chosen.

Prognosis and Outlook for Pudendal Neuralgia

Living with pudendal neuralgia can be challenging, but the outlook is not the same for everyone. The prognosis largely depends on how early the condition is diagnosed, the underlying cause, and how well the treatment plan is tailored to the individual’s needs. With a proactive approach—including physical therapy, lifestyle changes, and other targeted treatments—many people experience significant pain relief and a noticeable improvement in their symptoms.

Early diagnosis is key. When pudendal neuralgia is identified and managed promptly, there’s a much better chance of reducing nerve pressure and preventing chronic pain from becoming a long-term issue. A comprehensive treatment plan that addresses all aspects of the condition—such as muscle imbalances, nerve irritation, and daily habits—can make a real difference in quality of life.

For some, symptoms may persist despite best efforts, and in rare cases, severe pain can lead to ongoing discomfort or disability. In these situations, more advanced interventions like surgical decompression of the pudendal nerve may be considered to relieve pressure and restore function.

Ultimately, working closely with your healthcare provider to develop a personalized treatment plan is essential. With the right combination of therapies and support, it’s possible to manage symptoms, regain comfort, and improve overall well-being—even with a chronic condition like pudendal neuralgia.

Deterrence and Patient Education

Education is a powerful tool in both managing and preventing pudendal neuralgia. Understanding how everyday activities and habits can affect the pudendal nerve is the first step toward reducing the risk of severe pain and long-term complications.

Patients should be aware that certain activities—like prolonged sitting, horse riding, or anything that puts direct pressure on the pelvic floor—can aggravate symptoms or even contribute to the development of pudendal neuralgia. Making simple lifestyle changes, such as taking regular breaks from sitting, using supportive cushions, and modifying exercise routines, can help protect the nerve and minimize discomfort.

Maintaining strong and flexible pelvic floor muscles is also crucial. Regular stretching and gentle exercises can reduce muscle tension, improve nerve function, and support overall pelvic health. Avoiding habits that increase pelvic pressure, such as straining during bowel movements or lifting heavy objects improperly, can further decrease the risk of nerve irritation.

Healthcare providers play a vital role in patient education by offering resources, guidance, and support. Educational materials—whether brochures, online articles, or support groups—can empower individuals to recognize symptoms early, seek timely treatment, and make informed decisions about their care.

By staying informed and proactive, patients can take control of their condition, reduce the likelihood of severe pain, and improve their quality of life. Together, patients and providers can develop effective strategies for managing symptoms, preventing flare-ups, and ensuring the best possible outcomes for those living with pudendal neuralgia.

Living with Pudendal Neuralgia: Patient Tips

Living with pudendal neuralgia can be overwhelming, but small strategies help:

  • Keep a pain journal to track triggers and flare-ups.
  • Join support groups where you can share experiences and coping tips.
  • Pace your activities—alternate sitting, standing, and lying down to avoid prolonged pressure.
  • Don’t hesitate to seek mental health support—chronic pain can affect mood and outlook.

When to Seek Medical Help

You should seek medical attention if you have:

  • Persistent pelvic pain lasting more than a few weeks
  • Pain that interferes with sitting, sex, or daily activities
  • Symptoms that worsen over time despite home care

Early treatment prevents complications and helps avoid long-term nerve damage.

Book Your Appointment at Pelvis NYC

At Pelvis NYC, we specialize in diagnosing and treating conditions like pudendal neuralgia. Our team uses advanced pelvic floor physical therapy, personalized treatment plans, and holistic pain management strategies to help patients regain control of their lives.

pudendal neuralgia

👉 Don’t let pudendal neuralgia control your day-to-day life. Book your appointment at Pelvis NYC today and get a FREE 15-minute teleconsultation to start your path toward relief.

FAQs About Pudendal Neuralgia

1. Can pudendal neuralgia go away on its own? In some cases, mild nerve irritation may improve with rest and lifestyle changes. However, persistent symptoms usually require medical intervention.

2. Is pudendal neuralgia permanent? Not necessarily. With the right treatment—including physical therapy, nerve blocks, and lifestyle modifications—many patients experience significant improvement or even full recovery.

3. How do I sit with pudendal neuralgia? Using a special cushion (such as a U-shaped or donut cushion) reduces pressure on the perineum. Taking frequent standing breaks also helps.

4. Who is at risk for pudendal neuralgia? Anyone can develop it, but risks are higher in people who cycle often, sit for long periods, or have a history of pelvic surgery, trauma, or childbirth.

5. How is pudendal neuralgia diagnosed? Diagnosis typically includes a physical examination, review of symptoms, imaging if needed, and sometimes a diagnostic nerve block.

6. Does pudendal neuralgia affect life expectancy? No, pudendal neuralgia does not impact overall life expectancy. While it can significantly affect quality of life, it is not a life-threatening condition.

Final Thoughts

Pudendal neuralgia is a challenging condition, but it doesn’t have to control your life. With early diagnosis, comprehensive management, and the right blend of physical therapy, pain management, and lifestyle changes, many people find real relief.

If you’re struggling with ongoing pelvic pain and suspect pudendal neuralgia, the team at Pelvis NYC is here to help with compassionate, expert care.

Left Shoulder Pain: Causes, Symptoms, and Proven Treatment Options

Man holding his left shoulder in pain, representing common symptoms of left shoulder pain and stiffness.

Have you ever woken up with left shoulder pain that makes it hard to lift your arm or even sleep comfortably? You’re not alone. Shoulder discomfort is one of the most common musculoskeletal complaints. But when it specifically occurs in the left shoulder, it can be confusing—sometimes it’s just a muscle strain, while other times it could signal something much more serious, like a heart attack. In some cases, pain in the left shoulder is called referred pain, where the discomfort is actually coming from another part of the body, such as the heart. Left shoulder pain can be a sign of a heart problem, and recognizing referred pain is important for accurate diagnosis and timely treatment.

This guide will walk you through everything you need to know about left shoulder pain—its causes, symptoms, treatment options, and when to seek immediate medical attention.

Left Shoulder Pain: Why It Matters

The left shoulder is a complex ball-and-socket joint made up of bones, muscles, tendons, and ligaments. Because of its wide range of motion, it’s more vulnerable to injuries and wear-and-tear conditions than many other joints in the body.

left shoulder pain

Pain in the left shoulder can range from dull stiffness to sharp, shooting sensations, including sharp pain or sudden pain that may signal more serious underlying issues such as nerve compression or even heart problems. Sometimes the discomfort is limited to the shoulder itself, while in other cases it radiates down the arm or up into the neck. Some people may also experience shoulder blade pain, which can be related to problems with the muscles or tendons around the shoulder, such as tendonitis or muscle tears. Understanding the type of pain you’re feeling can give important clues about the underlying issue.

Anatomy of the Shoulder Joint

The shoulder joint, known medically as the glenohumeral joint, is one of the most complex and mobile joints in the human body. It’s a classic ball-and-socket joint, where the rounded head of the upper arm bone (humerus) fits into a shallow socket in the shoulder blade (scapula). This unique structure allows for an impressive range of motion, letting you lift, rotate, and move your arm in nearly every direction.

Surrounding the shoulder joint is the rotator cuff—a group of four muscles and their tendons that work together to stabilize the joint and keep the arm bone securely in the socket. These muscles and tendons are essential for everyday movements, from reaching overhead to throwing a ball. However, because the shoulder is so mobile, it’s also more vulnerable to injuries and conditions that can cause shoulder pain, such as rotator cuff tears, frozen shoulder, and shoulder arthritis.

Understanding the anatomy of the shoulder is key to recognizing why certain injuries happen and how they can affect your range of motion. Whether you’re dealing with mild discomfort or more serious shoulder pain causes, knowing how the bones, muscles, and tendons work together can help you and your healthcare provider find the best way to treat shoulder pain and restore function.

Causes of Shoulder Pain

There are multiple reasons for shoulder pain, and pinpointing the cause is essential for proper treatment. A variety of conditions can cause pain in the left shoulder, including injuries, inflammation, and systemic diseases. Some of the most common include:

  • Rotator cuff injuries (tendonitis, tears): The cuff is a group of muscles and tendons that stabilize the shoulder. Rotator cuff pain and rotator cuff tendinitis are common causes, often resulting from overuse or trauma.
  • Shoulder arthritis (wear and tear of cartilage): Arthritis can cause joint pain and stiffness in the shoulder, often accompanied by clicking or cracking.
  • Bone spurs that pinch tendons: These can cause pain by irritating or compressing soft tissue structures.
  • Bursitis (inflammation of fluid-filled sacs): Bursitis is the inflammation of the bursa, a fluid-filled sac that cushions the joint. Inflammation of the bursa can cause pain, swelling, and restricted movement.
  • Frozen shoulder or adhesive capsulitis: This condition involves inflammation and thickening of the connective tissue and soft tissue surrounding the joint, causing pain and stiffness.
  • Shoulder dislocation or fracture of the arm bone: These types of shoulder injury can cause severe pain and loss of function.
  • Poor posture or repetitive strain: Carrying heavy objects or repetitive overhead activities can lead to shoulder injury and exacerbate shoulder problems.
  • Nerve impingement: A pinched nerve can cause sharp pain, numbness, tingling, and muscle weakness in the shoulder and arm.
  • Thyroid disease: Thyroid disease is a risk factor for developing frozen shoulder and other shoulder problems.
  • Degenerative conditions: Joint pain can result from osteoarthritis or other degenerative diseases affecting the shoulder joint.

Each of these conditions requires different care, which is why proper diagnosis is important, because different shoulder problems and injuries require different treatments.

Frozen Shoulder and Adhesive Capsulitis

A frozen shoulder, medically known as adhesive capsulitis, is a condition where the shoulder joint becomes stiff and painful. Inflammation and thickening of the connective tissue and soft tissue surrounding the shoulder joint are responsible for causing pain and restricted movement. It often develops slowly and progresses through three stages:

  1. Freezing Stage – Gradual onset of pain with increasing stiffness.
  2. Frozen Stage – Stiffness limits mobility, but pain may decrease slightly.
  3. Thawing Stage – Slow improvement in range of motion.

This condition can take months—or even years—to fully resolve. Treatment usually includes stretching, physical therapy, and sometimes corticosteroid injections.

Mild Shoulder Pain: When It’s Not Serious

Sometimes, mild shoulder pain happens from sleeping awkwardly, carrying heavy bags, or carrying heavy objects, or spending too much time hunched over a laptop. In these cases, home remedies like ice packs, rest, and over-the-counter pain relievers may provide relief.

However, if mild discomfort lingers for more than a week or interferes with daily tasks, it’s best to consult a doctor to rule out underlying conditions.

Left Shoulder Pain and Heart Attack Warning Signs

One of the most concerning links to left shoulder pain is a heart attack. When blood flow to the heart is blocked, pain often radiates to the left shoulder, arm, or jaw. Sudden shoulder pain or sudden pain in the left shoulder should never be ignored, as it may indicate a serious medical emergency.

Seek immediate medical attention if your left shoulder pain is accompanied by:

  • Chest tightness or pressure
  • Shortness of breath
  • Sweating or nausea
  • Dizziness or lightheadedness

It’s always better to be cautious—don’t ignore these warning signs. If you experience sudden shoulder pain or any of these symptoms, seek treatment immediately.

Imaging Tests for Shoulder Pain

When the cause of shoulder pain isn’t clear, doctors may recommend imaging tests, such as:

  • X-rays – To check bone health, arthritis, or fractures.
  • MRI scans – To detect rotator cuff tears or soft tissue injuries. MRI is particularly useful for visualizing soft tissue structures such as tendons, ligaments, and the labrum.
  • Ultrasound – Useful for real-time images of tendons and muscles.

These tests help create a personalized treatment plan tailored to your condition.

Nonsurgical Treatment Options

Fortunately, most cases of shoulder pain can be treated with nonsurgical treatment methods:

  • Rest and activity modification to allow healing.
  • Physical therapy to improve mobility and strengthen muscles.
  • Anti-inflammatory medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), are used to reduce pain and swelling.
  • Corticosteroid injections for stubborn inflammation.

Surgery is usually reserved for severe injuries like complete rotator cuff tears or recurrent dislocations.

Surgical Intervention for Shoulder Pain

While many cases of shoulder pain can be managed with physical therapy, medication, and lifestyle changes, sometimes these conservative treatments aren’t enough. If you’re still experiencing significant pain, limited movement, or if your symptoms are getting worse, surgical intervention may be necessary to treat shoulder pain and restore your quality of life.

Common surgical options include rotator cuff repair, where damaged rotator cuff tendons and muscles are repaired or replaced; shoulder replacement surgery, which involves replacing the damaged ball and socket joint with an artificial implant; and arthroscopy, a minimally invasive procedure that uses a small camera and instruments to repair or remove damaged tissue inside the shoulder. These procedures can address issues like rotator cuff tears, severe arthritis, or persistent problems that haven’t responded to other treatments.

It’s crucial to seek emergency medical help if you experience sudden left shoulder pain, severe pain, or pain that rapidly worsens—especially if it’s accompanied by symptoms of a heart attack, such as chest pressure or shortness of breath. A physical therapist or orthopedic specialist can help determine if surgery is the right option for you and guide you through recovery, often combining surgical care with targeted physical therapy to help you regain strength and mobility in your shoulder.

If you’re struggling with ongoing or intense shoulder pain, don’t hesitate to seek medical attention. Early intervention can make a significant difference in your recovery and help you get back to your normal activities.

When to Seek Medical Attention

You should seek medical attention if your shoulder pain:

  • Persists for more than two weeks despite home care.
  • Interferes with daily activities, such as dressing, lifting, or driving.
  • Is sudden, severe, or associated with an injury.
  • Radiates down the left arm with chest pain (possible heart attack).

Early treatment can prevent chronic problems and speed up recovery. If your symptoms persist or worsen, seek treatment promptly to avoid further complications.

Feeling Pain in the Left Shoulder? Don’t Ignore It

Left shoulder pain can be frustrating, but it’s also your body’s way of telling you something is wrong. Whether it’s a mild shoulder pain from overuse, adhesive capsulitis, or even a heart attack, recognizing the symptoms early can make all the difference.

If you’ve been struggling with persistent shoulder pain, don’t wait. Consult a healthcare professional, explore nonsurgical treatment options such as physical therapy, and receive the right care before the condition worsens.

Book an Appointment with Pelvis NYC

At Pelvis NYC, we specialize in treating shoulder conditions through advanced nonsurgical treatments, physical therapy, and personalized care plans. Our team is here to help you regain mobility, reduce pain, and prevent further injuries.

👉 Take the first step toward relief today—Book your appointment with Pelvis NYC and get a FREE 15-minute teleconsultation.

Related Blog: How to Heal Lower Back Pain Fast with Physical Therapy?

Treatment for Pelvic Floor Dysfunction in Men: Your Complete Guide

Treatment for Pelvic Floor Dysfunction in Men

If you’re a man silently struggling with chronic pelvic pain, urinary problems, constipation, or sexual dysfunction, you’re not alone—and you’re not imagining things. These frustrating symptoms are often linked to pelvic floor dysfunction (PFD), a condition that affects the muscles deep within your pelvis. The good news? There’s effective, evidence-based help available. Treatment for pelvic floor dysfunction—especially through pelvic floor physical therapy—is helping more men finally get relief, restore confidence, and reclaim their quality of life.

What Is Pelvic Floor Dysfunction?

Your pelvic floor is a group of muscles at the base of your pelvis that support vital organs like your bladder, bowel, and prostate. These muscles play a critical role in urination, bowel movements, and sexual performance.

treatment for pelvic floor dysfunction

When those muscles are too tight, too weak, or not coordinating properly, you may experience pelvic floor dysfunction. In men, this often goes undiagnosed for years, as the symptoms are easily mistaken for other conditions—or dismissed altogether.

Common Symptoms of Pelvic Floor Dysfunction in Men

Knowing what to look for is the first step toward getting the right treatment for pelvic floor dysfunction. Symptoms may vary from person to person, but common signs include:

  • Pain or discomfort in the pelvis, perineum, lower abdomen, or genitals
  • Difficulty starting or stopping urination
  • Frequent urination or feeling like your bladder isn’t fully empty
  • Constipation, straining, or incomplete bowel movements
  • Erectile dysfunction or pain during ejaculation
  • Feeling of tightness, pressure, or heaviness in the pelvic region

If any of these sound familiar, it’s worth speaking to a pelvic health expert.

What Causes Pelvic Floor Dysfunction?

While the exact causes aren’t always clear, several factors may contribute to pelvic floor dysfunction in men, including:

  • Chronic constipation or excessive straining
  • Prostate surgery or pelvic trauma
  • Heavy lifting or poor body mechanics
  • Stress, anxiety, or trauma (which can cause muscle tension)
  • Aging and natural muscle weakening
  • Sports injuries or high-impact activities

Understanding the cause helps guide the best course of treatment for pelvic floor dysfunction, especially when it comes to restoring proper muscle function.

Pelvic Floor Muscle Dysfunction: Causes and Risk Factors

Men can develop pelvic floor muscle dysfunction from a variety of sources. Chronic constipation and straining are common contributors, along with physical trauma, prostate surgery, or high-impact sports. Emotional stress and anxiety can also lead to muscle tension in the pelvic area, exacerbating symptoms. Even poor posture or weak core muscles can contribute to long-term pelvic floor imbalance.

How Pelvic Floor Exercises Help

One of the most effective, non-invasive ways to treat PFD is through pelvic floor exercises. These include targeted movements designed to strengthen weak muscles and relax tight ones.

You might be guided through Kegel exercises (adapted for men), posture alignment, breathing coordination, and core-strengthening routines. Over time, these exercises improve muscle awareness, bladder and bowel control, and sexual function.

Nonsurgical Treatments for Pelvic Floor Dysfunction

Before considering surgery, many men find success with nonsurgical treatments. These can include pelvic floor physical therapy, manual therapy for muscle knots, biofeedback training, and pain management techniques. For some, cognitive or behavioral therapy may also be recommended to reduce anxiety-related muscle tension. Together, these approaches form the first line of treatment for pelvic floor dysfunction.

treatment for pelvic floor dysfunction

Lifestyle Changes to Support Recovery

Daily habits can significantly impact your pelvic health. Incorporating lifestyle changes such as staying hydrated, eating a fiber-rich diet, and avoiding straining during bowel movements can ease symptoms. Reducing heavy lifting, managing stress through mindfulness practices, and maintaining good posture also support pelvic muscle recovery.

Surgical Treatments: When Are They Necessary?

Doctors rarely recommend surgical treatments for pelvic floor dysfunction in men, but they may consider them in severe cases when non-invasive methods fail.

Surgical options may include:

  • Nerve release or decompression procedures
  • Correction of structural abnormalities
  • Treatment of severe pelvic organ prolapse (rare in men)

Surgery is typically a last resort, and most men improve significantly with nonsurgical treatments and therapy.

Floor Dysfunction Is Treatable—You’re Not Alone

Living with floor dysfunction can be frustrating and isolating—but it’s also highly treatable. The key is getting the right diagnosis and care from someone who understands male pelvic health.

Why Choose Pelvis NYC?

At Pelvis NYC, we specialize in treating men with pelvic floor dysfunction. Our lead therapist has not only studied this condition extensively but has personally experienced it—bringing empathy and expertise to your care.

We offer one-on-one therapy sessions in a private, respectful setting. Every treatment plan is tailored to your symptoms and lifestyle, with continued support throughout your recovery.

Get Started with a Free 15-Minute Teleconsultation

You don’t have to live with pelvic pain, urinary issues, or sexual dysfunction. Treatment for pelvic floor dysfunction is available—and it works.

Book your FREE 15-minute teleconsultation with Pelvis NYC today. We’re ready to listen, understand, and help you take the next step toward healing.

How to Heal Lower Back Pain Fast with Physical Therapy?

How to Heal Lower Back Pain Fast with Physical Therapy?

Almost everyone experiences back pain at some point in life. Whether it’s from sitting too long at a desk, lifting heavy objects, poor posture, or even stress, discomfort in the lower back can interfere with sleep, work, and everyday activities—these are all ways pain affects your daily life and ability to perform routine tasks.

The good news? If you’ve been wondering how to heal lower back pain, there are proven strategies that can bring both immediate relief and long-term recovery. Let’s explore the causes, treatments, and prevention tips that really work.

How to Heal Lower Back Pain Naturally

When people search for how to heal lower back pain, they’re often hoping to find effective, drug-free solutions. While every case is unique, the foundation for natural healing usually includes:

  • Resting smartly – short rest periods can help, but avoid staying in bed too long.
  • Stretching and strengthening exercises – to restore mobility and prevent stiffness.
  • Improving posture and body mechanics – to reduce unnecessary strain.
  • Physical therapy – for guided, targeted recovery.

Research suggests that these methods are supported by scientific studies for improving lower back pain.

Most cases of lower back pain improve within a few weeks, especially when these approaches are used consistently.

Pain Relief That Works

When back pain flares up, the first goal is usually to ease pain quickly. Here are some go-to strategies:

  • Ice or heat therapy to reduce inflammation or ease stiff muscles. For cold therapy, use an ice pack to help relieve pain and swelling.
  • Gentle massage to relax tight areas.
  • Over-the-counter pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, or acetaminophen.
  • Simple stretching routines to improve flexibility and circulation.

These can calm the discomfort, but remember—relief is temporary unless the root cause is treated.

Physical Therapy for Back Pain

If you’re serious about learning how to heal lower back pain, physical therapy should be high on your list. Physical therapists are the healthcare professionals who design and supervise these personalized plans to address back pain effectively. A therapist will design a personalized plan that may include:

  • Hands-on treatments to reduce tension.
  • Core and spine-strengthening exercises.
  • Posture correction techniques.
  • Education on how to move safely in daily life.

The goal isn’t just to relieve today’s pain—it’s to prevent tomorrow’s.

Benefits of Physical Therapy for Lower Back Pain

Physical therapy offers a powerful, evidence-based approach to relieve pain and restore function for those struggling with lower back pain. Working with a physical therapist means you’ll get a personalized plan tailored to your unique needs and the underlying cause of your pain. Through targeted exercises and stretches, physical therapy helps strengthen both your back and abdominal muscles, which are essential for supporting your spine and improving posture.

Manual therapy techniques and guided movements also boost blood flow to the painful area, speeding up healing and reducing discomfort. As you progress, you’ll learn how to move safely and avoid poor body mechanics that can trigger future episodes of back pain. The result? Not only do you experience significant pain relief, but you also gain the tools to return to your normal activities with confidence and maintain better spinal health for the long run.

Preparing for Physical Therapy: What to Expect

Starting physical therapy for lower back pain is a proactive step toward lasting relief. At your first appointment, your physical therapist will take time to understand your medical history, daily habits, and the specific nature of your pain. This thorough evaluation may include a physical exam and, in some cases, diagnostic tests like blood tests or imaging to pinpoint the underlying cause.

Once your needs are clear, your therapist will design a customized treatment plan. This often includes exercises to strengthen your back and abdominal muscles, stretches to improve flexibility, and hands-on techniques to relieve pain and ease muscle spasms. Throughout your sessions, you’ll work closely with your physical therapist, setting goals and tracking progress together. With expert guidance, you’ll find relief from lower back pain and build a foundation for a healthier, more active life.

Back Pain Relief Through Exercise

Movement is medicine. Regular exercise is one of the most effective ways to achieve long-lasting back pain relief. Here are a few safe, highly recommended stretches:

  • Knee-to-chest stretch – Lie on your back with your knees bent. Bring one knee toward your chest while keeping the other leg extended or bent. Hold the stretch, then slowly lower your leg back to the starting position and repeat with the other leg. This releases tension in the lower back.
  • Piriformis stretch – eases pressure on the sciatic nerve.
  • Kneeling lunge stretch – loosens tight hip flexors.
  • Neck and shoulder stretches – improve posture and reduce upper-body strain.

⚠️ Avoid quick, jerky movements or deep neck rolls, which can make things worse.

Understanding Low Back Pain

Low back pain can develop suddenly or gradually. Some common causes include:

  • Muscle strains and sprains from lifting or twisting.
  • Herniated discs can cause nerve compression affecting the spinal cord.
  • Sciatica, a sharp, radiating pain down the legs.
  • Poor posture or sitting for long hours.
  • Issues with spinal bones or an underlying medical condition can also contribute to low back pain.

The pain levels can range from mild to severe, sometimes making it hard to walk, sleep, or even sit comfortably.

Pain Relievers: When to Use Them

Pain relievers can be very helpful during flare-ups, especially for moderate pain. Anti-inflammatory medications reduce swelling, making it easier to stay active. But remember: they don’t “fix” the problem. Using medication as a crutch without addressing posture, strength, or flexibility often leads to recurring pain.

Why Back Pain Keeps Coming Back

If you’ve treated back pain before only for it to return, you’re not alone. Chronic back pain is often caused by:

  • Weak core and back muscles.
  • Repetitive strain from daily activities.
  • Uncorrected poor posture.

If your pain lasts more than several weeks or pain persists despite treatment, it may be considered chronic and require further evaluation.

That’s why learning how to heal lower back pain requires both short-term treatment and long-term prevention.

Relieve Lower Back Pain at Home

Want to start feeling better right away? Here are some simple ways to relieve low back pain naturally:

  • Stay lightly active—avoid prolonged bed rest.
  • Stretch daily, especially after sitting for long periods.
  • Practice proper lifting techniques.
  • Use ergonomic chairs or standing desks.
  • Sleep on a mattress that supports spinal alignment, and consider adjusting your sleeping posture to reduce discomfort.

Small, consistent changes can make a big difference.

Alternative Therapies for Lower Back Pain

While physical therapy is a cornerstone of back pain relief, many people find additional benefit from alternative therapies. Acupuncture, for example, uses fine needles to stimulate specific points on the body, which can help relieve pain and promote healing. Massage therapy is another popular option, as it relaxes tight muscles and increases blood flow to the lower back, easing discomfort and supporting recovery.

Chiropractic care focuses on spinal health through gentle adjustments and can help relieve lower back pain caused by misalignment or nerve pressure. Mind-body practices like yoga and Pilates are also excellent for improving posture, strengthening core muscles, and reducing stress—all of which contribute to back pain relief. Before starting any new therapy, it’s wise to consult with a healthcare professional to ensure it’s safe and appropriate for your specific needs.

Poor Posture and Back Pain

A few things damage the spine, like poor posture. Slouching at your desk, hunching over your phone, or standing with your weight unevenly distributed places extra strain on your muscles and joints. Over time, this leads to both discomfort and structural problems.

Carrying extra weight can increase the strain on your spine and worsen the effects of poor posture.

The fix? Train yourself to sit tall, engage your core, and keep your shoulders relaxed but not rounded.

Risk Factors for Lower Back Pain

Certain habits and conditions increase your risk of back problems, such as:

  • Sedentary lifestyle.
  • Jobs involving heavy lifting or long sitting hours.
  • Excess body weight.
  • High stress levels.
  • Previous injuries or spinal conditions.

These risk factors can trigger pain signals in the lower back, leading to discomfort and dysfunction.

Recognizing these risk factors helps you stay one step ahead.

Warning Signs You Shouldn’t Ignore

Most back pain is manageable at home, but there are red flags you shouldn’t overlook:

  • Pain that lasts more than a few weeks.
  • Numbness, tingling, or weakness in your legs.
  • Pain radiating down one or both legs (sciatica).
  • Sudden, severe pain after an accident.
  • Difficulty walking, standing, or sleeping.

If these warning signs appear, see a healthcare professional promptly.

Maintaining a Healthy Back for the Long Term

Keeping your back healthy is an ongoing commitment that pays off in every aspect of daily life. To reduce your risk of chronic low back pain, focus on maintaining a healthy weight and staying active with regular exercise like walking, swimming, or gentle stretching. Practicing good body mechanics—such as lifting with your legs, not your back, and avoiding heavy twisting—can help protect your spine from injury.

Lifestyle choices matter, too. Getting enough restful sleep, managing stress, and steering clear of smoking all support spinal health and lower your chances of developing persistent back pain. Regular check-ups with your healthcare provider can catch potential issues early, helping you avoid chronic low back pain and stay on track for a pain-free, active future. By making these habits part of your routine, you’ll give your back the best chance to stay strong and resilient for years to come.

Final Thoughts on How to Heal Lower Back Pain

Learning how to heal lower back pain isn’t just about short-term comfort—it’s about fixing the root cause, building strength, and preventing recurrence. With the right mix of physical therapy, exercise, posture correction, and home strategies, you can take control of your recovery.

At Pelvis NYC, our specialists create personalized programs to help you heal safely and effectively.

👉 Book your FREE 15-minute teleconsultation today at www.pelvis.nyc and take the first step toward a pain-free life.

Symptoms of Chronic Constipation You Should Never Ignore

Symptoms of Chronic Constipation You Should Never Ignore

Did you know that chronic constipation is often linked to a weak pelvic floor? Strengthening your pelvic floor muscles through targeted exercises can help restore normal bowel movements and significantly reduce the symptoms of constipation.

The management of chronic constipation involves a range of approaches, including dietary changes, lifestyle modifications, and medical treatments, in addition to pelvic floor exercises.

In this guide, we’ll explore how pelvic floor exercises can improve chronic constipation in adults, how to recognize constipation symptoms, and what treatment options—like biofeedback therapy—can help you regain control of your digestive health.

Understanding Bowel Movements: What’s Normal?

Bowel movements are a critical marker of digestive health. The frequency, consistency, and ease of your bowel movements can reveal much about your gastrointestinal system. In clinical practice, both stool frequency and stool form are important markers used to assess bowel health.

Healthy Bowel Movements Typically Involve:

  • 1–3 movements per day or every other day (individual variations are normal)
  • Smooth, soft stools (like a sausage or snake)
  • Minimal straining or urgency
  • A sense of full evacuation

Disruptions in this routine—especially infrequent or difficult bowel movements—may indicate chronic constipation or underlying bowel disease.

What Is Chronic Constipation in Adults?

Chronic constipation in adults is a long-term condition marked by difficulty passing stool, hard or dry stools, and a sense of incomplete evacuation. It affects millions and becomes more common with age, especially in women and people with sedentary lifestyles. The prevalence and risk factors of chronic constipation include demographic factors such as age and gender, as well as lifestyle factors like low physical activity and poor dietary habits. Functional constipation is a primary form of constipation that occurs without secondary medical causes, while idiopathic constipation and chronic idiopathic constipation refer to cases where no clear underlying cause can be identified.

Common Chronic Constipation Symptoms Include:

  • Fewer than three bowel movements per week
  • Hard, dry, or lumpy stools
  • Painful defecation
  • A feeling of blockage in the rectum
  • A sense that you can’t completely empty your bowels

Causes and Risk Factors for Chronic Constipation

Chronic constipation doesn’t have a single cause—it’s often the result of several overlapping factors. One of the most common risk factors is a low-fiber diet, which can slow down the movement of stool through the digestive tract. Not drinking enough fluids and leading a sedentary lifestyle can also contribute to sluggish bowel habits.

Certain medical conditions, such as irritable bowel syndrome (IBS), diabetes, and hypothyroidism, are known to increase the risk of developing chronic constipation. Medications are another important consideration; blood pressure medications, opioid painkillers, and some antihistamines can all slow colonic motility and worsen constipation symptoms.

Other risk factors include being over the age of 65, female gender, and a personal or family history of constipation, especially if it began in childhood. Recognizing these risk factors is key to identifying patients who may benefit from early intervention and targeted strategies to treat constipation before it becomes severe.

Diagnosis and Testing: How Is Chronic Constipation Identified?

Diagnosing chronic constipation starts with a thorough review of your symptoms and medical history. Patients with chronic constipation often report infrequent bowel movements, hard or lumpy stools, and difficulty passing stool. Your healthcare provider will likely perform a physical examination, which may include a digital rectal examination. This can help to check for issues like rectal prolapse or faecal impaction.

To rule out more serious conditions such as colon cancer or inflammatory bowel disease, your doctor may recommend diagnostic tests like colonoscopy, sigmoidoscopy, or imaging studies. Specialized tests, such as anorectal manometry or the balloon expulsion test, can help assess how well your pelvic floor muscles and rectum are functioning and identify problems like dyssynergic defecation.

A diagnosis of chronic constipation is typically made when you experience two or more of the following:

  1. Straining during bowel movements
  2. Hard or lumpy stools
  3. A sensation of incomplete evacuation
  4. Fewer than three bowel movements per week.

These diagnostic steps help ensure that any underlying bowel disease is identified and that your treatment plan is tailored to your specific needs.

The Link Between Constipation and the Pelvic Floor

When you strain repeatedly to pass stool, you may unknowingly damage your pelvic floor muscles. These muscles support your bowel, bladder, and reproductive organs. Over time, excessive pressure can lead to pelvic floor dysfunction, which worsens constipation instead of relieving it. Pelvic floor dysfunction can result in evacuation disorders, where impaired coordination of the rectal and pelvic floor muscles makes it difficult to evacuate stool. It is also often associated with anorectal disorders—structural or functional problems in the anorectal region—that further impair normal stool passage.

How Pelvic Floor Dysfunction Affects Bowel Health:

  • Impairs coordination needed for proper colonic transit (movement of stool through the colon)
  • Disrupts the relaxation and contraction of anal and rectal muscles
  • Increases risk of faecal impaction, a severe form of blockage where hardened stool becomes stuck in the rectum

Pelvic Floor Exercises for Chronic Constipation Relief

Pelvic floor exercises, often called Kegels, involve clenching and releasing the muscles that control urination and defecation. When done correctly, they help restore proper function and coordination of the pelvic muscles, improving chronic constipation over time.

However, identifying the correct muscle group is key. Without proper guidance, these exercises may be ineffective.

experts for chronic constipation

Biofeedback Therapy for Chronic Constipation

While pelvic floor exercises are a powerful first step, many patients achieve even greater success when combining them with biofeedback therapy—a highly effective, evidence-based approach that helps retrain the muscles for smooth, coordinated bowel movements. The effectiveness of biofeedback therapy is often measured by clinical response, which includes improvements in symptoms and increased bowel movement frequency.

What Is Biofeedback Therapy?

Biofeedback uses sensors and computer-guided visual or auditory feedback to help patients retrain pelvic muscles. During the session:

  • You’ll learn to identify and relax the appropriate muscles
  • You’ll receive real-time feedback on how well you’re performing the exercises
  • Therapists will guide you to improve coordination for smoother bowel movements

This therapy has shown significant success in treating chronic constipation in adults, especially when linked to pelvic floor dysfunction.

When to Seek Professional Help:

If you’re unsure how to activate your pelvic floor muscles or aren’t experiencing relief, it’s essential to consult a trained physical therapist. At PELVIS.NYC, Dr. Adam Gvili PT, DPT, customizes treatment plans for each patient, using evidence-based techniques including biofeedback therapy, manual therapy, and behavioral training.

Other Causes of Constipation to Consider

Irritable Bowel Syndrome (IBS) Irritable bowel syndrome, particularly IBS-C (constipation-dominant), is a common functional gastrointestinal disorder that leads to abdominal pain, bloating, and irregular bowel habits.

Inflammatory Bowel Disease (IBD) Unlike IBS, inflammatory bowel disease involves structural inflammation of the digestive tract and includes conditions like Crohn’s disease and ulcerative colitis. Though more commonly associated with diarrhea, some forms can cause chronic constipation.

Bowel Disease and Colonic Transit Slow colonic transit is a key factor in many forms of bowel disease. A sluggish colon may prevent the movement of stool, leading to constipation that’s unresponsive to diet or fiber alone.

Diet and Lifestyle Tips for Constipation in Adults

A well-balanced diet rich in dietary fiber plays a significant role in managing constipation. Aim for 25–30 grams of fiber daily from whole grains, fruits, and vegetables. Adequate fluid intake is also essential for maintaining normal bowel movements and preventing chronic constipation.

A high fiber diet and dietary fiber treatment are considered first-line strategies for managing chronic constipation, with soluble fiber (such as psyllium) being particularly effective in improving symptoms. Hydration and regular physical activity are also crucial.

  • Use stimulant laxatives only as directed by a healthcare provider and never for weight loss, as they do not promote actual weight reduction.

If you experience unintentional weight loss or fecal incontinence, these may indicate more serious underlying conditions and should prompt medical evaluation.

Additional Tips:

  • Avoid over-reliance on laxatives
  • Stay hydrated with at least 8 glasses of water per day
  • Schedule time for daily, unhurried bowel movements
  • Use a footstool to elevate your knees while on the toilet for optimal alignment

Preventing Complications of Chronic Constipation

Taking steps to prevent complications from chronic constipation is essential for long-term digestive health. Simple lifestyle changes, such as increasing your intake of high fiber foods, drinking plenty of water, and staying physically active, can help relieve constipation and reduce the risk of more serious problems. Avoiding foods that can worsen constipation—like processed foods and excessive dairy—while focusing on dietary fiber can make a significant difference.

Medical treatments, including stool softeners, over the counter laxatives, or pelvic floor therapy, may be recommended if lifestyle changes alone aren’t enough. Addressing underlying health issues, such as diabetes or thyroid disorders, and managing stress through relaxation techniques can also help prevent complications.

By staying proactive, you can lower your risk of developing issues like rectal prolapse, faecal impaction, or even colorectal cancer. Regular check-ins with your healthcare provider ensure that your symptoms are monitored and your treatment plan is adjusted as needed, helping you maintain healthy bowel habits and overall well-being.

When to Worry: Faecal Impaction and Severe Cases

In severe or untreated cases of chronic constipation, faecal impaction may occur, requiring urgent medical intervention. Symptoms may include nausea, vomiting, rectal bleeding, and inability to pass gas or stool. If you suspect this condition, seek professional care immediately.

In cases of severe or persistent constipation, colorectal cancer screening may be recommended to rule out serious underlying conditions.

Let Us Help You Break the Cycle

At PELVIS.NYC, we understand that no two cases of constipation are alike. Whether your symptoms stem from a weak pelvic floor, slow colonic transit, or a functional bowel disease, our approach is personalized and effective. We evaluate and treat conditions affecting the colon and rectum, including subtypes such as normal transit constipation and slow transit constipation.

Ready to Start Healing?

Book a free 15-minute teleconsultation with Dr. Adam Gvili today and begin your journey toward digestive health.

👉 Click to schedule.

Pelvis NYC team for chronic constipation

Final Thoughts

Chronic constipation in adults is more than just an inconvenience—it’s a signal that something in your digestive or pelvic system may be off-balance. With the right diagnosis, a tailored therapy plan, and consistent support, you can restore normal bowel movements and take back your quality of life.

Related blog: Addressing Sudden Urge to Poop in Men

Why Men Experience Lower Abdominal Pain After Vasectomy?

Why Men Experience Lower Abdominal Pain After Vasectomy?

A man may opt for a vasectomy if he does not want to impregnate someone in his lifetime. However, most of them experience lower abdominal pain after vasectomy as a response to their body’s fast healing, resulting in inflammation and secondary pain. But what is it really like after a vasectomy procedure? Is the pain bearable? Is there relief?

Continue reading to find out.

Overview of Post-Vasectomy Pain Syndrome

Post-vasectomy pain syndrome (PVPS) is a continuous or intermittent testicular pain lasting more than three months. About 1–2% of men who undergo a vasectomy experience this discomfort, which leads to some form of medical treatment.

In some cases, the pain may begin within one month following the procedure and continue for years following the surgery. Pain can be ongoing and short-lived and resolved with anti-inflammatory tablets, but can also become chronic. It can be mild to moderate chronic pain, and in rare cases, patients may experience debilitating pain. But do not worry because there are treatments used for PVPS.

The experience of lower abdominal pain after a vasectomy is only indicative of your body’s response to the healing process, which includes some inflammation and secondary pain. Typically, it is mild discomfort for 5-10 days and occurs in the scrotum area, but can also affect the groin or lower abdomen.

What Symptoms Should You Watch for After a Vasectomy?

If you’ve had a vasectomy and you’re still dealing with pain months later, you might be wondering what’s going on. You could be experiencing something called Post-Vasectomy Pain Syndrome (PVPS)—and while it’s rare, it’s real. The symptoms can range from mildly annoying to seriously disruptive, so it’s important to pay attention to what your body’s telling you.

Here are some common PVPS symptoms to look out for:

  • Ongoing testicular or scrotal pain: If the ache just won’t go away and it’s been more than a few months, it’s worth getting checked.
  • Lower abdominal pain: That dull, nagging pain in your lower belly or groin area could be related.
  • Pain during physical activity: Whether you’re working out, lifting something heavy, or just on your feet for too long—if it hurts, take note.
  • Discomfort during sex: Painful erections or discomfort during intimacy are common red flags.
  • Pain after ejaculation: Some men describe a sharp or lingering pain after climax, which can affect their quality of life.
  • Erectile dysfunction: Chronic pain can take both a physical and mental toll, making it harder to get or maintain an erection.

If any of these sound familiar, you’re not alone—and you’re not imagining things. It’s a good idea to reach out to a urologist who understands PVPS and can help you explore your treatment options. Catching it early can make a big difference.

Factors causing PVPS

In terms of the symptoms exhibited and the treatment required, there are a few main causes for testicular pain following vasectomy:

Neurogenic: Some chronic pain is caused by sperm build-up in the vas deferens, trapped in fibrous tissue. This can cause intense pain during activities that agitate your scrotum, such as running or cycling.

Granuloma: Sometimes sperm leakage occurs during or shortly after a vasectomy, causing a lump and swelling.

Epididymitis: Epididymitis results from an increase in pressure inside the epididymis, which is a tube that transports sperm from the testes to the urethra. Normally, men continue to produce sperm after a vasectomy, and the cells are reabsorbed by the body. However, they can develop a buildup of sperm in their vas deferen,s which can cause the epididymis to burst under pressure.

Testicular Torsion: If left untreated, PVPS can twist the spermatic cord that carries blood to the scrotum and cut off the blood supply.

Why Do Men Experience Lower Abdominal Pain After a Vasectomy?

It’s not uncommon for men to experience lower abdominal pain after a vasectomy, and there are a few reasons why this can happen. In most cases, the discomfort is temporary and part of the normal healing process—but for some, it may signal a more persistent issue like Post-Vasectomy Pain Syndrome (PVPS).

Common Causes of Lower Abdominal Pain After Vasectomy:

  1. Post-surgical inflammation: After a vasectomy, your body initiates a healing response. Mild swelling or irritation can sometimes radiate to the lower abdomen or groin area, causing discomfort.
  2. Nerve irritation or injury: Small nerves in the spermatic cord or pelvic region can become irritated during the procedure. It can lead to pain that may be felt higher up in the lower abdomen.
  3. Congestion pain: After the vas deferens is sealed, sperm may continue to build up, causing pressure or congestion in the epididymis. This can lead to a dull ache that radiates to the abdominal area.
  4. Referred pain: Sometimes, pain originating in the testicles or scrotum is “referred” or felt in the lower abdomen due to how nerves are interconnected in that area of the body.
  5. Infection or hematoma (rare): In some cases, post-operative complications like infection or internal bleeding (hematoma) can lead to localized pain that spreads toward the lower belly.

When to Seek Help

If the pain is sharp, increasing, or lasts more than a few weeks, it’s a good idea to check in with your urologist. Especially if it’s affecting your daily life, sex drive, or causing concern—early intervention can prevent chronic issues.

Diagnosis of PVPS

PVPS is different from acute postoperative pain. Most PVPS patients suffer from persistent orchalgia for greater than three months after surgery. However, some patients experience pain while ejaculating, having intercourse, or erection. 

The diagnosis of PVPS must be an exclusion diagnosis. A three-month follow-up history and physical are recommended after surgery. A scrotal ultrasound using color-flow Doppler is administered to every patient suffering from chronic testicular pain. It is recommended to obtain a routine urinalysis, a urine culture, and a semen culture to determine whether there is an infection.

Treatment Options for Post-Vasectomy Pain Syndrome (PVPS)

Post-Vasectomy Pain Syndrome (PVPS) is a long-term complication that affects a small percentage of men following a vasectomy. Characterized by chronic testicular pain lasting longer than three months, PVPS can significantly impact quality of life. The good news is that there are several effective treatment options for PVPS, ranging from conservative approaches to advanced surgical procedures.

1. Non-Surgical and Conservative Treatments

Many men with mild to moderate PVPS find relief through conservative, non-invasive methods:

  • Over-the-counter pain relief: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen help reduce swelling and manage pain.
  • Scrotal support: Wearing supportive underwear minimizes movement and pressure, which can ease discomfort.
  • Physical therapy: Specialized pelvic floor physical therapy can address muscle tension and nerve irritation.
  • Nerve blocks: Local anesthetic or corticosteroid injections into the spermatic cord can reduce nerve-related pain and serve as a diagnostic tool.

These methods are often the first line of treatment for chronic testicular pain after vasectomy.

2. Medication-Based Treatments

When conservative measures aren’t sufficient, doctors may prescribe medications targeted at nerve-related pain:

  • Neuropathic pain medications: Drugs like gabapentin, pregabalin, or tricyclic antidepressants (e.g., amitriptyline) help manage chronic nerve pain.
  • Hormonal therapy: In select cases, medications that reduce testosterone may be used to decrease testicular activity and reduce pain.

These treatments are particularly useful when pain is thought to be neuropathic or hormonal in nature.

3. Surgical Treatment for PVPS

For persistent, severe pain, surgical intervention may be necessary:

  • Microsurgical denervation of the spermatic cord (MDSC): A precise procedure that targets and severs specific nerves to stop the pain signal.
  • Vasectomy reversal: In cases where pressure buildup or sperm congestion is suspected, reversing the vasectomy may relieve symptoms.
  • Epididymectomy or orchiectomy: As a last resort, surgical removal of the epididymis or testicle may be considered, especially when all other options have failed.

Surgical options are typically recommended only after conservative and medication-based therapies have been exhausted.

4. Mental Health and Supportive Care

Living with chronic post-vasectomy pain can take a toll on mental health. Psychological counseling, pain management therapy, and support groups can be essential parts of a holistic treatment plan.

Physical Therapy as a non-surgical treatment for PVPS

Pelvic floor physical therapy can also be beneficial in the treatment of PVPS. People who undergo a vasectomy may experience significant pelvic pain. Due to the abnormal testicular pain they are experiencing, their pelvic muscles tend to tighten up. A physical therapist can teach them pelvic floor exercises to relax those muscles and take the strain off of other areas, such as the scrotum and testicles.

Pelvic floor therapy relieves pelvic pain and discomfort associated with testicular pain by relaxing the scrotum and testicle muscles. By using this therapy, you may be able to increase blood flow and relieve some symptoms.

At PELVIS NYC, we have successful treatments for post-vasectomy pain. By alleviating their symptoms, we enable them to carry on with their daily lives. We listened carefully to identify the source of their pain and formulate the best possible treatment.

Pelvis NYC Team for people experiencing Why Men Experience Lower Abdominal Pain After Vasectomy?

If you have more questions, visit www.pelvis.nyc and have your free 15-minute teleconsultation.


You might get interested in reading: Do You Still Ejaculate After a Vasectomy?

Related Blog: Real Story of How We Help Our Patient Recover from Lower Abdominal Pain

Ease Epididymitis Symptoms: A Proven Approach

Ease Epididymitis Symptoms: A Proven Approach

Introduction to the Male Reproductive System

The male reproductive system is a sophisticated network designed for the production, storage, and transport of sperm. Key components include the testes, epididymis, vas deferens, prostate gland, urethra, and bladder. The epididymis, a tightly coiled tube located at the back of each testicle, is essential for storing and maturing sperm before they travel through the vas deferens during ejaculation.

This system is closely linked to the urinary tract, making it susceptible to various infections. Urinary tract infections and sexually transmitted infections are among the most common causes of inflammation in the male reproductive system, including epididymitis. Because the epididymis connects directly to both the urinary tract and the vas deferens, infections can easily spread, leading to symptoms such as pain, swelling, and discomfort. Understanding how these organs work together is crucial for diagnosing and effectively treating conditions like epididymitis.

Male Reproductive System- epididymitis symptoms

Understanding Epididymitis

Epididymitis is a common condition involving inflammation of the epididymis—the coiled tube located behind each testicle that stores and transports sperm. Epididymitis is characterized by an inflammatory process affecting the epididymis, which leads to pain and swelling.

It’s one of the leading causes of testicular pain in men under 50, yet it often goes undiagnosed or misdiagnosed.

According to a 2023 study published in the Journal of Urology, approximately 600,000 cases of epididymitis are reported annually in the U.S. Early detection and treatment are key to avoiding complications like epididymo-orchitis, infertility, and chronic pelvic pain.

Epididymitis Symptoms

Recognizing the symptoms early helps prevent progression and complications. Common signs include:

  • Pain in the scrotum
  • One-sided scrotal pain or swelling
  • Redness or warmth in the scrotum
  • Painful urination or frequent urge to urinate
  • Penile discharge (white, yellow, or green)
  • Fever and chills (in acute cases)
  • Discomfort during intercourse or ejaculation
  • Fluid buildup around the testicle (hydrocele)

In some cases, pain may radiate to the lower abdomen, which can help differentiate between various acute scrotal conditions.

In chronic epididymitis, symptoms may persist for over six weeks, usually as dull, aching pain in the testicle or groin.

⚠️ Testicular torsion may mimic epididymitis but is a medical emergency. Immediate evaluation is essential for sudden, severe testicle pain.

Types of Epididymitis

Acute Epididymitis

  • Lasts < 6 weeks
  • Often caused by bacterial infections, including those caused by sexually transmitted pathogens such as Chlamydia trachomatis and gonococcal infection (Neisseria gonorrhoeae), or by urinary tract infections (UTIs)
  • May present with fever, scrotal tenderness, and swelling

Presumptive treatment is often initiated based on the most likely causative organisms before laboratory confirmation.

Chronic Epididymitis

  • Lasts >6 weeks
  • May result from prior infections, trauma, or autoimmune reactions
  • Symptoms are less intense but persistent

📌 A 2024 study in European Urology Open Science found that chronic cases respond better to anti-inflammatories, pelvic floor therapy, and lifestyle adjustments than antibiotics alone.

Causes and Risk Factors

Common Causes of Epididymitis

Understanding the underlying causes of epididymitis is key to preventing recurrence and tailoring effective treatment. While the causes can vary by age, lifestyle, and health history, here are the most common culprits:

1. Sexually Transmitted Infections (STIs)

In sexually active men under 35, Chlamydia trachomatis and Neisseria gonorrhoeae are the most frequent infectious agents. These bacteria ascend through the urethra, prostate, and vas deferens to infect the epididymis.

  • Often linked to unprotected sex or multiple sexual partners.
  • STIs may be asymptomatic, so routine screening is essential.

2. Urinary Tract Infections (UTIs)

Escherichia coli (E. coli) and other non-sexually transmitted bacteria can cause epididymitis, particularly in older men or those with urinary tract problems.

  • These bacteria can migrate from the bladder or urethra, especially when urination is obstructed or incomplete.

3. Tuberculosis (TB)

Though rare, tuberculous epididymitis can occur when Mycobacterium tuberculosis spreads from another site of infection (commonly the lungs).

  • Often seen in individuals with weakened immune systems or from TB-endemic areas.
  • Can cause chronic inflammation and granuloma formation in the epididymis.

4. Epididymo-Orchitis

In more severe infections, the inflammation can spread from the epididymis to the testicle, a condition known as epididymo-orchitis.

  • Often presents with more intense scrotal pain, swelling, and fever.
  • Can lead to testicular damage or infertility if untreated.

5. Chemical Epididymitis

This non-infectious form occurs when urine flows backward into the epididymis, often due to heavy lifting, straining, or trauma.

  • Associated with conditions like reflux of sterile urine from the bladder into the vas deferens.

Risk Factors of Epididymitis

Several factors can increase a man’s risk of developing epididymitis. Awareness and prevention can significantly reduce the chances of infection or recurrence.

1. Unprotected Sex or Multiple Partners

  • Engaging in unprotected sexual activity increases exposure to STIs like chlamydia and gonorrhea, which are leading causes of epididymitis in younger men.
  • Regular STI screening and condom use significantly reduce this risk.

2. Use of Urinary Catheters or Medical Devices

  • Indwelling catheters or intermittent self-catheterization can introduce bacteria into the urinary tract, especially in hospitalized or elderly patients.
  • Any foreign object in the urinary system increases infection risk.

3. Recent Pelvic or Urological Surgery

  • Procedures such as prostate surgery, vasectomy, or cystoscopy may disrupt normal urinary flow or introduce pathogens.
  • Post-operative inflammation can also mimic or trigger epididymitis.

4. Urinary Tract Structural Abnormalities

  • Conditions like urethral strictures, prostatic hypertrophy, or congenital malformations may impair urine flow and increase the chance of retrograde bacterial ascent.
  • Chronic retention or incomplete bladder emptying compounds the risk.

5. Use of Certain Medications (e.g., Amiodarone)

  • The antiarrhythmic drug amiodarone has been associated with a rare side effect of chemical epididymitis, especially at doses >200 mg/day.
  • Typically non-infectious and resolves upon discontinuation.

6. History of Prostatitis or Tuberculosis

  • Chronic or recurrent prostatitis (inflammation of the prostate) can serve as a reservoir for bacteria that spread to the epididymis.
  • Past or latent tuberculosis infections should raise suspicion in persistent or unusual cases.

7. High-Impact Physical Activities

  • Activities like long-distance cycling, heavy lifting, or motorcycling can irritate or traumatize the perineal and scrotal area, leading to inflammation or increased susceptibility to infection.
  • Wearing protective gear and taking regular breaks can help reduce the risk.

Diagnosing Epididymitis: How Is It Identified

Physical Examination

Your doctor may assess:

  • Swelling, tenderness, or lumps in the scrotum
  • Penile discharge
  • Enlarged or tender prostate (via rectal exam)

Diagnostic Tests

  • Urinalysis and urine culture: To identify bacterial causes
  • STI screening: To test for chlamydia or gonorrhea
  • Scrotal ultrasound: To distinguish epididymitis from testicular torsion or tumors
  • Blood tests: To assess for infection or inflammation

Differential Diagnosis: Ruling Out Other Conditions

Diagnosing epididymitis requires careful consideration, as its symptoms can overlap with several other serious conditions. One of the most critical distinctions is between epididymitis and testicular torsion—a surgical emergency that can threaten testicular viability if not treated promptly. Both conditions can present with acute scrotal pain, but testicular torsion typically involves sudden, severe pain and requires immediate intervention.

Other conditions that may mimic the symptoms of epididymitis include orchitis (inflammation of the testicle), testicular cancer, testicular infarction (loss of blood supply to the testicle), and mumps orchitis, especially in younger males. A thorough medical history, including recent sexual activity, number of sexual partners, and any previous urinary tract infections, helps identify risk factors and guide the diagnostic process.

A comprehensive physical examination is essential, often followed by diagnostic tests such as urinalysis, urine culture, and scrotal ultrasound. These steps help rule out other causes of scrotal pain and confirm the diagnosis of epididymitis. Considering all possible differential diagnoses ensures that patients receive the correct treatment and avoid complications from missed or delayed diagnoses.

Epididymitis Diagnosed: What to Expect Next

Once epididymitis is diagnosed, the primary goal is to treat the underlying bacterial infection and manage symptoms. Most patients will begin a course of antibiotic treatment tailored to the specific bacteria identified, which is crucial for resolving the infection and preventing complications. In addition to antibiotics, doctors often recommend supportive measures to relieve discomfort, such as resting, applying ice packs to the scrotum, and elevating the scrotum to reduce swelling.

For those experiencing severe pain, pain medications or anti-inflammatory drugs may be prescribed. It’s important to complete the entire course of antibiotics, even if symptoms improve, to ensure the infection is fully eradicated. Patients should also monitor for signs of complications, such as epididymo-orchitis, and seek medical attention if symptoms worsen or fail to improve. Regular follow-up appointments help ensure that the infection has cleared and that no further treatment is needed.

Bacterial Epididymitis: Treating the Root Cause

When caused by bacteria, especially in younger men, prompt antibiotic treatment is essential to prevent progression to severe infection and to support overall disease control. Supportive measures such as scrotal elevation, cold packs, and activity limitation are also recommended to reduce pain and swelling.

Standard Treatment Includes:

  • Antibiotics: Ciprofloxacin, doxycycline, or ceftriaxone depending on the pathogen
  • NSAIDs: To reduce inflammation and pain
  • Scrotal support: Elevation and cold packs for symptom relief
  • Sexual partner treatment: To prevent reinfection if STI is confirmed

The Role of Pelvic Floor Physical Therapy

While antibiotics remain the first line of treatment, pelvic floor physical therapy has shown promise in speeding up recovery, particularly in chronic or treatment-resistant cases.

Benefits of Physical Therapy:

  • Improves pelvic blood flow
  • Relieves pressure and muscular tension in the groin
  • Helps with urination and ejaculation-related pain
  • Reduces inflammation without side effects

💡 Clinical evidence suggests pelvic floor therapy improves outcomes when combined with medication for both acute and chronic cases.

how to improve epididymitis symptoms

How to Maintain a Healthy Male Reproductive System

Preventing epididymitis starts with proactive care of the male reproductive and urinary systems:

  • Practice safe sex and limit sexual partners
  • Stay hydrated and urinate regularly
  • Avoid prolonged sitting or repetitive groin trauma
  • Seek care for urinary symptoms early
  • Incorporate pelvic floor exercises under professional supervision

Maintaining a healthy male genitourinary tract is essential to reduce the risk of infections and inflammation that can lead to conditions like epididymitis.

Complications of Untreated Epididymitis

If not addressed, epididymitis can lead to:

  • Testicular torsion
  • Infertility: Due to scarring or blocked sperm flow
  • Chronic pain
  • Abscess formation
  • Increased risk of testicular cancer (in rare cases)

Severe or untreated cases may also result in complications involving the spermatic cord, such as abscess formation or impaired blood flow.

Prognosis: What’s the Outlook?

The outlook for most men diagnosed with epididymitis is positive, especially when treatment is started early. With appropriate antibiotic therapy and supportive care, symptoms typically resolve within a few weeks. However, if left untreated, epididymitis can lead to more serious complications, including epididymo-orchitis, testicular infarction, and even infertility due to scarring or damage to the reproductive tract.

Certain individuals, such as those with chronic epididymitis or underlying conditions like human immunodeficiency virus (HIV), may be at increased risk for persistent symptoms or complications. In these cases, ongoing management and lifestyle modifications may be necessary to control symptoms and prevent recurrence. Regular follow-up with a healthcare provider is essential to monitor recovery, address any lingering issues, and reduce the risk of long-term damage to the male reproductive system. Practicing safe sex and seeking prompt medical care for urinary or reproductive symptoms are key steps in maintaining reproductive health and preventing future episodes.

When to Seek Medical Help

Seek immediate care if you experience:

  • Sudden, severe testicular pain
  • Fever, chills, or nausea with groin pain
  • Discharge from the penis
  • Swelling that doesn’t improve in 48 hours
  • Difficulty urinating

Your Next Step: Expert Help Is Available

At Pelvis NYC, we specialize in helping men manage and recover from epididymitis through science-backed pelvic floor therapy. We’ve helped countless patients ease their symptoms, restore function, and prevent recurrence.

epididymitis symptoms: who can help

👉 Schedule your FREE 15-minute teleconsultation with one of our pelvic health experts today.

✅ Summary: Key Takeaways

Pudendal Nerve Entrapment: How Physical Therapy Can Help?

Pudendal Nerve Entrapment: How Physical Therapy Can Help?

If you’re a man experiencing unexplained pelvic discomfort, pain during sitting, or persistent urinary or sexual issues, you might be dealing with a little-known condition called pudendal nerve entrapment (PNE). PNE occurs when an entrapped pudendal nerve leads to nerve compression, resulting in chronic pelvic pain. It’s often misunderstood, misdiagnosed, and—worst of all—left untreated.

This blog will walk you through what pudendal nerve entrapment is, what causes it, how to identify it, and most importantly, how physical therapy can play a major role in recovery.

What Is Pudendal Nerve Entrapment?

The pudendal nerve is one of the main nerves in the pelvis. It runs from the lower back through a small canal in the pelvis (called Alcock’s canal) and branches out to serve the genitals, anus, and perineum (the area between the genitals and anus).

The pudendal nerve supplies motor and sensory innervation to the perineal region. It ncludes the external genitalia and anal sphincter, playing a crucial role in continence, sensation, and sexual function. It controls sensation and some muscle movements in that region, including the pelvic floor.

“The main branches of the pudendal nerve include the perineal branch, dorsal nerve, and inferior anal nerve. The perineal branch innervates the perineal muscles and skin, the dorsal nerve provides sensation to the penis in males and the clitoris in females, and the inferior anal nerve supplies motor innervation to the external anal sphincter and sensory innervation to the anal canal.”

When this nerve becomes compressed, irritated, or entrapped—often between ligaments or by tight muscles in the pelvis—it can lead to a painful condition called pudendal neuralgia. Pudendal nerve compression is a common cause of these symptoms. The resulting nerve pain can feel like burning, stabbing, aching, or numbness in the genitals, perineum, or rectum.

After passing through Alcock’s canal, the pudendal nerve is susceptible to entrapment, which can result in pudendal canal syndrome—a specific form of nerve entrapment within the pudendal canal.

Though it’s not widely recognized, pudendal nerve entrapment can affect both men and women. Symptoms of pudendal neuralgia may include genital numbness, sexual dysfunction, and bladder or bowel issues. Men, however, often report symptoms like:

  • A dull or sharp ache in the perineum or lower pelvis
  • A feeling of “sitting on a golf ball” or lump in the groin
  • Erectile dysfunction that doesn’t respond to typical treatments
  • Urinary urgency, frequency, or incomplete emptying
  • Pain that worsens while sitting and improves when standing or lying down

Understanding Pudendal Nerve Pain (Pudendal Neuralgia)

Pudendal neuralgia is a type of chronic pain that stems from irritation or damage to the pudendal nerve. Chronic pudendal neuralgia is a long-term condition that can be associated with chronic perineal pain, pelvic and perineal pain, and other chronic pain syndromes. It may come and go—or it might persist and affect your quality of life significantly. Because symptoms vary and mimic other conditions, it’s frequently misdiagnosed as prostatitis, pelvic floor dysfunction, or even psychological distress.

The pain may be:

  • Sharp, burning, or electric-shock-like
  • Localized to the penis, scrotum, perineum, anus, or inner thighs, with pelvic and perineal pain being common manifestations
  • Made worse by activities like cycling, squatting, or even sitting

If left untreated, it can contribute to anxiety, depression, and withdrawal from physical or intimate activities. Some patients experience persistent pain despite treatment, which can significantly affect daily activities.

Symptoms of Pudendal Nerve Entrapment

Pudendal nerve entrapment can present with a wide range of symptoms, often making daily life challenging. The most common sign is persistent pelvic pain, which may feel like a burning pain or numbness in the genital and anal regions.

Many people notice that their discomfort worsens when sitting and eases when they stand or lie down. This nerve entrapment can also lead to urinary frequency, constipation, or even painful bowel movements, making routine activities uncomfortable.

Sexual dysfunction is another frequent concern, with some individuals experiencing erectile dysfunction, painful ejaculation, or a decrease in sexual sensation. Others may describe a sensation of having a foreign object in the rectum or vagina, which can be both distressing and confusing. Because these symptoms can significantly impact quality of life. It’s important to seek an accurate diagnosis and appropriate treatment for pudendal nerve entrapment as soon as possible.

Causes of Pudendal Neuralgia?

Pudendal nerve entrapment typically results from nerve compression, which occurs when the pudendal nerve is pinched or irritated along its path through the pelvis. This compression may happen between ligaments, within tight spaces like Alcock’s canal, or from overactive pelvic floor muscles.

Pudendal neuralgia caused by nerve entrapment is often due to compression of nerve fibers at specific anatomical sites, leading to neuropathic pain that can worsen with sitting. The nerve fibers transmit pain signals, and their compression results in the characteristic symptoms of pudendal nerve entrapment syndrome. Prolonged sitting—especially on hard surfaces—can lead to chronic compression of the perineal region, placing constant stress on the nerve. Activities such as cycling or horseback riding can produce similar effects through repetitive pressure and friction.

Trauma, including falls or accidents that impact the lower back or pelvis, may also lead to pudendal nerve entrapment syndrome, especially when there is bruising or misalignment in the pelvic structures. Pelvic trauma is a recognized cause, as it can damage or entrap the pudendal nerve and its fibers, resulting in pain and dysfunction.

Surgical procedures in the pelvic or perineal region can leave behind scar tissue, creating adhesions that further compress the nerve. Chronic straining due to constipation or heavy lifting may also contribute to gradual injury. In some individuals, the nerve may be compressed by benign or malignant tumors, cysts, or anatomical abnormalities, although these cases are rarer. Identifying and treating the root source of nerve compression—whether muscular, structural, or surgical—is key to relieving symptoms.

When Is Decompression Surgery Considered?

When conservative treatments like physical therapy, nerve blocks, and medication do not provide adequate relief, pudendal nerve decompression surgery may be recommended. This surgical procedure involves carefully releasing the pudendal nerve from the tissues or ligaments compressing it—most commonly between the sacrospinous and sacrotuberous ligaments or within Alcock’s canal. Surgical decompression, including minimally invasive approaches like laparoscopic pudendal nerve decompression, aims to relieve nerve compression and provide pain relief.

Decompression surgery is typically reserved for individuals who meet specific diagnostic criteria, such as a positive response to a diagnostic pudendal nerve block and persistent pain or symptoms that have not improved with non-invasive care. Persistent pain despite conservative treatment is a key reason for considering surgical intervention. Because this is a complex and delicate procedure, it should be performed by surgeons who specialize in pelvic neuropathies. While not everyone is a candidate, those who undergo successful decompression may experience significant relief from pain and a better quality of life. However, surgery is not a guaranteed solution and some patients may continue to experience persistent pain even after intervention, so it should be considered only after thorough evaluation and exploration of other options.

How Do You Diagnose Pudendal Nerve Entrapment?

The diagnosis of pudendal nerve entrapment is a structured process that involves clinical evaluation based on established criteria, neurophysiological testing, and advanced imaging techniques.

Diagnosing pudendal nerve entrapment can be tricky. It’s not something you can see on a typical X-ray or even a standard MRI. Instead, diagnosis relies on a combination of clinical symptoms, physical examination, and sometimes specialized tests. Pudendal nerve entrapment syndrome is recognized as a clinical entity with specific diagnostic criteria, including history, physical examination, nerve blocks, and imaging such as MRI or ultrasonography to confirm nerve entrapment and rule out other causes.

When considering what conditions to rule out, sacroiliac joint dysfunction and chronic pelvic pain syndrome should be included in the differential diagnosis, along with other causes of pelvic or perineal pain.

Here’s how the process typically goes:

1. Clinical Evaluation

A thorough history of your symptoms, especially their relation to sitting and whether they change with movement, gives the first clues. Pudendal neuropathy is a broader term that refers to nerve injury or damage from various causes, such as trauma, childbirth, or compression, and may or may not involve entrapment. Pudendal neuralgia caused by pudendal nerve entrapment is a specific subset, where nerve compression leads to chronic pain, and is diagnosed using established criteria. Doctors will often follow a set of diagnostic criteria, including:

  • Pain in the pudendal nerve area
  • Worsening pain when sitting
  • No pain when lying down or at night
  • No loss of sensation or motor function
  • Temporary relief from a diagnostic pudendal nerve block

2. Diagnostic Pudendal Nerve Block

A local anesthetic is injected near the pudendal nerve in a procedure known as pudendal nerve block injections, which serve as both a diagnostic and therapeutic tool. If your pain improves for a few hours or days afterward, it confirms the pudendal nerve is involved.

Pain medication, such as local anesthetics or corticosteroids, may be used in conjunction with these nerve block injections to provide temporary relief and reduce inflammation. This procedure also helps guide treatment options.

3. Imaging and Nerve Tests

High-resolution MRI, CT scans, or pelvic floor EMG may be used to rule out structural problems. These are less about seeing the nerve directly and more about excluding other conditions.

Can It Be Treated Without Surgery? Yes. Here’s How.

While decompression surgery is an option in more severe cases, non-surgical treatment is highly effective for many people—especially when started early. This is where pelvic floor physical therapy plays a central role.

Nerve Compression: How It Affects the Pudendal Nerve

Nerve compression is a key factor in the development of pudendal neuralgia and chronic pelvic pain. The pudendal nerve runs through the pelvic floor muscles and passes close to several structures, including the ischial spine, sacrospinous ligament, and the pudendal canal.

When these surrounding tissues—such as tight muscles, ligaments, or tendons—press on the nerve, it can lead to symptoms like numbness, tingling, and neuropathic pain in the pelvic area.

Prolonged or repeated compression can cause lasting nerve damage, resulting in chronic neuropathic pain that is often difficult to manage without targeted treatment. Understanding exactly where and how the pudendal nerve is being compressed is vital for choosing the right therapy. Whether that involves physical therapy to relax the pelvic floor, nerve blocks, or, in some cases, surgical intervention. By addressing nerve compression early, it’s possible to reduce pain and prevent long-term complications.

How Physical Therapy Helps Pudendal Neuralgia

pudendal nerve entrapment

In some cases, muscle relaxants may be prescribed alongside physical therapy to help reduce pelvic floor spasm and improve the effectiveness of treatment.

A specially trained pelvic health physical therapist can:

  • Teach you how to relax and lengthen the pelvic floor muscles
  • Guide you through exercises to strengthen weak muscles and improve coordination
  • Use manual therapy techniques to release tight or tender areas
  • Provide education on posture, body mechanics, and lifestyle modifications

✅ Release Pelvic Floor Tension

Overactive or tight pelvic floor muscles can compress the pudendal nerve. Therapy focuses on relaxing these muscles through manual techniques and guided exercises.

pudendal nerve entrapment

✅ Correct Postural Imbalances

Poor posture or spinal alignment may strain nerves in the pelvis. PT helps you improve posture to reduce unnecessary pressure on the nerve.

✅ Identify Aggravating Movements

A trained eye can spot which activities or movements irritate your nerve—and help you adjust or eliminate them safely.

✅ Teach Safe Stretching & Mobility

Stretches that target hip rotators, hamstrings, and the lower back can open up tight areas that may be indirectly affecting your nerve.

✅ Support Bladder and Bowel Function

Therapists can help you develop habits that prevent straining, such as healthy bathroom posture, breathing techniques, and dietary changes.

✅ Incorporate Pain Management Tools

Devices like TENS units can help block pain signals from the pudendal nerve. Therapists guide proper use for maximum benefit. In cases where pain is refractory to conservative treatments, advanced neuromodulation techniques such as sacral nerve stimulation and spinal cord stimulation may be considered. This can use for complex or persistent neuropathic pain conditions.

Physical therapy is especially helpful when nerve entrapment is caused by muscle compression, not a structural defect. It is something quite common in active men or those who sit for long periods. Persistent genital arousal disorder, which can be associated with pudendal nerve compression, may also benefit from similar pain management strategies.

Lifestyle Changes for Managing Pudendal Neuralgia

Making thoughtful lifestyle changes can have a significant impact on managing pudendal neuralgia symptoms and improving overall quality of life. One of the most effective strategies is to avoid activities that trigger or worsen pain. Examples are prolonged sitting or cycling. Using ergonomic cushions, taking frequent breaks, and adjusting your daily routine can help minimize discomfort.

Maintaining a healthy weight and engaging in regular, gentle exercise can support pelvic health. It can reduce pressure on the pudendal nerve. Practicing good posture and incorporating pelvic floor physical therapy into your routine can strengthen pelvic muscles. Additionally, it can improve bladder and bowel function. Stress management techniques, like meditation and deep breathing, are also valuable tools for coping with chronic pain and reducing symptom flare-ups.

By adopting these lifestyle changes and working closely with a physical therapist, individuals with pudendal neuralgia can take proactive steps to manage their symptoms, regain control, and enhance their quality of life.

When Is Surgery Necessary?

If conservative treatments fail to relieve symptoms over several months, pudendal nerve decompression surgery may be considered. This involves surgically releasing the nerve from surrounding tissues to reduce compression. It’s a complex procedure and should be done by a surgeon experienced in pelvic nerve disorders. Pre-surgical nerve blocks are often used to predict whether surgery will help.

Managing Chronic Pudendal Pain

Living with chronic pudendal pain can be both physically draining and emotionally overwhelming. Especially when the symptoms persist without a clear explanation or diagnosis. Fortunately, there is a range of treatment options available that can help patients manage pain and improve their quality of life.

A comprehensive approach typically includes pelvic floor physical therapy as the foundation. It aimed at releasing muscle tension, restoring mobility, and reducing nerve irritation. Alongside therapy, patients often benefit from pain management techniques. Examples are the use of TENS (transcutaneous electrical nerve stimulation) units, which deliver low-level electrical currents to disrupt pain signals.

Medications for nerve-related pain—such as gabapentin, amitriptyline, or duloxetine—can also be prescribed to help calm nerve activity and reduce discomfort. For some, pudendal nerve blocks or pulsed radiofrequency treatments may be used to target the source of the pain more directly.

Additionally, psychological support, particularly cognitive behavioral therapy (CBT), can be an important part of pain management. It helps patients develop better coping mechanisms and address the emotional strain that often accompanies chronic pain.

Lifestyle modifications are equally important in reducing symptom flare-ups. This may involve adjusting exercise routines, using ergonomic cushions when sitting, avoiding activities that aggravate the nerve, and improving bowel and bladder habits to avoid straining. With the right combination of interventions—and the support of a skilled care team—many patients are able to manage their symptoms effectively and regain a sense of normalcy in their daily lives.

Take the First Step Toward Relief

At PELIVS NYC, we understand how difficult pudendal nerve pain can be, both physically and emotionally. That’s why we offer expert evaluation and individualized pelvic floor therapy to help you regain control over your health.

We also offer a FREE 15-minute teleconsultation so you can speak to a professional, ask questions, and explore whether therapy might be right for you.

You don’t have to live in pain. Get the right diagnosis, the right treatment, and your life back.

Related Blog: Pudendal Neuralgia: PT Is Your Treatment

How Do You Get Rid of Hard Flaccid Syndrome?

HOW TO GET RID OF HARD FLACCID SYNDROME

What is Hard Flaccid Syndrome?

Hard Flaccid is a newly coined term that describes a symptom of pelvic floor dysfunction/CPPS. But before we dive deep into how to get rid of your hard flaccid syndrome, let us understand first what could be the cause and risk factors.

Similarly, patients describe their symptoms to be a nuisance throughout the day and in the bedroom. Men will often describe that their penis doesn’t hang as low as it did in a flaccid state and seems somewhat retracted. Men will describe that their penis can feel cold, takes more physical stimulation to get aroused, feels rubbery during an erect state, the penis doesn’t get as much blood flow/maintain an erection, and a weak stream of urine.

What are the psychological effects of hard flaccid in men?

As for why this happens? We don’t understand the full mechanism behind it. In fact, the majority of medical professionals will deny that this diagnosis even exists and will say “it’s all in your head” and probably prescribe you some sort of PDE5 inhibitor (Viagra/Cialis) to get rid of your “anxiety”. The dangerous part of using the word anxiety is that you may have developed or worsened your anxiety due to this issue as it would any male going through this, but anxiety isn’t causing this issue.

Prior to feeling these symptoms, we men never had to think about our penis. In fact, we only used it for the 2 P’s; Pee and Pleasure. So the fact that now you are constantly thinking of “how much urine is coming out”, “will I be able to maintain and keep a rigid erection” induces anxiety and further takes the SEX out of SEXY. All you are left with is a Y (see what I did there?). This constant feedback loop causes anxiety and further increases sympathetic tone which is the antithesis of getting an erection.

So this blog post is for those that have been searching for some answer, for those who are looking for options, doable options to get rid of a hard flaccid syndrome. This is written for you!

It is equally important to know that these symptoms are real and they are very much treatable. Furthermore, in Pelvis NYC, we do have a working hypothesis that hypertonic/weak pelvic floor muscles may be causing the issue. The majority of men seen with this condition have very tight lower abdominals, their perineum is weak and cannot sustain a contraction longer than 10 seconds.

Who can help in getting rid of hard flaccid syndrome?

First thing is, always get yourself to a primary care physician or urologist to get medically cleared for anything serious. High blood pressure, diabetes, obesity, as well as High cholesterol are one of the few conditions that will start as erectile dysfunction.

Second, get yourself to a pelvic floor physical therapist who can help evaluate and treat you. Remember not all medical professionals are equal, just because you saw one should not mean that you have exhausted your options.

Third, start to take matters into your own hands. Do your best to control the variables in your life that are easily controllable.  Start by evaluating your diet, sleep, stress, and movement. The second you start to see improvements in some areas you will notice improvements within others as well.

What are the pelvic floor exercises I can do now to get me on the path of getting rid of hard flaccid?

1)    Ease the tension around the lower abdominals. Try these:

a.     Cobra stretch ( 2 minutes min with exhalation at the top to let your belly go)

b.     Couch stretch ( 2 minutes- inhale and exhale into the stretch)

c.     Foam/Lacrosse ball – Find a tender area and gently breathe through it This is a nice soft tissue release.

2)    Decrease tension around perineum

a.     Deep Squat stretch – This will help stretch your adductors and your perineum (2 min). If you have a bathtub you can use the buoyancy to help decrease the strain on your knees

b.     Happy Baby – 2 mins

At Pelvis NYC we want you to know that we understand what you are going through. We truly care about your well-being. Now that you know these symptoms are real and that it is treatable….BREATHE!

The next step is to follow some of the recommendations here, see what works for you, and let us know how we can help. Contact us now!

The Male Physiotherapist: An Interview with Dr. Adam Gvili, PT, DPT

Pelvic floor dysfunction affects more women than men, but MEN ARE AFFECTED TOO. Since most physiotherapists are focused on treating women, a lot of men are silently suffering, left untreated, misdiagnosed, and experiencing depression and anxiety. That is why a need with a Male Physiotherapist is essential.

In this interview between Simon Edward Smith of The Medical Journo on Youtube entitled Interview With Male Pelvic Specialist Dr. Adam Gvili, they have discussed below topics:

00:15​ Can you explain a bit about what you do?

Dr. Adam Gvili: I’m a physiotherapist as you know, in the States, right I’m here in New York City & my specialty is the male pelvic floor. I hope to treat females one day, but I’d like to focus solely on males for now.  I also treat orthopedically and treat a lot of athletes and I really enjoy treating in full spectrum. And the only population I don’t treat is pediatrics. Coz I think there are much better people out there that can focus on pediatrics than men.

So I treat a lot of females for orthopedic issues but I won’t treat them for the pelvic floor. Obviously, I’ll treat men for any issue. 

Simon Edward Smith: “Right and this is based out of New York, you’ve got a clinic there?

Adam: Yeah right in Manhattan.

Simon: How long have you had that for?

Adam: About two years now.

01:40​ Dr. Gvili’s experience with pelvic floor dysfunction 

Adam: I don’t know how much you know about me. I myself went through pelvic floor dysfunction a couple of years back. Maybe ten years ago, at that time there was nobody out there to treat it. Really, in terms of men treating men. Right there were females treating it, but having a conversation like ‘hey you know when you pee at the urinal and you get this weird feeling, oh wait you don’t pee at the urinal right?’. And you can probably relate to this topic.

It’s like a weird dead end that I couldn’t complete a plan of care. But luckily I did meet a woman who is really familiar with male anatomy. I can give her a lot of kudos and I did learn from her. One of the reasons I started on my own, was because I was like there are no males treating males and guys don’t like to talk about their penis that much and that is the truth.

Simon: Yeah so what are your experiences in pelvic pain?

Adam: So luckily I only had some pain like an occasional shooting pain. Sometimes into the rectum maybe two seconds and it goes away. It was just a hypertonic pelvic floor. So as a patient, I had some issues like weird erectile dysfunction, premature ejaculation. Muscles are so tight that it is constantly contracting around my prostate. And it’s almost a borderline persistent general arousal disorder.

And I remember the third physical therapy session got better. It pushes the right buttons so I think that was what it was.

03:18​ Dr. Gvili’s treatment of his pelvic pain 

Simon: What would you do in a physiotherapy session to recover so quickly?

Adam: So we didn’t do much movement base stuff which is kinda I think what is needed to speed up the process but what I did appreciate was this certain individual did a lot of internal and that’s part of my practice as well. I do a lot of internal. I’m gonna kick that taboo on the side. Guys treating guys.

I think even orthopedic clients need that therapy with touch to get that therapeutic effect right. I need to tone down your system. If that is the case, most of my guys have had a hypertonic pelvic floor. I treat mostly an average of 20 to 40, we had the outliers but I used it to tone down the system first before trying to get you engaged or to believe that this is gonna work. Because by the time you’ve gotten to me, you’ve seen so many practitioners that have run you down some rabbit hole. Googling and thinking that you have a terminal disease so I have to calm you down a bit and the way to do that is by internal.

04:31​ The taboo over male-treating-male treatment 

Simon: You said that there was a taboo with men treating men. Do you find that in the US then?

Adam: Totally! And it’s funny! Because when you speak to practitioners in the UK and Australia who are light years ahead of the US. We’re practitioners and we’re here to get people better and that’s our goal. And that has nothing to do with gender. But for some reason when you speak to people coming out of school or people that might be interested in specialties. They hear what you do and ‘oh I can never do that’ those were the usual answers that follow and you do get that a lot.

05:15​ The influence of A Headache In The Pelvis

Simon: You’ve heard of a headache in the pelvis? Well, that’s all internal. Not all of it actually no that’s wrong but some of it is internal isn’t it. And that was crazy in the US. I was quite surprised that it is such a big book within the physiotherapy world. I’m surprised it’s not just common being accepted into the practice.

Adam: It’s such a big one in the physiotherapy practice.

Simon: It’s such a big-known book that I’m surprised that there is a bit of an issue around men treating men.

Adam:  So it’s interesting I do give Dr. Wise a huge kudos because they kind of got this whole movement started. If you really think about it, especially for males. I’ve had a wand and I used it. I’m not the biggest fan of it. But I mean internals out there for some reasons it’s still a taboo right.

Like when I took my first men’s pelvic floor course. I remember it was a two or three-day course either way we spent a good two hours or an hour and a half talking about what you do in a situation where a guy gets an erection. So it was more geared towards women feeling comfortable treating men as opposed to just how do we diagnose and treat men. Even within the female kind of sector, there was a taboo here like oh what do we do right.

06:59​ What name would you give to this condition?

Simon: What name would you give to this coz there’s a lot of debate of groups over what terminology people should use. But you know coming from actually from the field what would you call it?

Adam: Yeah it’s tricky because have you heard of sciatica?

Simon: Yeah that’s the nerve down the thigh.

Adam: Yeah it’s actually at the back of the leg.

Adam: Sciatica or it can be in your spine it could be coming along that pathway. Like pelvic pain, we have an umbrella term, we kinda branch out from there. So I don’t necessarily know if I would rename it because it depends on someone’s symptoms and it depends on it being a multi-fast issue we don’t know what’s going on. I think the biggest disservice we have done so far is diagnosing people with stuff we’re not sure they have.

Simon: Right, such as an inflamed prostate.

Adam: What the h*** does it even mean?

Adam: No seriously I’m a little more animated than your average physical therapist. But what the h*** does that even mean. I have a leading urologist in New York City referring me to clients. Thankfully, I’m very thankful for that. But how can I feel an inflamed prostate? You can’t feel if it’s baggy but can I tell if it’s really inflamed. I’ve touched many prostates. I don’t know if that’s necessarily true. Can I be honest? It could be wrong.  Maybe I’m feeling but I’m telling you what I think. or I mean I have this theory that specifically in the US but I don’t know it is in the UK but we over medicalize here. We definitely over medicalize. We diagnose, the reason why we have to diagnose is so we get paid by the insurance 

I never walk out of a doctor’s office saying we’re not really sure what it is just do this, and this. And we’re always looking for an answer for some reason. How do we know it’s necessarily the pelvic floor and it’s a hip issue? How do we know it’s not a low back issue? So many things can cause the said symptoms. That I think we do some disservice, let’s say it’s for sure like this when we don’t have enough research. Majority of those diagnoses that you’ve heard 

09:42​ The problem with giving it a name 

Simon: Yeah! Cole Monahan mentions that giving a diagnosis can be a bit definitive and not really help the situation. Like you said that there are so many different symptoms coming from different places and it’s hard to classify them.

Adam: Totally! And then I’ve had people who have had a one-night stand and said it happens after that. I never had sex before and they tell me they have these symptoms. So when that happened the first time. That person came to me and said I’m actually a virgin. I’ve never had oral sex either. But I have these symptoms. That was like someone shot me in the head. Because I was like we thought to believe that this could potentially be something that changed your urethral or bladder flora.

Whoa, so I’m always at the question mark and I think that it’s the exciting part about treating the pelvic floor that constantly comes up.

10:44​ Issues around internal treatment and trigger points 

Simon:  So I really want to ask what this internal treatment is? Do you say you’re not a massive fan of the wand? Is that because there are few different types? Is that the easy one, the magic wand?

Adam: It’s kind of like an S-shape. Like a small S shape. I’m not the biggest fan because… to go and search for trigger points, I don’t know how helpful that is. Also unless you’re sort of a Marvel DC Comic character when you have a long arm, or you actually can make it to put it in your butt. You might have a problem kind of relaxing certain muscles because you’re utilizing them in order to contract them to a certain position right.

Well that being said I’ll never tell someone not to do something. In most cases, I won’t say no to do something. So if that makes you feel better, do it.

Simon: So you’re using your finger then?

Adam: Yeah we use gloves.

Simon: You’re using your finger like a wand basically?

Adam: So am I looking for a trigger point or not? I have people that seem that don’t have that much tension in their pelvic floor but they go through all the gamma symptoms and everyone who does, has a high torn pelvic floor. So I’m not necessarily looking for trigger points. But something that says that I’m in the right area right. Especially the first session which is evaluation. I go around and try different things and I’ll tell my clients to text me the next two or three days and then I have a log two-three days and another two-three days until they come in. and we’ll see if that did work and we’ll stick with that a little bit and then when we are at the point where we’re stagnating then maybe we’ll switch to something else.

12:47​ Individual treatment for clients 

Simon: So what are these? Are you telling them to stretch? Or do they do the massage and set the internal massage themselves? What is it? Or just a combination of different methods?

Adam: Yeah, I don’t have cookie-cutter treatment. If it takes someone with a really high tone pelvic floor that kinda sits all day, and doesn’t move much. They would do really well, just kind of going out for a walk starting slow, deep squats. My favorite is deep squatting in your bathtub. I don’t know in the UK if you have traditional bathtubs, not sure if you do. Curve the edges on the side. 

 So you can deep squat with your back with supported heels down that curved the edges will further push you to the hip flexion. So what you’ll get is the opening of that perineum and adductor fascia. That’s my favorite kind of talk of almost everyone on their first visit just to see if we get a change because that is what we are looking for right. An active change.

Simon: It’s funny you say that. Because that is the position that I would do. The wand, that’s the exact position that is really helpful. That deep squat just pulls everything open. You can feel like releasing… come open… so I can certainly associate with that.

Based on the above conversations, we can feel how passionate Dr. Adam Gvili is in treating male pelvic floor disorders and how he works with them closely to improve their symptoms and normalize their pelvic floor.

Do you want to know more about a male physiotherapist and how Dr. Gvili treats his patients? Want to learn more tips and advice from an expert who experienced pelvic floor disorder himself? Watch out for our next blog.

Related Blogs: Physical Therapy for Men: FAQs Answered and Guide to Physical Therapy: What You Need to Know