Pelvic Pain, Abdominal Pain, Genital Pain

Pelvic Pain, Abdominal Pain, Genital Pain

Specialized Male Pelvic Floor Evaluation for Pelvic Pain

Men with chronic pelvic pain often have pelvic floor muscles that are weak or stuck in a state of constant tension. These muscles support the bladder, bowels, prostate, and sexual organs and when they cannot relax properly, pain, urinary, bowel, and sexual symptoms may follow.

At Schafer Physical Therapy, your care begins with a comprehensive, one-on-one evaluation performed by a board certified Doctor of Physical Therapy (DPT) with advanced training in male pelvic health. Our goal is to identify why your symptoms are happening, not just where they hurt.

Below is what you can expect during your first visit.

1. Detailed Medical History

Your evaluation starts with a thorough conversation. We discuss:

• Your symptoms and when they began
• What worsens or relieves them
• How symptoms affect daily life, exercise, bowel and bladder function, and sexual health
• Past injuries, surgeries, medical conditions, and medications

This information is critical as many pelvic pain conditions are influenced by factors beyond the pelvis alone.

2. Comprehensive Physical Examination (External)

Pelvic pain is rarely isolated. We evaluate the entire system that influences pelvic floor function:

Spine, Breathing, and Core

Assessment may include:

• Neck and jaw (for complex or long standing cases)
• Thoracic spine and rib cage mobility
• Lumbar spine mobility and strength
• Breathing patterns (diaphragmatic vs. upper chest)
• Abdominal wall tension and control

A constantly braced abdomen often mirrors an overactive pelvic floor.

Hips and Groin

The hips and pelvic floor are deeply connected. We assess:

• Hip adductors (groin)
• Hip flexors
• Gluteals and deep hip rotators
• Hamstrings

We evaluate tenderness, length, strength, and coordination, as these muscles frequently contribute to pelvic symptoms.

External Perineal Assessment (With Consent)

When appropriate, the clinician may assess:

• The perineum
• External pelvic floor muscles
• Penis and testicles

This provides valuable information about muscle tone, tenderness, and symmetry prior to any internal examination.

3. Neurological Examination

Pelvic pain often involves the nervous system, not just muscles.

We may assess:

• Sensation in the perineum, penis, scrotum, and inner thighs
• Sacral nerve reflexes 
• Neural tension involving the sciatic and pelvic nerves
• Muscle strength patterns

This helps determine whether nerve sensitivity or irritation is contributing to your symptoms.

4. Internal Rectal Examination (When Indicated)

An internal rectal exam is never automatic and is only performed with your full understanding and consent. When appropriate, it provides unmatched clinical information.

The exam allows assessment of:

• Pelvic floor muscle tone (overactive vs. underactive)
• Trigger points and muscle tenderness
• Coordination and timing
• Ability to relax and contract
• Endurance and symmetry

The process is explained step by step, performed slowly and respectfully, and stopped immediately if you are uncomfortable. There are no surprises and no pressure.

5. Movement and Functional Assessment

We evaluate how your pelvic floor behaves during real world tasks, such as:

• Squatting
• Lunging
• Hip hinging
• Single-leg balance

Breath holding, compensations, and excessive tension often appear here and provide critical insight into why symptoms persist.

6. Treatment Planning: Manual Therapy, Exercise, and Education

Your evaluation flows directly into a clear treatment plan.

Manual Therapy

Depending on findings, treatment may include:

• External myofascial release (abdomen, hips, groin)
• Internal pelvic floor release (when appropriate)
• Spinal mobilization or manipulation techniques
• Neural mobilization techniques

Manual therapy helps restore mobility, circulation, and nervous system safety.

Exercise Prescription

Exercises are selected carefully and progressed appropriately. These may include:

• Diaphragmatic breathing
• Pelvic floor relaxation strategies
• Hip and trunk mobility
• Strength training with compound movements (squats, lunges, hinges)
• Functional retraining for daily activities

Not every man needs Kegels. In fact, many men with pelvic pain need the opposite.

Education

Education is a cornerstone of recovery. We focus on:

• Understanding pain mechanisms
• Reducing fear and uncertainty
• Normalizing symptoms
• Building confidence in movement

One-on-One Care, Every Visit

All sessions are private, one-on-one for a full hour. You receive undivided attention, individualized care, and a clear home program designed to help you maintain results long-term.

We don’t just treat symptoms, we help you understand your body so you can stay better for many years to come.