by Jill Margo, afr.com
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As a result, the pain is often incorrectly diagnosed and poorly treated.
This is worrying because when pain is left unmanaged, new nerve pathways can be sensitised and the condition is more likely to become chronic.
As the pain cycle deepens – influenced by anxiety or lack of a diagnosis – more organs may become involved and pain can persist long after the original cause of pain has gone.
This means investigations, scans and blood tests often come back normal.
SOME HIDE CONDITION
While pelvic pain is most common in desk-bound, professional men under 50 who have high levels of work stress, it can happen to any man if the conditions are right.
It can affect their ability to sit, concentrate, sleep, exercise and have intercourse. Some just live with it because disclosure is too embarrassing.
Some hide it by rearranging their schedule, coming in late, organising short meetings and knowing where the toilet is.
When it occurs in the lower pelvis, men have described it like sitting on a golf ball with pain radiating into the testes, the groin, the lower back or up towards the navel.
According to an article in Andrology Australia's newsletter, one in 10 Australian men will experience it for more than six months. They have what is known as "chronic pelvic pain syndrome".
Although there are several possible causes, for many years CPPS has been treated as an organ-centric disease, usually of the prostate. The diagnosis is usually prostatitis, a benign inflammation or infection, and treated with antibiotics.
In 90 per cent of cases, men don't respond, says Shan Morrison, director of Women's & Men's Health Physiotherapy in Melbourne and author of the article.
MULTIDISCIPLINARY APPROACH
While prostatitis is a real condition, it is not the only one and the new approach is broader. It takes all the organs, nerves, vessels, muscles, bones and joints in the area into account and acknowledges the role of the brain.
In this bio-psychosocial approach, the bio determines where in the pelvis the pain originates and how it impacts the region while the psychosocial looks at how the brain and social conditions entrench it.
Pain may be felt in the perineum, penis, testes, anus, low back, buttock, tailbone, hip or groin. It may occur on exertion, on emptying the bladder or bowel, on erection or ejaculation or on no cue at all.
Pain can also disrupt the process responsible for initiating an erection.
Morrison recently conducted an audit of 112 men with chronic pelvic pain who had attended her practice over three years. Most were professional, around 40 and had already seen three specialists.
Some 80 per cent self-reported high stress levels and most had pain in their testes or perineum.
Overall, 25 per cent achieved full resolution, 29 per cent had some improvement, 18 per cent didn't benefit and the rest were lost to follow up.
Because of the mind-body nature of pain, she says a multidisciplinary approach is best. This could include a urologist, a pain medicine specialist, a pelvic floor physiotherapist and a psychologist.
New thinking in the area is reflected by a recently devised system to help doctors diagnose the cause of pelvic pain.
It's called UPOINT with each letter guiding diagnosis: Urinary, Psychosocial, Organ specific, Infection, Neurological and Tenderness.
Men usually have two or more of these factors.
In recognition of the lack of services available to men with pelvic pain, the United States recently passed legislation to allow gynaecologists with experience in the area of women's pelvic pain to see men as patients.
started PT, taking QUrol