Part of Men's pelvic health: pelvic floor dysfunction in men, and where to start

Male pelvic pain: what causes it, and what actually helps

Male pelvic pain, meaning pain in the pelvis, perineum, testicles, penis or back passage that has gone on for months, is more often a muscle problem than an infection, which is why a course of antibiotics so often changes nothing. Before any of this is applied to you, read the warning list on this page, because a few of the causes of the same pain need checking quickly rather than treating with exercise. The European Association of Urology's 2025 chronic pelvic pain guideline states that in most cases of chronic pelvic pain there is no ongoing tissue damage, inflammation or infection to find, and the readable study behind its muscle claim is a 1999 series of 103 men at a university urology clinic, all of whom had negative microbiological tests and most of whom had already had several courses of antibiotics, in which 88.3 percent had tender pelvic floor muscles that worked poorly or not at all (Zermann 1999); that is a specialist referral clinic rather than men in general, the widely quoted figure of 92.2 percent traces to a 1999 article nobody here could read, and no prevalence figure for the wider population appears on this page. The guideline's physiotherapy answer is myofascial treatment as first-line treatment, at a strength rating it labels Weak, with biofeedback as an adjuvant, and the direction of the work is learning to let the muscles go rather than strengthening them. So squeezing harder is usually the wrong exercise for this pattern, and a man who arrived here from a Kegel page should read the section on that before he carries on. Where the pain started after an operation such as a hernia repair or a vasectomy, the guideline has a name for that, chronic post-surgical pain, and the question belongs back with the surgeon or a urologist rather than with another course of antibiotics. What a page cannot do is tell you which cause is yours, and a few of the possibilities need checking quickly rather than treating with exercise, so read the warning signs at the foot of this page first. This page reports what guidelines recommend and never advises a medicine.

Warning signs, and when to get help

What causes pelvic pain in men?

Most often a muscle that has stopped letting go, and much less often an infection, which is the reverse of how this is usually explained to men.

The guideline on this subject belongs to the European Association of Urology, the pan-European urology body. Start with its plainest sentence: in most cases of chronic pelvic pain, ongoing tissue trauma, inflammation or infection is absent.

The guideline's 2025 edition prints a figure you will meet everywhere, that 92.2 percent of men visiting a tertiary center for pelvic pain had pelvic floor muscle dysfunction. We followed that one back and it does not survive the trip, so this page does not use it. The paper it comes from is a 1999 article in a journal that PubMed does not index. The guideline itself marks that reference as having no abstract available, and it quotes the same reference as 88 percent in a different chapter.

What is readable is the peer-reviewed paper the same four authors published that year. They went back over 103 men who came to a university urology clinic with pelvic pain between 1994 and 1997. Every one of them had negative microbiological tests before entry, and every one had had between 1 and 12 courses of antibiotics in the preceding 6 to 36 months. In 88.3 percent, the striated muscle was tender on examination with poor to absent pelvic floor function (Zermann 1999). Read the entry conditions rather than the percentage: this is a referral clinic, filtered by everything that had already failed, so it tells you what a pelvic pain clinic sees and not what proportion of all men have this.

The guideline's second figure traces cleanly, and it needs the same care. The Chronic Prostatitis Cohort Study examined 384 men with chronic pelvic pain syndrome and 121 men with no symptoms at seven centers, and found tenderness somewhere in 51 percent of the patients against 7 percent of the controls (Shoskes 2008). The guideline calls that muscle tenderness. The paper counted tenderness at 11 sites, and the commonest by far was the prostate, 41 percent against 5 percent, with the pelvic floor itself tender in 13 percent of patients on the outside and 14 percent internally and in none of the controls.

So the 51 percent is not a pelvic floor figure, and what the pelvic floor numbers do show is that tenderness there turned up only in the men who had pain. One more line from that paper is worth as much as either percentage: tenderness did not correlate with inflammation or infection in the prostate fluid.

What they do support is a change of direction. If you have had the tests, had the antibiotics and still hurt, the muscle layer is the thing most likely to have been skipped, and it is the one thing a physiotherapist can examine directly. There is one condition on that sentence. The tests have to have been about the pain you have now. A set of results from two years ago settled the symptom you had two years ago, and if what you are feeling today is new, worse or somewhere different, it needs looking at again before anything on this page is applied to it.

Continence Health Australia has the plainest list for recognizing yourself in this. Under overactive pelvic floor muscles it names pelvic pain, pain during or after sex, constipation or difficulty emptying the bowel, a strong or urgent need to pass urine, and frequent or painful urinating, and it describes overactivity as less common but very treatable with specialized pelvic floor muscle activation combined with relaxation. Note which way round that treatment runs, because it is the opposite of what most men are handed.

Chronic pelvic pain syndrome, and why the name keeps changing

You will be handed several names for this and they are mostly describing the same problem from different angles.

Chronic prostatitis, chronic pelvic pain syndrome, primary prostate pain syndrome, levator ani syndrome, pelvic floor myalgia. The guideline's own threshold for calling pain chronic is three months, continuous or recurrent, in line with the international classification of diseases, so a fortnight of perineal ache is a different conversation. It is also not a conversation to have with this page. Pelvic, perineal or testicular pain that started in the last few weeks has not yet had anything on the warning list ruled out, so take it to a doctor rather than reading the muscle explanation across onto it. Everything below is written for pain that has already been looked at and has already lasted months.

The guideline uses a system of pain syndromes named by where the pain is felt, which is a deliberate move away from naming an organ that may not be the source. That is why the label on your notes can change between clinics without anything about you changing.

A name that points at the prostate tends to produce another prostate treatment, and a name that points at the pelvic floor tends to produce an assessment of the pelvic floor. If nothing aimed at the gland has helped, the name is worth revisiting with whoever is looking after you.

None of this means the pain is imagined or that you have been fobbed off. Long-standing pelvic pain involves muscle, nerve and how the nervous system is processing those signals, and all three are real and treatable.

Why squeezing can make it worse

If you came here from an article about Kegels, read this section before you do another set.

A muscle that is already short, tight and tender is not in a position to produce a strong contraction, so it often tests as weak. The obvious conclusion, that it needs strengthening, is the wrong one, and a program of longer and harder holds usually produces more pelvic ache and no change in the symptom that brought you in. The guideline records that rectal pain treated with pelvic floor muscle therapy is relieved only when patients learn to relax the muscles, which puts the sequence the right way round: release first.

So if you have been doing daily squeezes for weeks and your pain has crept up, stop them and get assessed rather than pushing on. Pelvic floor exercises for men is the page you probably came from, and the section there on when squeezes are the wrong exercise sends men straight back here for this reason. For the tight-against-weak question as a subject in its own right, including why no questionnaire can settle it, tight or weak pelvic floor is the page, and it has a men's section.

Letting go is trainable. Breathing without bracing, unhurried positions and our diaphragmatic breathing page are where most programs for this start, and strengthening often returns later, once the muscle can release on demand.

Two different answers, because the guideline splits the pelvic floor from the prostate, and a physiotherapy site owes you both halves rather than the flattering one.

In the section on managing pelvic floor dysfunction, the summary of evidence states that myofascial treatment is effective, at evidence level 1b, and that biofeedback improves the outcome of myofascial therapy, at level 1a. The recommendations that follow are to apply myofascial treatment as first-line treatment, at a strength rating of Weak, and to offer biofeedback as an adjuvant to muscle exercises in patients with anal pain due to an overactive pelvic floor, at a strength rating of Strong. The mismatch between a level 1a summary and a Weak recommendation is in the document and we are not going to smooth it over. A strength rating weighs more than the evidence level, and the panel's own method says that a Weak rating typically means lower quality evidence, an equivocal balance of benefit against harm, or uncertainty and variability in what patients themselves prefer. The honest reading is that the panel believes in this treatment without being sure how much it delivers.

The other half is the list for primary prostate pain syndrome, and physiotherapy is not in it. The guideline names multimodal, phenotypically directed treatment at Weak; antimicrobials, specifically quinolones or tetracyclines, over a minimum of six weeks in treatment-naive men with under a year of symptoms at Strong; alpha-blockers for men with under a year of symptoms at Strong; high-dose oral pentosan polysulphate at Weak; acupuncture at Strong; and non-steroidal anti-inflammatory drugs with a caution about side effects at Weak. Those are reported here because you are entitled to know what the guideline covering your problem actually says. They are not advice, no page here recommends or discourages a medicine, and every one of them is a conversation with a doctor.

The guideline panel includes a pelvic physiotherapist, so the physiotherapy section is not an outsider's view of the profession.

What a pelvic health physio does for male pelvic pain

The assessment is the part worth booking for, because it answers the question no page can.

It is normally an internal examination, done with your consent and explained first, and you are entitled to say no to it. It looks at whether the muscle contracts, whether it lets go afterwards, how long it can hold, and which spots are tender. Men are often surprised by how specific the tenderness turns out to be, and finding it is what turns a vague pelvic ache into a treatable finding.

Saying no does not end the appointment. The history is the largest part of the assessment and it needs no examination at all: where the pain sits, what sets it off, how it behaves with peeing, with a bowel movement, with sitting and with sex, which operations you have had, and what has already been tried. The guideline also recommends a validated symptom score, because severity and the response to treatment cannot be judged any other way, and it suggests a daily pain diary alongside it covering voiding, sexual activity, activity levels and painkillers. From outside, a physiotherapist can examine your tummy wall, groin, hips, buttock and low back, and press those muscles to see whether they reproduce your own pain, which the guideline tells clinicians to look for actively in this syndrome, at a strength rating of Weak.

That outside examination is not a consolation prize. In a cohort of 72 men with this diagnosis, all of them already in a physiotherapy program, pressing the external oblique brought on the man's own suprapubic, testicular or groin pain in at least 80 percent of those who had pain at the matching site, and palpating the rectus abdominis reproduced penile pain in more than 75 percent of cases, as did the puborectalis internally (Anderson 2009). Both of those abdominal muscles sit under a hand on the outside.

Be straight about what it leaves open. Whether the muscle contracts, holds and lets go is tested in men by a rectal examination, which the guideline says plainly, and in the cohort study quoted earlier the commonest tender site of all was the prostate, which nothing from outside reaches. The outside findings are specific rather than sensitive: not one of the 121 men without symptoms was tender at the external pelvic floor or above the pubic bone, but only 13 and 9 percent of the men with pain were, so a normal external examination rules nothing out. An external assessment narrows the question instead of settling it. The release work can still start, because learning to drop the floor when the pain comes on, breathing that does not brace and taking the strain out of your toilet habits need nothing internal, and you can change your mind at a later appointment.

Treatment follows the guideline's order. Hands-on work on the painful, tight muscles is first, biofeedback is offered as an adjuvant to muscle exercises for anal pain from an overactive floor, and the home work is release rather than strength: learning to drop the floor at will, breathing that does not brace, and taking the load off it between times. Straining on the toilet is the commonest thing still loading it every day, and pelvic floor weakness, constipation and bowel control covers that.

Be realistic about the timescale and about the evidence, which is thinner in men than a first-line label suggests. The randomized trial the guideline cites for myofascial physical therapy enrolled both prostate pain and bladder pain patients, and in the prostate pain group it did no better than general body massage; the clear advantage was in the bladder pain group. The trial that did favor this direction in men compared biofeedback and pelvic floor relaxation against conventional treatment, meaning alpha-blockers, anti-inflammatories and sitz baths, in 84 men with prostate pain syndrome: both groups improved at three months, and three months after treatment stopped only the relaxation group had held on to it. That is the evidence sitting underneath a recommendation the panel itself grades Weak.

None of that is a reason to skip the treatment, since it is the first-line recommendation and the alternatives have their own limits. It is a reason to expect retraining over months, to judge progress over weeks rather than sessions, and to be told early if it is not working.

Ask for a pelvic health physiotherapist, or a pelvic health physical therapist in the USA, and say that your problem is pain rather than leaking when you book, because the assessment and the first appointment are not the same for the two.

What else the pain can be

Pelvic pain in men is a location, not a diagnosis, and several other things live at that address.

The ones that need checking rather than treating are in the warning list at the foot of this page, each with its own route and its own speed: a testicle that is suddenly and severely painful, which is an emergency and not a wait-and-see; a lump, swelling or change in a testicle; a fever with pelvic, perineal or genital pain; blood in your urine or in your semen; a bladder that will not empty; and the numbness and bladder or bowel change picture that belongs to the nerves at the base of the spine. Do not work out which of those is most likely before acting on it. The list is sorted by how fast, which is the only sorting that helps when you are the one in pain.

Then there are the neighbors, which are common and are somebody else's page. Pain that is really coming from the low back or the hip is covered on weak pelvic floor, back and hip pain and on low back pain. Pain centered on the tailbone has its own program at tailbone pain, and groin pain that behaves like a muscle or tendon injury is at groin pain. A weak or stop-start stream, or a bladder that never feels empty, is a flow problem rather than a pain problem and has its own list of causes: men's pelvic health sets out that fork, with the NHS as its source.

There is one group this page would otherwise leave out, and it is a large one: men whose pain started after an operation. The guideline treats that as a condition with a name, chronic post-surgical pain, meaning pain that appears or gets worse after a surgical procedure and persists beyond healing, which the current international classification puts at three months or more.

The operations around the groin and pelvis with a recognized risk include inguinal hernia repair and vasectomy. After a hernia repair, chronic post-surgical pain affects up to 10 percent of patients at six months, and it can be felt in the groin, the scrotum or both. After a vasectomy, the reported incidence of post-vasectomy pain runs from 2 to 20 percent. In one cohort study of 625 men, 14.7 percent had scrotal pain at six months, and the mean severity among them was 3.4 out of 10, so most of that pain is mild and a small minority of it is bad enough to affect daily life.

The international groin hernia guideline, written by the hernia societies themselves, names chronic pain alongside recurrence as the most frequent problem following groin hernia repair, so this is not an awkward or unusual thing to raise with a surgeon. Pain felt in the testicle, the epididymis or the cord above it with no local cause found has a label of its own too, scrotal pain syndrome. The nerves that supply the scrotum run through the groin, which is why an operation anywhere along their course can produce pain felt in the testicle.

If that is your situation, tell whoever you see that the pain started after your operation, because it moves the assessment off the prostate and onto the nerve and the scar. Go back to the team that operated, or ask to be referred to a urologist, rather than on to another course of antibiotics.

Three details from the guideline are worth having before you ask for another scan or agree to another procedure. Its summary of evidence records that ultrasound of the scrotal contents does not aid either the diagnosis or the treatment of scrotal pain, at evidence level 2b, so a normal scan does not close the question and another scan rarely opens it. It finds no evidence for surgical treatment of prostate pain, naming transurethral resection of the prostate and radical prostatectomy, so more prostate surgery is not the way out of this one. And where surgery does have a place it is narrow and conditional: the guideline suggests microsurgical denervation of the spermatic cord for men whose testicular pain improves after a local anesthetic block of that cord, at a strength rating of Weak, and it records reconnecting the vas as effective for pain after vasectomy at evidence level 2b. Those are urology decisions, and the honest thing for a physiotherapist to do is say so instead of working around them.

Pain that began after treatment for prostate cancer, whether an operation or radiotherapy, goes back to the team that treated you before anyone treats it as a muscle problem. The chronic pelvic pain guideline this page rests on does not deal with pain after radiotherapy, which we checked in the 2025 full text, so this page gives no figure and no timeline for it.

Anything to do with prostate cancer, its monitoring or its treatment belongs with a urologist, and no part of this page stands in for that. What this page does carry on cancer is routing rather than reassurance: the list below has its own lines for a lump or a change in a testicle, blood in your urine, blood in your semen, new back, hip or pelvic pain if you have had cancer, pain at night or at rest, and the spinal cord compression picture, each with the speed that belongs to it. If leaking rather than pain is your main problem after an operation, life after prostate surgery is the page.

When pelvic pain needs urgent attention

Read this section as the counterweight to the rest of the page, because a page that tells you your pain is probably muscular has just handed you four good reasons not to get checked.

The first is the obvious one: if it is muscular, there is nothing to find, so why bother. The answer is that you do not yet know it is muscular, and the only way the muscle diagnosis is worth anything is if the alternatives have been looked at.

The second is more subtle. Men who have been told once that they have chronic pelvic pain, or chronic prostatitis, tend to file every later symptom under that heading, and that is exactly how a new and different symptom goes unreported for months. A diagnosis from two years ago does not cover a change that happened last week.

The third is the antibiotics. A course that did nothing feels like proof that nothing is wrong, and it is not: it is one line of inquiry closed. Blood in the urine, a lump in a testicle or a fever all mean the same thing today as they would have meant before you took them.

The fourth is one this page hands you itself. If what you have read here fits, you will leave with a muscle explanation, and that explanation is dated today. It does not cover a symptom that turns up in six months. Everything on the list below counts again every time it happens, however well the release work is going, and pain that changes its character or moves somewhere new while you are being treated is a reason to be examined again rather than a reason to try a different technique.

So use the list below on its own terms. Nothing on it is managed with exercise, waiting or a breathing technique, and red flags in physiotherapy explains why we keep it apart from the advice.

For physiotherapists

The authority here is the EAU chronic pelvic pain guideline, limited update March 2025, and its pelvic floor dysfunction section is section 5.4.10. Summary of evidence: myofascial treatment is effective, level 1b; biofeedback improves the outcome of myofascial therapy, level 1a. Recommendations: apply myofascial treatment as first-line treatment, strength rating Weak; offer biofeedback as an adjuvant to muscle exercises in patients with anal pain due to an overactive pelvic floor, strength rating Strong. The 1a against Weak pairing is in the document as printed, and the grade letters here are words in the table rather than image badges, so nothing was inferred from a verb. All four were read in the full guideline PDF, section 5.4.10, rather than taken from a secondary source.

That is the guideline for the pain side. For the continence side of male pelvic floor work the authority is a different EAU document, the male lower urinary tract symptoms guideline, which is where the post-prostatectomy training recommendation and its Weak rating sit, and our condition page on pelvic floor exercises after prostate surgery sets that out.

Two points for the conversation with a referrer. Physiotherapy does not appear in the guideline's recommendation list for primary prostate pain syndrome, which runs multimodal phenotypically directed treatment, antimicrobials and alpha-blockers inside the first year of symptoms, high-dose oral pentosan polysulphate, acupuncture and NSAIDs; it sits in the pelvic floor dysfunction section instead. And the guideline's own record that rectal pain responds to pelvic floor muscle therapy only when patients learn to relax is the sentence to quote when a strengthening program has already been tried and has made things worse.

The post-surgical limb of the same guideline is the part most often skipped, and a fair share of male pelvic pain sits in it. Primary scrotal pain syndrome is section 3.2.5.3, with its two special forms, post-vasectomy scrotal pain syndrome and post-inguinal hernia repair pain; chronic post-surgical pain is section 3.2.5.7. The recommendations are in section 5.4.3: inform patients about the risk of post-vasectomy pain when counseling them for a vasectomy, Strong; do open rather than laparoscopic inguinal hernia repair to reduce the risk of scrotal pain, Strong; and offer microsurgical denervation of the spermatic cord in patients whose testicular pain improves after a spermatic block, Weak. The summary of evidence in those sections gives ultrasound of the scrotal contents no value in either the diagnosis or the treatment of scrotal pain at 2b, and vasovasostomy as effective in post-vasectomy pain at 2b. All read as words in the tables of the 2025 full text, as above.

The practical consequence for a caseload is to ask every man with pelvic or scrotal pain what operations he has had, including a vasectomy he may not think of as surgery, and to send the nerve question back rather than treat around it.

Both of the guideline's headline figures have now been traced to the papers that produced them, and they came out differently. The 92.2 percent tertiary-center proportion is reference 121, Zermann et al, Infections in Urology 1999, which PubMed does not index and which the guideline itself marks as having no abstract available; the same reference is quoted as 88 percent in the myofascial pain section of the same document. This site states neither figure and uses the same group's peer-reviewed series instead: 103 men, 88.3 percent with tender striated muscle and poor to absent pelvic floor function, J Urol 1999.

The 51 against 7 percent comparison is reference 122, Shoskes et al 2008, and it is tenderness at any of 11 examined sites rather than muscle tenderness: prostate 41 against 5 percent, external and internal pelvic floor 13 and 14 percent against none in the controls. Quoting the 51 percent as a pelvic floor figure overstates the pelvic floor finding about fourfold, so do not quote it that way to a patient. There is also no verified figure for the prevalence of pelvic floor dysfunction in men, and the "up to 16 percent" that circulates has no study behind it that we could find, which is why no number of that kind appears anywhere in this topic.

Warning signs

Get emergency help now

Emergency: sudden, severe pain in a testicle, testicle pain that comes with feeling sick, being sick or pain in your tummy, or testicle pain that has lasted more than an hour or carries on while you rest. Go to an emergency department straight away or call emergency services, and do not drive yourself.
Emergency: you cannot pee at all, especially if your lower tummy feels full and painful. Call emergency services or go to an emergency department straight away, and do not drive yourself.
Emergency: if you have an artificial urinary sphincter, the device with a pump in your scrotum that you squeeze when you want to pee, and you cannot pee at all, call emergency services or go to an emergency department straight away, and do not drive yourself. Say that you have an artificial urinary sphincter as soon as you arrive, and say it again before anyone passes a tube (catheter) into your bladder for any reason, because the cuff around the tube that carries your urine out (the urethra) has to be switched off first. Passing a catheter through a cuff that is still closed is one of the recognized causes of the cuff wearing through that tube (erosion), and the staff in front of you will not know the device is there unless you tell them. If you were given a card or a letter about the device, show it, and if you are not sure you have been understood, ask for a urologist or the urology team on call to be involved before any catheter goes in, because a catheter placed by someone not trained in the device is one of the listed risks for that erosion.
Emergency: numbness, tingling or altered feeling around or under your genitals, between your inner thighs, or around your bottom (anus), for example it feels different when you wipe after using the toilet. Call emergency services or go to an emergency department straight away, and do not drive yourself. This can be a sign of pressure on the bundle of nerves at the base of the spine (cauda equina syndrome), which needs emergency treatment.
Emergency: you suddenly cannot control your bladder or bowels at all. The same applies to new leaking of pee or poo, new trouble starting to pee, not being able to feel yourself peeing, not noticing when you need to poo, a new change in how your genitals feel during sex, new trouble getting or keeping an erection, new trouble ejaculating, or new trouble reaching orgasm, if it comes with back pain, sciatica, or pain, tingling, numbness or weakness in one or both legs. Call emergency services or go to an emergency department straight away, and do not drive yourself. These can also be signs of cauda equina syndrome.
Emergency: sciatica in both legs, or pain, tingling, numbness or weakness in both legs. The same applies if you lose feeling in one leg. Call emergency services or go to an emergency department straight away, and do not drive yourself.
Emergency: since any operation in your pelvis, including an operation for prolapse or for leaking, removal of the womb (hysterectomy) or removal of the prostate gland, you have pain in your tummy or pelvis that is severe or came on suddenly, a wound from the operation that opens up, bleeding that suddenly becomes much heavier or that soaks a pad within an hour, or you feel faint, dizzy or breathless, your heart is pounding, or you feel very unwell. Stop your pelvic floor exercises and call emergency services or go to an emergency department straight away, and do not drive yourself.
Emergency: you have had cancer, now or in the past, and your back or neck pain feels like a tight band around your body, or you have new or worsening pain spreading down an arm or leg, weakness, numbness, pins and needles or a loss of feeling in your arms or legs, trouble walking, or trouble controlling your bladder or bowels. Those symptoms count on their own, with or without back or neck pain. Call your cancer team's emergency number straight away, or go to an emergency department if you do not have one or cannot get through, and do not drive yourself. This can be cancer pressing on the spinal cord (metastatic spinal cord compression), which needs treatment straight away.
Emergency: sudden, severe pain in your lower back or tummy that is not like your usual back pain, if you have been told you have a swelling of the main blood vessel in your tummy (abdominal aortic aneurysm), you are over 60, you smoke or used to smoke, or you have high blood pressure. The same applies if sudden, severe back or tummy pain comes with feeling faint or passing out, pale, sweaty or clammy skin (on brown or black skin this can be easier to see on the palms of the hands or soles of the feet), a racing heartbeat or being short of breath. Call emergency services straight away. This can be a sign of an aneurysm bursting, which needs treatment in hospital at once.

Get help today

Same day: aching or discomfort in a testicle that worries you, a lump or swelling in a testicle, a change in its shape or in how it feels, or one testicle that has become bigger than the other. Get an urgent appointment with your doctor the same day.
Same day: a lump or bulge in your groin or upper thigh has become painful or tender, or you have a groin lump and a bloated tummy, you feel or are being sick, you are constipated, or you have a high temperature or feel hot, cold or shivery. This can be a hernia that has become trapped. Get medical help straight away, the same day, for example at urgent care or an emergency department. If the pain is severe or came on suddenly, you cannot poo or pass wind at all, you are vomiting blood or your vomit looks like coffee grounds, or you have suddenly become confused, call emergency services or go to an emergency department straight away.
Same day: a fever, or feeling hot, cold or shivery, together with pain in your pelvis, perineum, genitals or back passage, or with pain when you pee. Get medical advice the same day and say how quickly it came on. Do not treat this with exercise, and if you feel very unwell, go to an emergency department. If you also become confused, very drowsy or have trouble speaking, call emergency services or go to an emergency department straight away.
Pain or burning when you pee together with a high or very low temperature, feeling hot or cold and shivery, or pain in your back just under the ribs. Get medical advice the same day, as this can be a kidney infection. If you also become confused, very drowsy or have trouble speaking, call emergency services or go to an emergency department straight away.
Blood in your pee, which may look pink, red or dark brown, even a small amount, even once, and even with no pain. Get medical advice the same day. It needs checking even if it goes away.
Same day: since an operation for leaking, such as a sling or an artificial urinary sphincter, you have a fever or feel hot, cold or shivery, bleeding or a discharge that smells from the wound, a wound from the operation that is oozing or whose edges are coming apart, new or worsening pain or swelling around the operation site, including in your scrotum, or pain in your pelvis that is new or getting worse quickly. Stop your pelvic floor exercises and contact your surgical team, or the ward you went home from, the same day, and if you cannot reach them get medical help the same day anyway, for example at urgent care or an emergency department. These can be signs of an infection or of bleeding from the repair. If the pain becomes severe or comes on suddenly, a wound from the operation opens up, the bleeding suddenly becomes much heavier, or you feel faint, dizzy, breathless or very unwell, call emergency services or go to an emergency department straight away rather than waiting for a call back, and do not drive yourself.
Same day: since an operation in your pelvis for any other reason, for example removal of the womb (hysterectomy) or removal of the prostate gland, you have a fever or feel hot, cold or shivery, heavy bleeding, discharge that smells, a wound from the operation that is oozing or whose edges are coming apart, or pain in your pelvis that is new or getting worse quickly. Stop your pelvic floor exercises and contact your surgical team, or the ward you went home from, the same day, and if you cannot reach them get medical help the same day anyway, for example at urgent care or an emergency department. These can be signs of an infection or of bleeding. If the pain becomes severe or comes on suddenly, a wound from the operation opens up, the bleeding suddenly becomes much heavier, or you feel faint, dizzy, breathless or very unwell, call emergency services or go to an emergency department straight away rather than waiting for a call back, and do not drive yourself.
Same day: since any operation in your pelvis, a calf or thigh that is newly swollen or getting more swollen, warm, tender, red or darker than usual, has swollen veins that are sore to touch, or has a throbbing or cramping pain that does not fit your injury or condition, or that feels different from normal muscle soreness. Stop your pelvic floor exercises and get medical advice the same day, because surgery in the pelvis raises the risk of a blood clot (deep vein thrombosis). If you are also short of breath or have chest pain, call emergency services.
Same day: new back, hip or pelvic pain and you have had cancer, now or in the past. Get medical advice the same day and mention your cancer history. If you are being treated for cancer now, contact your cancer team the same day.
Pain at night or at rest that keeps getting worse. If you are being treated for cancer now, contact your cancer team the same day.
Same day: pain at night or at rest that keeps getting worse. If you have had cancer, now or in the past, get medical advice the same day and mention it, even if the pain is not getting worse. Do the same if you have back, hip or pelvic pain and are losing weight without trying, even if it does not hurt at night.

Book an appointment

Pain at night or at rest that keeps getting worse. See your doctor within a few days.
Routine: blood in your semen, even if it happened only once. Book an appointment with your doctor so that it can be looked at. It is not something to wait out and it is not something this page can explain.
Within 2 weeks: a lump in your groin or upper thigh that is not painful, especially one that gets bigger when you cough or sneeze and smaller when you lie down. This can be a hernia. Book an appointment with your doctor.
Within 2 weeks: a lump in your groin or upper thigh that does not hurt and does not behave like a hernia, meaning it does not get bigger when you cough or sneeze, it does not get smaller when you lie down, it feels hard or fixed in place, or it is slowly growing. A painless groin lump is not always a hernia, and a swollen gland with no explanation needs looking at in its own right. Book an appointment with your doctor and ask for the lump itself to be examined rather than treated as a hernia on the history alone. Say when you book if you also have night sweats, an unexplained fever, itching, shortness of breath or weight loss you did not intend, because those change how quickly it should be looked at.
Routine: since an operation for leaking, such as a sling or an artificial urinary sphincter, the leaking you had it done for has come back or is getting worse, or you have new pain, new bleeding, or new trouble peeing or pooing. Stop your pelvic floor exercises and book an appointment with your surgical team rather than waiting for your next routine review. A repair can give way and a device can stop working, and after mesh surgery these are also the symptoms a specialist checks the mesh for. Which of those it is takes an examination, and it is not something this page or a physiotherapist can tell you.
Routine: new trouble emptying your bladder or your bowels, a weak or stop-start stream, dribbling after you think you have finished, or a feeling that you have not emptied. Book an appointment with your doctor rather than doing more pelvic floor squeezes, because a flow or emptying problem has its own causes. If you are passing only small amounts and your lower tummy feels full or swollen, or you are leaking all the time without feeling the need to go, get medical advice the same day.
Routine: pain in your pelvis, perineum, testicles or back passage that squeezing brings on or makes worse, or a feeling that you can never fully let go down there. Stop the squeezes and book an appointment with a pelvic health physiotherapist or your doctor, because an overactive pelvic floor needs the opposite treatment from a weak one.

Common questions

Is male pelvic pain the same as prostatitis?

Prostatitis is the label most men are given and it is often not what is going on. The European Association of Urology's chronic pelvic pain guideline says that in most cases of chronic pelvic pain there is no ongoing trauma, inflammation or infection to find, and the readable study behind its muscle claim examined 103 men at a university urology clinic and found tender, poorly working pelvic floor muscles in 88.3 percent of them (Zermann 1999). The Chronic Prostatitis Cohort Study then examined 384 men with the diagnosis and 121 men without, and found tenderness somewhere in 51 percent against 7 percent, with the pelvic floor itself tender in 13 to 14 percent of the patients and in none of the controls, and with tenderness unrelated to inflammation or infection in the prostate fluid (Shoskes 2008). The practical point is that the name on your notes may describe where it hurts rather than what is wrong, and that a muscle assessment is worth having.

Why did the antibiotics not work?

Because a course that changes nothing is information rather than a failure. The guideline recommends a minimum of six weeks of antimicrobials, quinolones or tetracyclines, in treatment-naive men with less than a year of symptoms, so a trial of them is a reasonable step and often the first one taken. If they have not helped, that points away from an infection and toward the muscle, nerve and pain-processing side, which is where physiotherapy sits. Any decision about starting, stopping or repeating a medicine belongs to the doctor who prescribed it, and nothing here is advice about one.

Do Kegel exercises help or make male pelvic pain worse?

For this pattern they are usually the wrong exercise, which is the opposite of what most of the internet tells men. The guideline records that rectal pain treated with pelvic floor muscle therapy is relieved only when patients learn to relax the muscles, and it recommends myofascial treatment as first-line treatment. A floor that is already short, tight and tender cannot produce a strong squeeze from where it sits, so it can also test as weak, which is how men end up with a strengthening program for an overactivity problem. Learning to let go usually comes first, and strengthening often comes back later once the muscle can release, so the sequence matters more than the choice.

What does a pelvic health physio actually do for pelvic pain?

The assessment comes first, and it is normally an internal examination, done with your consent and explained beforehand, looking at whether the muscle contracts, whether it lets go afterwards, how long it holds, and what is tender. The treatment the European guideline puts first is myofascial treatment, which is hands-on work on the painful, tight muscles, and it also offers biofeedback as an adjuvant to muscle exercises in men whose anal pain comes from an overactive pelvic floor. Alongside that, the practical work is learning to release at will, breathing without bracing, and sorting out the things that keep loading the floor, such as straining on the toilet. Expect retraining over months rather than a procedure. You can say no to the internal part and the appointment still goes ahead: the history, a pain diary and an examination of your tummy wall, groin, hips and low back from outside still gather useful information, and you can change your mind later.

Could pelvic pain in men be cancer?

This page cannot rule anything out and does not try to, which is why it has a warning list rather than a reassurance. Several of the lines on it exist for exactly that question: a lump, swelling or change in a testicle, blood in your urine, blood in your semen, and pain at night or at rest that keeps getting worse, which has its own route if you have had cancer now or in the past or are losing weight without trying. Being told you have a muscle problem once does not cover a symptom that is new or different now. If something on that list applies to you, use the route beside it rather than reading on.

My pelvic pain started after an operation. Is that connected?

Often it is, and it has a name rather than being a mystery. The European guideline classes pain that appears or gets worse after a surgical procedure and persists beyond healing, meaning three months or more, as chronic post-surgical pain. Around the groin and pelvis the operations with a recognized risk include inguinal hernia repair, which leads to chronic post-surgical pain in up to 10 percent of patients at six months and can be felt in the groin, the scrotum or both, and vasectomy, after which the reported incidence of post-vasectomy pain runs from 2 to 20 percent. The nerves that supply the scrotum run through the groin, which is why an operation anywhere along their course can produce pain felt in the testicle. So tell whoever you see that the pain started after your operation, because it points the assessment at the nerve and the scar rather than at the prostate, and ask to go back to the team that operated or to a urologist rather than on to another course of antibiotics.

References

European Association of Urology. EAU Guidelines on Chronic Pelvic Pain. Limited update March 2025, sections on primary prostate pain syndrome, section 5.4.10, management of pelvic floor dysfunction, sections 3.2.5.3 and 3.2.5.7 on primary scrotal pain syndrome and chronic post-surgical pain, sections 4.2.1 and 4.2.2 on assessing pelvic pain and focused myofascial evaluation, and section 5.4.3, management of scrotal pain syndrome. https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelines-on-Chronic-Pelvic-Pain-2025.pdf
Zermann DH, Ishigooka M, Doggweiler R, Schmidt RA. Neurourological insights into the etiology of genitourinary pain in men. Journal of Urology. 1999;161(3):903-908. PMID 10022711
Shoskes DA, Berger R, Elmi A, Landis JR, Propert KJ, Zeitlin S; Chronic Prostatitis Collaborative Research Network Study Group. Muscle tenderness in men with chronic prostatitis/chronic pelvic pain syndrome: the chronic prostatitis cohort study. Journal of Urology. 2008;179(2):556-560. doi:10.1016/j.juro.2007.09.088
Anderson RU, Sawyer T, Wise D, Morey A, Nathanson BH. Painful myofascial trigger points and pain sites in men with chronic prostatitis/chronic pelvic pain syndrome. Journal of Urology. 2009;182(6):2753-2758. doi:10.1016/j.juro.2009.08.033. PMID 19837420
European Association of Urology. EAU Guidelines on Management of Non-neurogenic Male LUTS. Update April 2024, section 5.6.3.2.3. https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelines-on-Non-Neurogenic-Male-LUTS-2024.pdf
Continence Health Australia. Pelvic floor exercises for men. https://www.continence.org.au/living-with-incontinence/pelvic-floor-exercises/pelvic-floor-exercises-for-men/
NHS. Urinary incontinence: causes. Page last reviewed 15 June 2023. https://www.nhs.uk/conditions/urinary-incontinence/causes/
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NHS. Slipped disc. Page last reviewed 24 April 2024. https://www.nhs.uk/conditions/slipped-disc/
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NHS. Hernia. Page last reviewed 19 May 2026. https://www.nhs.uk/conditions/hernia/
Martins FE, Bernal J, Tryfonyuk L, Holm HV. Artificial urinary sphincter and stricture disease: surgical principles in management. Translational Andrology and Urology. 2024;13(8):1717-1728. doi:10.21037/tau-23-16. PMID 39280683
Kosuru S, Ozcelik C, Wong TR, Mordukhovich I, Khanmammadova N, Isali I. Comparative analysis of male stress urinary incontinence treatments: a review of efficacy, safety, and clinical outcomes. Current Urology. 2026;20(3):155-164. doi:10.1097/CU9.0000000000000321
NHS. Abdominal aortic aneurysm. https://www.nhs.uk/conditions/abdominal-aortic-aneurysm/
National Institute for Health and Care Excellence. Abdominal aortic aneurysm: diagnosis and management (NG156). 2020. https://www.nice.org.uk/guidance/ng156
National Institute for Health and Care Excellence. Suspected cancer: recognition and referral (NG12). Published 23 June 2015, last updated 15 April 2026, recommendation 1.6.7 on testicular cancer and recommendation 1.10.6 on non-Hodgkin lymphoma in adults. https://www.nice.org.uk/guidance/ng12

Written and checked by the PocketPhysio editorial team. Last updated 2026-11-03.

This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.