It can be very unnerving when a man experiences testicular pain. This is pain that is often felt in one testicle, but can extend from the abdomen to the groin, and involve the penis itself or spread back towards the rectum. It can be constant but usually varies in pain, sometimes leaving altogether for short periods of time. Sometimes it even switches sides. It’s usually achy and tender but can be sharp and shooting. Certain activities such as sitting for long periods, rigorous activity, heavy lifting, exercise (especially abdominal or inner thigh exercises), sexual activity, and straddling a bicycle or motorcycle can make it worse. Men will often report that the pain can be easily increased by stress, including busy times at work, relationship issues, career change, moving, deadlines, illness…even worrying about the pain itself. The pain can interfere with sexual function. It can lead to erectile dysfunction, pain with erection, or pain with orgasm. It can also change urinary habits. You may notice an increased urge to urinate, that you go to the bathroom more often, that your urine stream has changed, or perhaps you now have issues trying to get a urine stream going.
Usually, the first course of action when you have testicular pain is to head to the doctor. Depending on your symptoms and the doctor, different exams and tests can be done. Testicles will often be examined for swelling, torsion, or varicose veins. A manual prostate exam (performed via rectum) is often done to determine if there is any swelling or irregularities with the prostate gland. Sometimes blood tests are done to check for things like infection or elevated prostate proteins, and a sample of prostate fluid may be collected to check for a bacterial infection. Sometimes a urinalysis is done, and then sometimes you are sent on for things like diagnostic ultrasound, CT scans or to a specialist like a urologist. But this is all dependent on symptoms and preliminary test results. The simplest remedy is if there is a prostate infection or a diagnosis of bacterial prostatitis, and the antibiotics work. End of story. But these are not the cases that end up at my office.
So how does a diagnosis of non-bacterial prostatitis, chronic prostatitis, or chronic pelvic pain syndrome work?
Well, here are some examples of what my patients have experienced: they present to their doctor with testicular pain, often times it has been worsening over a few weeks or months. Occasionally the pain seems to be gone but now it is almost consistently there. They have pain with sitting, or with exercise or after sex. Maybe their urine stream is diminished. Some men will test positive for an infection and are prescribed antibiotics. If the antibiotics don’t work and the test is still positive for an infection then they may need a different antibiotic or another round of antibiotics. Sometimes the doctor doesn’t wait for the test results and assumes based on other findings that there is an infection, so the patient is put on antibiotics for a couple of weeks (up to a month) just in case. Occasionally the results come back negative but the symptoms seem like an infection so they are given antibiotics anyways. Whatever the reason, the antibiotics don’t deal with the testicular pain (even if they do treat an infection).
So now what?
Now they are usually sent off to see a urologist, or a gastroenterologist or a chronic pain specialist. All the while their testicular pain remains, they are getting more and more concerned about the cause, the stress and worry is mounting, and sometimes other symptoms begin to worsen. Now bowel movements might be difficult, they can’t even begin to think about successfully having sex and sitting at work is very problematic. Some men never get to this point, but some do. By the time another round of tests come back negative or another round of antibiotics do not help, they are then typically given the diagnosis of non-bacterial prostatitis (inflammation of the prostate NOT due to an infection), or chronic prostatitis (which is kind of a misnomer as there may or may not actually be any real inflammation) or chronic pelvic pain syndrome (a general term used to describe pain in the pelvis lasting for more than 6 months).
This is where pelvic floor physiotherapy comes in.
For many, although the pain feels like it’s coming from the testicle it’s actually coming from a surrounding muscle or connective tissue. This can include the muscles that support the testicles, the muscles that support the penis, or muscle tissue around the anal sphincter. These pelvic floor muscles can be too tight or over-active and need to be taught how to relax. Often there are taut bands of muscle tissue called trigger points that are tender to touch but can also refer pain to other body parts. An example of a trigger point might be someone who gets a tension headache due to muscle tightness. They feel the pain in their head, but the source of the pain is a trigger point in the neck or shoulder muscles. Sometimes the pain is actually being referred to the testicles from a muscle farther away from the source of pain. This farther source of pain can be found in the abdominals, deep hip muscles, buttocks, or muscles in the middle or lower back.
Usually a combination of myofascial (muscle and connective tissue) massage, trigger point release, conditioned pelvic floor muscle relaxation, stretches, activity modification and postural changes are used to help treat the pain. There are certainly other tips and tricks too (stay tuned for more about that). If you think that you or someone you know may have chronic prostatitis (or non-bacterial prostatitis, or chronic pelvic pain syndrome) then speak to your family doctor about a referral for pelvic floor physiotherapy treatment.
BSc., MSc. PT