Pelvic Tension Disorder

Prostatitis can cause pain in the pelvic area.  Another cause of pelvic pain called Pelvic Tension Disorder (sometimes called Chronic Tension Disorder) is all too common in men.  Pelvic tension can lead to prostatic congestion which can worsen or even cause prostatitis.  However, here will focus solely on outlining what pelvic tension disorder is and treatment options.

As you can see from the illustration of the male pelvis below, the pelvis is lined with multiple muscles.  Together, these muscles create a cradle on the floor or bottom of the pelvis and hence are commonly referred to as pelvic floor muscles.  Two of these muscles are the IC and BS muscles that attach the penis to the pelvic floor.  Muscle images below copyrighted by Veisland Medical Images and used by permission.

Sagittal - BV-MI-04076 (1).jpg

Pelvic tension disorder can occur when the pelvic muscles that surround the prostate and pelvic region tighten.  Pelvic tension is often seen in men who are perfectionists.  We often joke of someone being “anal retentive” as someone who is always uptight.  You know who these guys are and you may be one of them.  However, men who are literally “anal retentive” or that clench their pelvis a lot can develop pelvic tension disorder.  However, tension in the pelvic muscles can come in response to pain (especially pain from prostatitis).  This is a natural reflex for the muscles to pull or lift the pelvic floor in a subconscious way to get the prostate “out of pain’s way”.  This tension in the pelvic floor muscles can then create pain in the muscles as they continue to contract.  For example, if you make a fist and tighten it, it doesn’t initially hurt; however, if you continue to keep that fist tight, it will eventually start to become painful.  The same holds true with the pelvic floor muscles. 

Another reason men contract their pelvic floor is to help enhance sexual sensations or speed up ejaculation.  These muscular effects on sexual sensations are often due to the proximity of the pelvic floor muscles to the prostate.

 

The image below shows the muscles of the pelvis as seen from above and inside the pelvic bones. 

PF 1.jpg

In the above picture the hole in the center is the anus.  You can also see three small holes leading to the penis.  Through the bottom hole, the urethra passes allowing urine and semen to pass.  The top two holes are for the blood vessels leading to the erectile tissues that cause erections.    As you can see, the majority of the pelvic floor is made up from the levator ani which is the main muscle for the pelvic floor.   The prostate rests on the levator ani.  Further back is the coccygeus muscles and piriformis muscles.

The pelvic floor muscles, namely the levator ani group of muscles, support the organs inside a man’s pelvis – including the prostate.  In fact, in the image below you can see that the prostate lies on top of the pelvic floor muscles.  When the pelvic floor muscles are engaged, sexual stimulation is heightened leading to a shorter time to ejaculation.  Tension in the muscles presses against the prostate, creating a sensation of “more fullness” in the prostate gland.  In addition, the pelvic plexus of nerves involved in sexual stimulation run near the pelvic floor muscles and clenching of those muscles can create more firing in these nerves.  Relaxation of these muscles can often diminish sexual sensations by removing pressure from the prostate (so it feels “less full”) and helps slow nerve firing in the pelvic plexus.  Image below copyrighted by DNA Illustrations and used by permission. 

PF & Prostate.jpg

The urethra passes from the prostate and into the penis through the pelvic floor muscles.  During urination, the pelvic floor muscles are relaxed.  When men want to stop a stream of urine, they tighten these muscles and this “pinches” the urethra closed, thus stopping urination.  So it makes sense that if the pelvic floor muscles are tight or locked, it can be difficult for a man to urinate.  In men with pelvic tension, they often see urination as something they “push” to do, rather than “relax” to do.  This pushing creates enough pressure in the bladder to force urine past the “closed door” of pelvic muscles.  This can lead to these men having a split urine stream, where the urine splits into two separate streams as it exits the penis.  There’s only one urethra, so there should be only one stream of urine, but tension in the pelvic muscles creates separate pressures along the urethra that can result in this split stream.  If urine is not able to pass freely through the urethra, it can back up into the prostate causing inflammation and prostatitis.  This may be the one of the causes of non-bacterial prostatitis.

Tension in the pelvic floor muscles can also make it difficult for semen to pass through the urethra.  Some men with pelvic tension may notice a decrease in the amount of semen ejaculated or they may not ejaculate semen at all from time to time.  In pelvic tension disorder, high pressure is created within the gland during arousal and emission thus making ejaculation more of a painful event rather than a pleasurable event.  This locking or closing of the pelvic floor muscles can cause semen to get backed up.  It’s not uncommon for semen to be forced backwards/upwards into the bladder since it can’t exit to the penis.  This is called retrograde ejaculation.  Semen can also get backed up in the reproductive glands.  This may cause fluid in the ejaculatory duct to back up into the seminal vesicles or prostatic fluid to back up into the prostatic ducts.  Semen may or may not move up into these glands but the fluid produced by these glands congests and does not release, thus leaving the reproductive glands engorged with fluid rather than relieved of fluid after ejaculation (remember two-thirds of semen is produced by the glands during sexual stimulation).  This can create further inflammation and congestion in the reproductive glands. 

The pelvic muscles also extend to the exterior of the pelvis.  In the image below you can see the levator ani and its relative proximity to the muscles of the buttocks (gluteus maximus) as well as muscles of the penis (BS and IC muscles).  As you can well imagine, tension in the pelvic muscles also includes tension in the ischiocavernosal (IC) and the bulbospongiousus (BS) muscle that connect to the penis and are involve in erections and ejaculation.  As these already tight IC muscles contract during an erection to stabilize the penis – pain can occur (think again of clenching your fist even tighter after having it already tightened and hurting).  This is one reason why erections can become painful in men with pelvic tension.  This can also be one reason why wet dreams can become interrupted as nocturnal erections that precede a wet dream can be painful enough to wake a man up prior to ejaculation.

During ejaculation, the BS muscle contracts rhythmically to propel semen out of the penis.  If the pelvic muscles are already tense, these contractions may not coordinate well, leading to slightly abnormal release of semen from the penis or a complete clamping down of the urethra at the base of the penis preventing semen from progressing further out.  In addition, the BS muscles contract repeatedly during ejaculation – this can radiate out to the nearby levator ani muscles causing further pain with each contraction thus leading to painful ejaculation.

PF2.jpg

Treatments for men with pelvic tension can include both medication therapy and non-medication therapy. 

  • Prostate specific alpha blocker medications such as tamsulosin, alfuzosin, extended-release doxazosin, etc. cause the urethra and prostate to relax.  One side effect of this medication is that the neck of the bladder will often relax more and thus retrograde ejaculation (ejaculating backwards into the bladder rather than out of the penis) can occur more often.  Even though this is not ideal, it is better than prostate fluid getting trapped in the prostate without being able to exit. 

  • Anti-inflammatory medications such as ibuprofen and naproxen are also helpful.  Not only do they reduce the pain associated with the tight muscles, erections, and ejaculation – they can also decrease tension in the muscle by helping to eliminate some of that pain (if the muscles are tensing because there’s pain, then decreasing pain can let those muscles ease up and stop “protecting” or “lifting” the prostate and pelvic floor quite as much). 

  • Non-drug therapies are often the most useful for pelvic tension.   In severe cases, pelvic floor physical therapy can be used.  This may involve seeing a physical therapist or other trained professionals that can manipulate the muscles in the pelvis to work out “knots” and help the muscles return to a state of relaxation. 

  • Avoiding activities that involve sitting or placing pressure on the pelvis can create tightness.  This can range from sitting in a car too long, riding a bike or horse (straddle-type sitting), or even using muscles while going to the bathroom (pooping). 

  • Conscious relaxation during sexual activity can also help.  Pain and tightness in the pelvis often occurs when some of these muscles undergo tension during sexual activity.  For example, the IC muscles are under tension and stress during an erection and especially during intercourse.  Depending on the sexual position, men often use the upper thigh and pelvic floor muscles during intimacy.  Ejaculation works the BS muscles and this too can cause tension. The natural tightening of these muscles during intercourse can create tension in surrounding pelvic floor muscles and worsen pelvic tension.  Even nocturnal erections and/or wet dreams during sleep can create some pelvic tension in the morning after waking up from a night of multiple erections.  Similar tension can occur after spontaneous erections during the day.

  • Simple pelvic floor therapies performed at home can also help men. 

 

 

PELVIC FLOOR SELF-THERAPY

The following self-therapies have been helpful in some men.  They are not a substitute for treatment by a healthcare professional and often are an adjunct or add-on to therapy prescribed, outlined, or administered by a healthcare provider.   These therapies can include relaxation techniques, stretches, trigger point release, and massage.

Just like massaging a kinked neck can give some relief, so too can massage of tight muscles in other areas of the body – including the pelvic region.  We include self-massage techniques here since finding a physical therapist or other healthcare provider that is trained in male pelvic floor can be difficult and appointments don’t always coincide with flares of symptoms. 

Many men associate the pelvic region with either going to the bathroom or for sexual purposes, so they may not be familiar with the various muscles and their locations.  And unlike sore muscles men may massage after weightlifting, many of the pelvic muscles are often deep beneath the surface or surrounded by sexually sensitive areas. 

  

Relaxation Techniques

  • Concentrating on relaxing the pelvis when sitting or standing (for men that have had pelvic tension a long time they may feel that they might pass gas).  This can re-train the muscles to be in a relaxed state.  This would be the equivalent of not clenching your fist for a few minutes each day.  As men get better at this they can eventually spend more time relaxed and less time clenched – reversing the pelvic tension.

  • Consciously think about relaxing when urinating and not pushing.  For most men, this may require that they sit down to urinate (which they may already do since they often have a split urine stream that decreases their “aim”).  Relaxing to urinate can sometimes take a lot of concentration.  In addition, many men that have dribbling problems have pelvic tension.  These men push when urinating then when they stop pushing the urine flow stops.  However, eventually those pelvic muscles will relax and when they do, that’s when the small amount of urine trapped in the urethra is let past the pelvic muscles and dribbling occurs.  So learning to relax during urination can also help decrease dribbling afterwards.

  • Take warm soaking baths to help the muscles relax.  Just like a warm bath or hot tub soothes aching leg and back muscles, a warm soaking bath (submerging the entire pelvis) can help relax the pelvic muscles.

  • In sexually active men, limiting the number of ejaculations can help.  Frequent ejaculation (especially more than once a day) can cause the pelvic muscles to contract hard (especially the IC and BS muscles that attach to the penis) – thus increasing pelvic tension and pain.  This does not mean that married men shouldn’t have sex, but sexual activity limited to 3-4 times per week can give the pelvic floor muscles a break. 

  • If the individual is sexually active, ensure that subconscious tension is not happening during sexual activity.  As stated previously, men can flex their pelvic muscles to speed or intensify sexual sensations (sometimes unknowingly).  If this occurs, men with pelvic tension may need to consciously keep their pelvic muscles as relaxed as possible and not clench the pelvic floor to “speed things up” or “intensify things”, especially right before ejaculation.  In addition, sexual positions that take tension off the upper thighs (man lying on side or back) can reduce pelvic tension.

 

Stretches

Any stretching that loosens the upper thigh and groin area going to be helpful.  Typically doing each stretch and holding for 5-10 seconds and doing 5 reps is often seen a starting point.  Some stretches used include (but are not limited) to the following:

  • Standing Stretches

    • Forward Lunge

    • Side Lunge

    • Quad Stretch (heel to butt)

    • Hands to floor (legs apart and legs straight)

  • Lying (these can be done standing but they create less tension when done lying on the back

    • Knee to Chest

    • Knee to Side

  • Seated Stretches

    • Butterfly (knees out and to the floor)

    • Hamstring Stretch

    • Cross-Over Stretch (one knee up and twist to each side)

Below are visual examples of these stretches:

shutterstock_446204131 - Forward Lunge.j
shutterstock_446204131 - Side Lunge.jpg
shutterstock_1018972000 - Quad Stretch.j
shutterstock_1018972000 - Feet Apart Ham
shutterstock_1018972000 - Knee to Chest.
shutterstock_446204131 - Knee to Side.jp
shutterstock_60099178.jpg
shutterstock_94528738.jpg
shutterstock_502575229.jpg

Trigger Point Release

Trigger points are areas of tightness in a muscle that can cause pain to radiate to other nearby portions of the body.  Trigger points are often felt as tender, small knots.  Trigger points on or near the pelvis (abs, thighs, back, glutes) can create pain in the pelvic region.  This pain perpetuates the cycle of pelvic tension disorder.

Trigger point release is a technique where a trigger point is identified, then pressed firmly with a fingertip for 30-60 seconds.  The pressure is removed for a few seconds then the fingers perform a small circular massage of on the trigger point for about 10 seconds. 

 

Healthcare providers trained in pelvic floor trigger points can help you identify areas that may benefit from trigger point release and recommend a frequency.  Many men can identify these areas on their own.  Treatment every day to every other day can sometimes help reduce the tension and pain caused by these trigger points. 

For the purposes of this site, we will highlight a few of the areas men can look for trigger points that can negatively affect pelvic tension and cause pelvic pain.  The following areas shown outline the rough areas where a trigger point may be found.  To find a trigger point, take the index finger and press down in various areas.  If there is a tender spot, perform trigger point release (press for 30-60 seconds, release, and massage for a few seconds).   Trigger point release can be repeated if the pain doesn’t go away.  If after the second time, pain doesn’t go away, make a note to come back to that area another time – don’t overdo it.  For an in-depth reference on trigger point release, a great reference is A Headache in the Pelvis by Wise and Anderson.

 

Some common areas where pelvic floor trigger points occur are shown on the next few pages.  These are rough locations and individual men may vary a little as to where trigger points occur.  If you see dots that form a line, then other areas along that line may be places where trigger points can occur.

Below are a few likely spots to go looking for trigger points on the back/rear side:

 

  • Lower back parallel to the spine (green)

  • Around the tailbone and the inside of the natal cleft/butt crack (blue)

  • The lower rim of the buttocks and sit bones (light blue)

  • Above and below the crest of the pelvis (red

  • Down the center of the hamstrings/thigh (purple)

shutterstock_112082807 - Dots.jpg

Shown below are a few likely spots to go looking for trigger points on the front side:

  • Above and below the crest of the pelvic bone (red)

  • Down the side over the hip (orange)

  • Either side down the linea alba from belly button to the base of the penis (green)

  • In the crease of the leg (blue)

  • Down the inner thigh and quadraceps (purple)

shutterstock_90203401 - Dots.jpg

Shown below are a few likely spots to go looking for trigger points under the penis, between the legs, and in the crack of the buttocks:

 

  • The underside of the penis near the base (red)

  • Behind the scrotum on the perineum (yellow)

  • Sit bones and in the crack of the buttocks near the anus (light blue)

  • Inner thigh (purple)

shutterstock_118550059 copy Dots.jpg

Shown above are a few likely spots to go looking for trigger points around the genitals:

  • The base of the penis is the most common site (light blue)

  • Anywhere in the pubic hair region fanning up to abs (red)

  • The groin starting behind scrotum and extending up crease of leg (purple)

  • Inner thigh

shutterstock_185810852 - Dots.jpg

Pelvic Floor Massage

 

Pelvic floor massage (self-massage) is often very helpful in men with pelvic tension.  We’ll break these down into five main areas on the pelvic floor:

  • Natal cleft (crack of the buttocks) and tailbone

  • Perineum (between the scrotum and anus where you sit on a bike)

  • Base of the penis

  • Pubic and groin regions  

  • Other areas of the body (thighs, abs, buttocks, lower back, etc.)

 

Each of these areas focuses on different set of muscles in the pelvis.  As a man becomes more familiar with his symptoms and the muscles involved, giving a good massage to troublesome areas can bring relief.  The massage regimen shown below works the muscles of the pelvis from the back to the front.

After a hot shower can be a good time to perform these massages as the muscles are more relaxed.  Another good time is often when lying in bed, especially after having an erection or ejaculating.  Before starting, it’s best to get down to the underwear.  A single, thinner layer of fabric allows men to feel the muscles without slipping or tugging on hair and may be more comfortable.  However, one complaint men have is that the underwear can create “rug burns” when working against the skin.  In addition, some men find it difficult to find certain landmarks and muscles.  Because of this, many men find that removing their bottoms or placing the hands beneath the underwear so they have direct contact with bare skin is easier and more effective – either way works.  A few side notes:

  • Never do anything that induces pain.  If the area is painful, lighten the pressure and massage more gently.  If it continues to be painful, simply stroking the skin gently can be a good first step.

  • If the massage is sexually stimulating, it’s best to stop and wait for things to calm down.  However, it isn’t uncommon for the penis to become a little engorged (beginning stages of an erection) but not rigid.  This can be a sign that the muscles are relaxing, thus allowing blood flow to the tissues of the penis.  If an erection occurs, stop, cool off, then resume when the rigidity has passed.  Sexual stimulation and erections tightens the pelvic floor and penile muscles so keeping sexual stimulation out of the equation is key.

  • If you find that hair is getting tugged or the skin is irritated, you can use lotion to lubricate the area.  If using lotion, be sure to warm it up by rubbing the lotion vigorously in the hands first.  Cold lotion can cause the muscles to tighten and we want muscles to relax.

 

Natal Cleft (Crack of Buttocks) & Tailbone - The first muscles we’ll review are those around the buttocks and tailbone shown within the circle area below. 

PF3.jpg

The pelvic muscles in this area of the body include the external anal sphincter and the levator ani muscles.  The external anal sphincter is the muscle that surrounds the anus.  The internal anal sphincter and levator ani muscles are found deeper inside the body as seen in light red in the picture below.  

shutterstock_74635003.jpg

To work this area, here are some thoughts and ideas that may be of some benefit.  As you move from area to area, begin by looking for trigger points and doing trigger point release of those areas.  If you feel “everything hurts”, do the massages outlined first to loosen the muscles up then look for trigger points and do trigger point release at the end.

  • Before starting, clip the fingernails short as the fingertips will be applying fair amounts of pressure to sensitive areas.  Clipping the fingernails prevents injury and scratching of these surfaces.

  • Lie down on your left side and pull your knees slightly up until they’re about 90 degrees to your body (basically the position you’d have if you were sitting in a chair). 

  • The easiest muscles to start with are the glutes or buttocks.  Many men with pelvic tension disorder find that the sit bones (the bones that hit a chair when sitting) are often most tender.  You can start by pressing on the sit bones and massaging the gluteal muscles outwards from there.  Kneading the entire right butt cheek all the way from the top near the back to the bottom near the upper thigh can help loosen the muscles so they don’t interfere later when we work the pelvic floor.  The glutes can also be worked from the outside near the hip towards the crack of the buttocks.  When completed, check for trigger points on the “sit bone”, and on the lower rim of your buttocks where the leg starts and do trigger point release if necessary.

  • Once the glutes are relaxed, take your right hand and place your four fingers into the cleft or crack of your buttocks.  Line your middle finger and ring fingers over the anus itself.  This will leave your pointer finger just below the anus and the pinky finger just above the anus.  The palm of your hand can then rest on the outside of the buttocks.

  • The first muscle that can be worked is the external anal sphincter.  As you gently press, you’ll feel a ridge of muscle that falls off the anus and away from anus (towards your butt cheek).  This muscle felt here is the external anal sphincter.  As you see from the previous illustration, the external anal sphincter extends up into the body.  Gently follow the muscle up into the body as you press into the pelvis and relax this muscle through massage.  If it is particularly sore, applying even constant pressure for 30-60 seconds then releasing and gently massaging can help.

    • Be cautious that you’re over the external sphincter so you do not enter the anus and affect the interior sphincter.

  • The second set of muscles that can be worked are the levator ani muscles.  Begin by pressing away from the anus towards the butt cheek.  This will feel like you are squeezing the butt cheek between your fingers in the crack and the palm of the hand on the butt cheek.  As you press more deeply into the pelvis (away from the anus) with your fingers, you can begin reaching the deeper levator ani muscles that fan out from the anus.  The levator ani contains two slings that connect to the tailbone (coccyx) and wrap around the anus, with one connecting to the pubic bone near the prostate.  In fact, the prostate can be swept by the levator ani muscles and tension in these muscles can make the prostate feel full or congested, making a man feel like he needs to ejaculate.  Tension in these same muscles can also press the urethra as it leaves the prostate making it difficult for the prostate to relieve itself of as much fluid as it should during ejaculation.  As you press more deeply, and massage in small circles using the fingers, this can massage and relax some of these muscles.  Again, these muscles are more deep than the anus so you’ll have to press firmly to get some depth, but not too hard.  For some men, once the levator ani have relaxed fully, it may be possible for them to press these muscles deeply enough into the pelvic cavity to sweep the prostate.  For some this creates a mild prostate massage which can help alleviate tension and congestion in the upper portions of the prostate.  Do not go too deep!  If you feel pain, back off and only apply enough pressure to massage and relieve knots.

  • As you move outward in the crack of the buttocks, you will feel the pelvic bone.  It is possible to get up under the pelvic bone and massage the muscles that line the pelvis.  The more the muscles in the pelvis are relaxed the more likely the levator ani will be to revert to a relaxed state.  You can move up and down this pelvic bone and as deeply as you can go without causing pain.  Again, if you find a sore “knot” you can press on this knot for 30-60 seconds then release and massage gently.

  • The final area that can be massaged is the tailbone area.  Both of the levator ani muscles as well as the external anal sphincter connect to the tailbone.  Pressing the muscles between the anus towards the underside of the tailbone can help stretch and relax this area.  This is often performed by placing the index or middle finger just below the tailbone and pressing in slightly.  As this muscle relaxes, hooking the finger on the underside of the tailbone and lifting slightly can help stretch these muscles as well.  Stretching and lengthening this muscle can be very effective since so many of the pelvic floor muscles attach to the tailbone thus making this area a problem area for men with pelvic tension.

  • This entire sequence is then repeated by turning onto the right side and using the left hand to do the same areas on the left side of the body.

 

Perineum - The second group of muscles we’ll review are those in the perineum, between the scrotum and anus.  This is shown within the circle area below:

PF4.jpg

The perineum is the area between the anus and the back of the scrotum where you would ride a bike.  In order to do self-therapy in this area, it is best to lie on the back and slightly separate the legs (with legs flat).  When the legs are close together, the pelvic bones and thigh muscles can obstruct or block the muscles that we will focus on. 

Here is a rough guide on how to work this area:

  • Begin by cupping the non-dominant hand and lifting the scrotum out of the way.  This will allow your dominant hand to gain access to the area without the risk of accidentally tagging the testicles. 

  • Palpate near the anus and move towards the scrotum.  You should feel a small raised ridge of skin, this is the raphe.  If you’re on the raphe, you’re in the right spot.  Right as you leave the anus, there is a small extension of muscle that points towards the scrotum.  You can massage this muscle to create some relaxation. This muscle is an extension of the rectal muscles (external anal sphincter). 

  • As you follow the raphe you’ll feel and spot where the bone and muscle drop into a deeper cavity.  This valley is where you want to work since the levator ani is in this area.  As you move up the raphe, you will feel the root of the penis beneath the scrotal area.  We will come back and work the root of the penis later, so for the time being, stay in this little “valley”. 

  • Gently but firmly pressing in this area can massage the underside of the levator ani.  Once the levator ani are relaxed, pressure can actually indirectly massage the lower portions of the prostate and some men with congested prostates may feel the pressure in their prostate more than they do in their muscles.  This pressure may feel like fullness for some men and may be sensitive.  The pelvic plexus of nerves runs through this area, so it can be sensitive to both pain and sexual responses.  Listen to your body to determine which areas would benefit and which areas should be avoided.

  • As you move the fingers up to the scrotum you may feel the root of the penis (especially if muscles have relaxed or you have triggered an erection).  A band of muscle leaving the raphe of the back of the scrotum or center line, heading over towards the pelvic muscle can be felt.  This muscle goes in both directions and is between 1-2 inches in length and is called the transverse pubic muscle.  This muscle can be stretched further by separating the legs further, so adjusting the spread of the legs may be necessary. 

  • This area can all be done with the dominant hand, but some men find that switching hands can be beneficial when working one side or another.  In fact, working this area on both sides with each hand can work these muscles from different angles and can be helpful (working both left and right sides with the right hand then switching and working both left and right sides with the left hand).

  • For men who wake up from a failed wet dream, the massaging of this area can provide some relief from congestive symptoms. 

 

Root of the Penis  - The third group of muscles we can work is the base or root of the penis.  As described earlier, the root of the penis is located deep within the body.  It can be felt through the lower scrotal skin. 

The best time to massage this area is immediately after ejaculation (wet dream or sexual activity) while the penis is still somewhat erect and to help these muscles return to a relaxed position.  Some men who have tenderness in this area during nocturnal erections may also want to massage this area briefly upon awakening while the penis is still erect or somewhat erect as long as the working of these muscles is not sexually stimulating.  Working these muscles is difficult when the penis is flaccid; however, it is not necessary or recommended to get an erection just to work this muscle group – this area should be treated only after ejaculation or after a spontaneous erection like nocturnal erections.    

To access this area, lie on your back and pull the testicles up just slightly so they fall to the right and left of the center of the scrotum.  The main muscle we will focus on in this area is the lower portions of the bulbospongiosus muscle (BS muscle) as shown in the circle below: 

PF5.jpg

The BS muscle’s main function is to assist in ejaculation.  The BS muscle compresses the urethra repeatedly causing semen to spurt or shoot out in waves.  At right you can see how the BS muscle wraps around the base of the penis.  Any tightening or locking of this muscle can prevent efficient ejaculation and can cause semen to become backed up into the prostate creating inflammation, congestion, and pain. 

PF6.jpg

This may be an area of focus for men that feel like semen is not being expelled during ejaculation or that the penis feels like it locks down and semen seeps out rather than spurts out.

To massage the BS muscle, take one or two fingers and place them on the “back” side of the scrotum.

 

  • Gently press into the scrotal skin and move over the BS follow the rounding ridge of the penis as it falls to the left and to the right into the pelvis so you can feel where the base of the penis is.  The BS muscle actually wraps around the root of the penis.  You may need to hold the testicles with the other hand to keep them from rolling into this center line.

  • Assess and see if there are any knots or sore spots that need to be massaged.  Massaging these muscles can increase blood flow to the area (which is actually a good thing); however, this blood flow can create blood flow into the penis causing an erection.  Typically, this type of erection is not erotic and often leads to a semi-erection rather than a full erotic erection.  If this occurs, you’ll notice that the root of the penis will swell and the BS muscles will stretch.  Having a slight erection may also make it easier to feel knots in the BS muscles for a few seconds – this is also the main reason that after ejaculation or when waking up with a nocturnal erection is a good time to perform this massaging. 

  • The muscles of the penis do not extend up the shaft so there is no need or reason to massage up the shaft of the penis.  Any erotic and sexually stimulating motions creates more tension in the pelvic and penile muscles and we’re looking for relaxation of those muscles.  Likewise, nerves on the rear of the scrotum can be sexually stimulating (usually near the scrotal raphe near the perineum), so avoiding this area if sexual stimulation occurs is important as well.

  • Note – masturbating at this point is completely counterproductive and not only reverses any benefits gained from massaging this area, but often worsens pelvic tension. This should not be sexually stimulating, so if sexual arousal and firmer erections occur it is best to skip this until an erection is subsiding.

Pubic & Groin Regions - The final group of muscles we will work focus primarily on the ischiocavernosal (IC) muscles in the groin and the pubic area.  We will also work some of the muscles that are close to the IC muscle attachments. The areas we will focus on are shown in the circles below:

PF7.jpg

The upper portions of IC muscles can be felt in the pubic hair at the base of the penis.  These muscles extend down the sides of the groin and attach near the transverse muscle to the side and behind the scrotum.  The role of the IC muscles are to pull the penis into an upright position during an erection. 

This area is an area to potentially work on if the penis does not “pump” during ejaculation or “pumps then locks”.   It’s also an area to work if there is tenderness or pain in the base of the penis/pubic hair region after an erection.

 

To work the IC muscles, it’s best to be lying down rather than standing up (especially if an erection occurs).  Suggestions are as follows:

  • Take the forefinger and press it into the very upper part of the scrotum right where the penis exits the body and the scrotum meets the pubic hair line.  The IC muscle connects to the side of the lower shaft of the penis.  If the area is tender, press down and hold the tender area for 30-60 seconds then release and massage using small circles. 

    • If the penis is slightly erect the muscle insertion on the penis can sometimes be felt further up the penis shaft rather than down in the pubic hair (which is more common when the penis is flaccid). 

    • Sometimes the best time to work this area is when you wake up with an erection or if you get a spontaneous erection (non-erotic) while massaging these areas.  During this time, the BS muscles on the very lower portion of the shaft can sometimes be pressed to help it relax if it is tender.  Another good time to do self-therapy is after ejaculation, this helps both the IC and BS muscles return to a relaxed state.  If an erection is becoming sexually sensitive stop – continuing does no good.  Cool off and allow the sexual sensitivity to diminish.  Again, masturbation at this point would be counterproductive and reverse any benefits.

  • The IC muscle can then be tracked from the pubic hair area along the outer rim of the scrotum towards the crease of the leg.  Oftentimes if the penis is slightly erect, this muscle is easier to feel as it will tend to stretch and contract.  When the penis is flaccid it may be difficult to find this muscle but massaging is best when there isn’t an erection.  Gently pressing on this area can help massage the IC muscle. 

    • Because the spermatic cord is located in the upper area of the scrotum, it’s important to pay attention to make sure you’re not displacing this cord or pressing on it.  Keeping on the outer edges of the scrotum should prevent this.  If you feel you can’t tell what you are feeling or not, then it’s probably best not to massage this area.

  • The IC muscle attaches on the bottom about three-fourths the way down the side of the scrotum, deep at the pelvic bone between the leg and the perineum.  Oftentimes this bone insertion will have knots that should be compressed for 30-60 seconds then released and massaged.   

 

Massage of Other Areas - Other nearby muscles can affect the pelvic floor.  Tension in these muscles can create tension in the pelvic floor.  For this reason, it may also be important to massage the upper thighs, lower abs, lower back, and gluteus (buttocks). 

A technique called skin rolling may be helpful.  Skin rolling involves pinching a large portion of the skin then rolling it back and forth in the fingers.  Skin rolling is most easily performed on the abs – rotating around areas of the abs that seem tight. 

If you are otherwise a tense individual all the way around, massage of other areas of the body such as the neck, chest, upper back, arms, lower legs, and feet may even relieve tension and ultimately produce overall relaxation which can lead to relaxation of the pelvic floor as well.  If these are performed, their best done before doing pelvic floor massage.  

 

 

THE REVOLVING DOOR OF PROSTATE/PELVIC TENSION DISORDERS

A revolving door of inflammation, pain, and congestion can occur in some men with prostatitis, pelvic tension disorder, and prostatic congestion where one condition can lead to or worsen another.  

Images on this page from top to bottom include:

  1. copyrighted by Veisland Medical Images and used by permission

  2. copyrighted by Veisland Medical Images and used by permission

  3. copyrighted by DNA Illustrations and used by permission.

  4. copyrighted by Veisland Medical Images and used by permission

  5. Elnur/Shutterstock.com

  6. Elnur/Shutterstock.com

  7. Elnur/Shutterstock.com

  8. Elnur/Shutterstock.com

  9. Elnur/Shutterstock.com

  10. Elnur/Shutterstock.com

  11. Ahturner/Shutterstock.com

  12. Nicholas Piccillo/Shutterstock.com

  13. Cynoclub/Shutterstock.com

  14. CLIPAREA/Shutterstock.com

  15. CLIPAREA/Shutterstock.com

  16. BlueRingMedia/Shutterstock.com

  17. SciePro/Shutterstock.com

  18. copyrighted by Veisland Medical Images and used by permission

  19. ilusmedical/Shutterstock.com

  20. copyrighted by Veisland Medical Images and used by permission

  21. copyrighted by Veisland Medical Images and used by permission

  22. copyrighted by Veisland Medical Images and used by permission

  23. copyrighted by Veisland Medical Images and used by permission