Our pelvic pain service treats a wide range of conditions. Some patients come to the clinic with their condition already diagnosed, while others come to find out what they are suffering from. Our men’s health physiotherapy service has decades of experience in treating a wide range of conditions, so you can be confident that we are at the forefront of pelvic healthcare when treating your condition.
Hard flaccid is a condition characterised by a change in the shape and size of the penile shaft. The penis is often found to be in a semi rigid or partially flaccid state giving the impression that it is somewhere between hard and flaccid, hence hard flaccid. The condition mainly affects younger men between the ages of 12 and 35, though we have had patients in their 50’s attend the clinic. The main and most distressing feature of hard flaccid is the penis shape. However, it can often be accompanied by pain, bladder problems, erectile dysfunction, premature ejaculation, or a combination of symptoms.
The cause of hard flaccid may be trauma, excessive sexual activity or sexual trauma, porn addiction, or as a result of chronic prostatitis.
Hard flaccid is thought to happen because of a change in blood flow and/or nerve reflex activity causing the penis to remain in a semi-rigid state. Pelvic floor muscle activity is closely linked to the persistence of this problem. Manual therapy, rehabilitation with ultrasound and shockwave therapy are excellent for the treatment of hard flaccid.
Chronic pelvic pain or chronic prostatitis is a distressing condition that may occur after a prostate infection, or sometimes for no known reason or cause. We diagnose chronic prostatitis (type 3B) when the infection has passed or there is no infection found, and pain persists. It is often advisable to obtain a medical screen prior to our pelvic health assessment to ensure an infection has been excluded.
Prostatitis manifests in pain in lower abdomen, pelvic, lower back, or perineum pain. Sometimes it can affect the genitals. There is often a need or urgency to urinate with little or voiding, and there might be pain with urination. Ejaculation can be painful, and while erections are often possible, they too can be painful. Sitting can be painful, and you may find yourself not able to find comfort from the pain or discomfort. Painkillers may not be helpful, and countless antibiotics have usually been tried with little benefit.
Once the pelvic region becomes sensitised, the muscles tighten and contract, helping to drive the persistence of pain. Over time, the body learns to remain in this state of tension, and only targeted therapy and rehabilitation will break this pattern and re-educate the nervous system for recovery. Complete recovery with even the most stubborn of conditions is possible.
Pudendal neuralgia is an entrapment neuropathy where the pudendal nerve becomes irritated or trapped within the pelvis. Pain is felt in the penis and in the perineum, with the classic “golf ball” sensation when sitting. The entrapment can be temporary and associated with muscle tension, or it can be structural, requiring an injection or surgery to release.
The pudendal nerve can also be associated with pelvic pain and may give rise to other conditions. The research literature places pudendal neuralgia as a stand-alone condition, void or any other pelvic complaints. Our experience is that it may present with other chronic pelvic pain conditions.
There will often be a positive response to pudendal palpation, and we have found manual therapy and shockwave to be helpful for this condition.
Peyronie’s disease is an unpleasant condition characterised by the formation of plaque in the erectile tissue, causing the penis to bend to one side. The cause of the plaque formation may be due to metabolic factors, genetic or trauma. Using our pelvic ultrasound scanner, we can identify the locations of plaque for targeted therapy like shockwave therapy.
Treatment can also be found in surgery or injections, to help break down or remove the plaques. We have used Shockwave Therapy to treat this condition with a high success rate for reducing pain and in some cases a reduction in curvature.
The removal of the prostate for the treatment of prostate cancer is called a prostatectomy and will often leave men with incontinence and a loss in erectile function. This is because of damage to nerves and local muscles. Pelvic floor muscle training is essential after prostatectomy and has a wealth of evidence to support its inclusion in recovery.
Our goals are to help men recover their toileting and sexual function using the very best in techniques and treatment. Rehabilitation has been shown to be highly effective when ultrasound guided pelvic floor training is used to retrain pelvic floor muscles alongside progressive strength training. Emerging evidence and our own experience have shown that focus shockwave therapy helps to regain erectile function and should be started early in the recovery process.
Painful bladder syndrome is a complex and often misunderstood condition, manifesting in an increased frequency or need to pass urine (usually more than 8 times in a 24-hour period). It may be that the feeling of needing to void never leaves you. This is caused by an over excitation of the nerves related to the bladder. It may be related to a previous infection in the bladder or may have no known cause, making treatment very difficult.
This can be treated with pelvic floor rehabilitation, education, pacing and more advanced techniques such as shockwave therapy and percutaneous tibial nerve stimulation (PTNS).
PTNS is an evidence based therapy involving the placement of needles into the feet and shins and delivering a small stimulus. This rehabilitates the nerves closely linked to the bladder and reduces urgency and the need to void.
Call us today for further information on what conditions we can diagnose and treat at our clinics.