In a subset of men with chronic bacterial prostatitis, pelvic floor myalgia or abdominopelvic muscle myalgia is a clinically significant concurrent finding — identified by tenderness on transrectal digital palpation of the pelvic floor muscles, with or without elevated resting muscle tone. This specific presentation has a distinct first-line evidence-based approach.
Pelvic floor muscle tenderness, detectable on transrectal digital palpation, is the defining feature of this sub-population. Pelvic floor myalgia — pain on palpation with or without increased resting tone — is common among men with chronic pelvic pain and frequently co-exists alongside chronic bacterial prostatitis.
The evidence-based regimen for this presentation is centred on individualized manual physical therapy directed at the affected musculature — applied both internally and externally. The complete structured protocol, including specific techniques, session parameters, and additional options for patients with elevated muscle tone, is available in full via the link below.
DOI: 10.1097/JU.0000000000004564
Clinicians should perform digital palpation of the pelvic floor muscle transrectally in men to identify tenderness suggesting a diagnosis of pelvic floor myalgia.
Pelvic floor myalgia (normal PFM tone with pain on palpation) is common among men with chronic pelvic pain and may co-exist in many male chronic pelvic pain conditions, including CP/CPPS, IC/BPS, and CSCP.
In men with pelvic floor myalgia or abdominopelvic muscle myalgia, clinicians may offer individualized manual physical therapy techniques (e.g., myofascial release of affected tissues both internally and externally).
Clinicians may utilize electromyography biofeedback training to improve active pelvic floor muscle resting tone and relaxation time to improve pain, urination, and quality of life in patients with increased pelvic floor muscle tone.
Patients in the MPT received external myofascial manipulation of the pelvic floor, abdominal wall, back, buttock, thigh, and suprapubic area; internal (transrectal) MPT provided by a pelvic floor physical therapist; and home exercises/stretching.
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