Treating Chronic Prostatitis with Pelvic Floor Physical Therapy
Updated: 11 minutes ago
Chronic prostatitis can be a challenging condition that significantly impacts one's quality of life. Men suffering from this condition often face discomfort, pain, and frustration due to the persistent nature of their symptoms. However, there is hope on the horizon for individuals seeking a holistic approach to managing chronic prostatitis.
Understanding Chronic Prostatitis
Before delving into treatment options, it's essential to comprehend what chronic prostatitis entails. Chronic prostatitis, also known under the umbrella of chronic pelvic pain syndrome (CPPS), is a condition characterized by persistent pain and discomfort in the pelvic region. This condition can lead to a variety of symptoms, including urinary issues, sexual dysfunction, and emotional distress. It's crucial for individuals experiencing these symptoms to seek proper guidance and treatment to alleviate their suffering.
This blog post specifically will be addressing non-bacterial chronic prostatitis, meaning that you are not dealing with an acute infection that needs to be treated with medication. Anyone that is having an active infection within their prostate needs to be seen by a physician and receive the medical care to deal with that infection. The AUA’s 2025 guideline also advises against repeated courses of antibiotics for chronic prostatitis when urine cultures and STI tests come back negative.
Chronic prostatitis is the most common urologic diagnosis in men under 50.
Signs and Symptoms of Chronic Prostatitis:
Bladder and Supra-pubic Pain
Urinary Urgency and Frequency
About 47% report that certain foods or drinks worsen their symptoms (Herati et al., 2013)
Diagnosis of exclusion
Could this also be Interstitial Cystitis? Sometimes. In the NIH-funded MAPP study, up to 75% of men diagnosed with chronic prostatitis reported bladder symptoms such as pain as the bladder fills or a painful urge to urinate, but in the RICE population study only about 17% of men who met the criteria for either condition met the criteria for both. In my experience, the diagnosis one received depends more on the provider and the lens they are approaching the patient through than the actual symptom presentation itself. Read more about interstitial cystitis here.
The Role of Pelvic Floor Physical Therapy
Pelvic Floor Physical Therapy (PFPT) has emerged as a promising approach in managing chronic prostatitis. The American Urological Association’s 2025 guideline on male chronic pelvic pain recommends that clinicians check the pelvic floor muscles for tenderness, and lists manual physical therapy, including internal and external myofascial release, as a treatment option. By addressing the neurological and musculoskeletal aspects of the condition, pelvic floor PT aims to relieve pain and improve overall pelvic function. This specialized form of physical therapy focuses on strengthening, stretching, and relaxing the muscles of the pelvic floor and surrounding trunk to enhance comfort and mobility, and improving the conduction and signaling of the nerve tissue to reduce overall pain.
Patients suffering from chronic prostatitis will be initially confused about how physical therapy could help with something like the prostate, and the subsequent pain. In acute infections, the pain is created by the inflammation of the body fighting the bacteria. In chronic conditions, especially when a pathology such as a bacterial infection is no longer present, the majority of the pain is coming from the nerve and soft tissue surrounding the prostate and other pelvic organs. In treating the soft tissue and nerve tissue that is inflamed, tight, reactive, or irritated you can ultimately alleviate chronic prostatitis in general.
How Pelvic Floor PT Works
During a pelvic floor PT session, a trained therapist will perform an evaluation to assess the individual's specific concerns and needs. The therapist will then develop a customized treatment plan that may include a combination of exercises, manual techniques, dry needling, and relaxation strategies aimed at improving pelvic floor function. By working closely with a pelvic floor PT, individuals can experience targeted relief and long-term benefits.
To read more about what pelvic floor physical therapy is, reference our blog here.
To address the elephant in the room, yes a PFPT session that would be evaluating your pelvic floor would likely include a pelvic floor muscle assessment. That means intra-rectal work by a trained therapist certified in doing that type of assessment. It does differ from a digital rectal exam (DRE) that your physician may have done where they are feeling the prostate. The muscle assessment would include palpating (pressing on) each individual muscle to find out which muscles, if not all of them, are contributing to your unique symptom presentation.
Benefits of Holistic Treatment
Embracing a holistic approach to treating chronic prostatitis can offer a myriad of benefits. Unlike traditional treatments that may solely target symptoms, a holistic approach considers the individual as a whole, addressing physical, emotional, and lifestyle factors that may contribute to the condition. Pelvic floor PT not only targets the physical symptoms but also promotes emotional well-being and empowers individuals to take an active role in their recovery.
Lifestyle Modifications and Self-Care
In addition to pelvic floor PT sessions, making lifestyle modifications and practicing self-care can further enhance the effectiveness of treatment. Incorporating stress-reducing activities such as mindfulness, yoga, or meditation can help manage emotional factors that may exacerbate symptoms. Furthermore, maintaining a balanced diet, staying hydrated, and engaging in regular physical activity can contribute to overall well-being and symptom relief.
Your pelvic floor physiologically is wired to get tight when you are stressed, because that tension helps support you so you can run away from the threat. Unlike our ancestors though, our daily threats are less likely to be a predator or famine, and more likely to be an email or unwanted phone call. Or the holidays. Especially the holidays. Read more about how tight muscles can cause pelvic floor pain here.
In my experience, men are not as likely to lean into self-care as women. Without going too deep into the existential conversation of gendered stereotypes, allowing yourself to actually listen to what your body needs and take care of yourself is not anything other than an important means to an end which is to feel better and live a better quality of life.
TLDR
Chronic prostatitis is a complex condition that requires a comprehensive and holistic treatment approach. Pelvic floor PT offers a promising solution for individuals seeking natural and effective ways to manage their symptoms and improve their quality of life. By embracing a holistic mindset, engaging in personalized treatment plans, and incorporating lifestyle modifications, individuals can embark on a journey towards healing and empowerment. Remember, you are not alone in your battle against chronic prostatitis—empower yourself with knowledge and seek the support you deserve.
Get help with this, in person or at home
If your prostatitis comes with urinary urgency, frequency or burning, the PelviPain Project Urinary Pain Program is built for you too: 30 videos, written for men and women, no diagnosis needed. See the Urinary Pain Program →
In Denver? Book an evaluation with Dr. Caroline →
Dr. Caroline Gamwell, PT, DPT, PRPC, is a Doctor of Physical Therapy specializing in pelvic health and orthopedics. She earned her doctorate at Northwestern University in Chicago, IL, with a focus on chronic pain rehabilitation. She holds the Pelvic Rehabilitation Practitioner Certification (PRPC) from Herman & Wallace and the APTA's Certificate of Achievement in Pelvic Health (CAPP), as well as a post-graduate certification in treating pregnant and postpartum athletes. She owns Worth It PT, a boutique pelvic health practice in Denver, CO. Her strongest passions lie with helping others conquer their chronic pain and achieve their intimacy goals.
