Hip and pelvic pain are very closely related in men, realistically in everyone, but this blog post will focus specifically on men. So if you're experiencing one or the other, or both of them together, this is very common. Just know that you don't have to deal with it. There is treatment that can help you, specifically pelvic therapy.
Why Hip and Pelvic Pain Often Show Up Together
Due to their anatomical proximity, the hips and pelvic floor frequently interact during movement. These regions share muscles, nerves, ligaments, and other soft tissue.
When there is dysfunction in one area, it directly affects the other.
How the Hip and Pelvic Floor Are Connected
Muscles that stabilize the hip are in close proximity anatomically to the pelvic floor.
This includes the iliopsoas, piriformis, and obturator internus.
Studies have also examined the obturator externus, pectineus, and gluteus minimus muscles as a source of pelvic pain coming from the hip.
The obturator internus is a muscle worth highlighting because of its role in both the hip and pelvic floor. This muscle works to externally rotate an extended hip and abduct a flexed hip as well as provide significant deep stabilization to the hip joint.
The obturator internus also has fascial connections to support and accept load through the pelvic floor and hip. The pudendal nerve (innervating parts of the pelvic floor) passes through the fascia of the muscle, so tightness of the muscle can place pressure on the nerve.
The proximity of the hip joint and pelvic floor are further interconnected by other ligaments, nerves, and connective tissue that help them function in conjunction.
Because nerves supplying the pelvic floor and pelvic region pass through the hip, muscle dysfunction in the hip can irritate these nerves.
Common Causes of Hip and Pelvic Pain in Men
While there are plenty of causes outside of specifically hip and pelvic root causes, I'm going to focus mostly on those that are specifically related to the hip and pelvis.
If you have something like core weakness, you may experience hip pain as well.
Just know that this list is not extensive, and there could be a pelvic floor component (which, by the way, the core is a part of) to many orthopedic symptoms.
Here are three specific conditions that are causes of hip and pelvic pain in men:
Chronic Prostatitis (CP/CPPS): genitourinary, prostatic, or pelvic pain without signs of infection; people with CP/CPPS are shown to have difficulty relaxing the pelvic floor, further worsening pain
Nerve irritation: irritation to any of the nerves supplying the pelvic floor and pelvis can lead to pain and pelvic floor dysfunction; sometimes this is a result of muscle imbalances or decreased mobility in the hip
Hip Dysfunction: referred pain due to nerve irritation, soft tissue inflammation, such as a muscle strain or tendinitis, or joint or cartilage issue, such as a labral tear, arthritis, or hip impingement
Regardless of what triggers hip or pelvic pain, the adjacent area will inevitably be impacted. Even with a true hip diagnosis, your pelvic floor remains impacted.
Symptoms That Point to a Pelvic Floor Link
If your hip pain is accompanied by penile, testicular, or anorectal pain, bowel dysfunction, urinary dysfunction, or sexual dysfunction, the pelvic floor should be examined.
Here are specific symptoms broken down by specific systems:
Frequency or urgency
Hesitancy
Pain with urination
Weak or interrupted flow
Bowel Symptoms:
Straining
Incomplete emptying
Pain with evacuation
Anorectal pain
Pain during or after ejaculation
Difficulty with ejaculation
Erectile dysfunction
Decreased libido
If you are treating your hip pain and seeing minimal improvement, it may not be the source of your pain. Taking a deeper look at the pelvic floor could help figure out the cause of your discomfort.
Conditions Often Mistaken for Hip Problems
Because these areas are so intertwined, the underlying cause of someone’s symptoms can often be misdiagnosed.
Those with true pelvic floor dysfunction can frequently be diagnosed with hip conditions instead.
The following hip conditions are frequently confused with pelvic floor dysfunction:
Sacroiliac dysfunction
Hip impingement or tendinopathy
Low back pain
Hip tightness
Groin pain
How a Physical Therapist Evaluates Hip and Pelvic Pain
A rectal assessment can be performed to assess the pelvic floor muscles.
During a pelvic floor assessment, a pelvic floor specialist will look at muscle tone, strength, coordination, skin changes, and tissue mobility.
A PT will also perform a thorough, whole-body musculoskeletal exam. This exam assesses strength, mobility, coordination, proprioception as well as additional special tests to better diagnose the pain.
It is important to identify the source of the pain for proper treatment. Seeing a PT that is specialized in the pelvic floor can help differentiate where the pain source is.
Treatment Options That Address Both Areas
There are different interventions that can address both the pelvic floor and the hips. Often, a multidisciplinary approach is best to achieve complete resolution of symptoms.
Physical Therapy can be a very effective intervention as we are able to assess and treat both the pelvic floor and hips through a conservative method. Interventions would include manual therapy, exercise prescription, and lifestyle changes.
Pain management (any of the following can be used as an adjunct to PT):
Trigger point injections
Acupuncture
Medication
When to Seek Help
These are symptoms that are common and can be addressed.
If you find that your symptoms impact your quality of life, limit your daily activities, or prevent you from doing activities you enjoy, it is best to reach out to a healthcare provider.
Where to Find Men’s Pelvic Floor Therapy in Monterey
If you are local to Monterey, the staff at Monterey Pelvic Health would love to help you.
We offer pelvic floor therapy for men and have an orthopedic/pelvic floor physical therapy blended approach.
Our treatment allows for both the hip and pelvic floor to be treated in one space as well as allow us to help you get back to whatever activity you enjoy, whether it's lifting, running, playing with your kids, etc.
To get started, you can request an appointment or give our clinic a call.