What is the perineum?
The perineum is the area located between the anus and the scrotum in men and between the anus and the vagina in women. The major muscles of the pelvic floor all attach to the perineum. This is one of the most common areas of pain in men and women who suffer from various forms of pelvic pain. But perineum pain can also be caused by injuries, urinary tract issues, infections, and other conditions.
In men, however, the pain may be located in the perineum but may also radiate to the testes and the rectum. Also, it’s important to note that in men, pain in the perineum has very different causes than in women.
Perineum pain is also known as perineal pain.
What causes perineum pain in men?
The causes of perineal pain are varied, but fall into two different categories:
General Causes
- Duct obstruction
Duct obstruction occurs when one of the ducts that carry the bile out of the liver to the intestine becomes blocked.
2. Entrapment of pudendal nerve
Pudendal nerve entrapment is the situation in which the pudendal nerve ( located in the pelvic area) is compressed in Alcock’s canal. Usually, pain is getting worse while sitting.
3. Abscess
An abscess contains infected fluid. It can grow large before making you ill, that is why you should check the cause immediately.
4. Prostatitis
Prostatitis is the inflammation of the prostate gland, that gives you pain or frequent need to urinate. It can cause chronic pelvic pain syndrome.
5. Perineural cyst
The perineural cysts, known as Tarlov cysts, are sacs filled with fluid in the sacral area of the spine. They can cause pain in the lower back and pelvic floor.
6. Ischiorectal abscess
An abscess in the space between the sheet of muscle that assists in the control of the rectum and the pelvic bone. It is often secondary to a disease of the anus.
7. Benign prostatic hyperplasia
BPH is the non-cancerous enlargement of the prostate. It is a common condition as men age. Perineum pain might be caused by prostate enlargement.
Abdominal Causes
- Colitis
- Appendicitis
- Proctitis
Symptoms of the perineum pain
Typical symptoms of perineum pain include one or more of the following:
- Genital pain, anal and rectal pain, suprapubic pain, pain in the bladder area, tailbone pain, groin pain, low back pain
- Discomfort when sitting (many say that it feels like they are sitting on a golf ball), pain after bowel movements
- Urinary frequency, urgency, hesitancy, burning, frequent nighttime urination
- Sexual pain including orgasm and post orgasm discomfort (can even be the next day)
How do you diagnose the cause of the perineal pain?
Diagnostic workup to identify the cause of perineal pain starts with a conversation regarding your recent medical history. Afterwards, the discussion is usually followed by a physical exam. This will determine the amount of pain you are in and if there is anything in the area directly causing the pain. Also, other tests used in diagnosing the cause of perineal pain include:
- Blood tests
- Urinalysis
- Radiological evaluation or ultrasound
Perineum pain treatment
Treatment of perineal pain in men can be challenging. That is why a thorough evaluation is necessary to determine the most likely cause of perineal inflammation or pain. This then guides the treatment decision in order to treat the underlying cause of perineal pain.
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Also, a common treatment for perineal pain or perineum pain is bed rest which will help relax the perineal area. This is because if it’s simply stretched or bruised, bed rest will allow the area to repair itself. What is more, other treatment options that can help include perineal massage and antibiotic treatment.
For the best advice when it comes to perineal pain or any other urologic issue, you should not hesitate to set an appointment with an experienced urologist such as dr. David B Samadi.
Related: Dr. David Samadi has been recognized as one of the top robotic prostatectomy surgeons in the World.
