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Introduction
Pain and other symptoms in the pelvis in men are often difficult to localise, and symptoms of rectal, penile lower abdominal pain may all come from pelvic trigger points. A number of factors will cause trigger points to persist, including physical trauma, psychological stress, and dietary factors.
Most of the urinary symptoms such as frequency, nocturia and urgency are the same in both sexes, and are described in detail here whilst those symptoms related to the male genitalia and prostate gland are described below.
Puborectalis (part of the levator ani muscle group)
The most commonly involved muscle group in men, associated with chronic prostate, and shooting penile pain is the puborectalis muscle- part of the muscle group known as the levator ani. Trigger points in this muscle cause a sensation of fullness and pressure in the prostate, and may refer pain to the urethra and the bladder. It is also associated with an increased frequency of bladder emptying and sensations of urgency.
As the diagram illustrates, the puborectalis muscle passes from the pubic bone, through the pelvis and around the rectum like a sling. Relaxation of the muscle allows emptying of the rectum during defecation.
Trigger points in this muscle group may be de-activated by a number of means including manual stimulation, postisometric relaxation or by needling adjacent structures that share a similar segmental innervation (S3, 4).
Coccygeus
The coccygeus muscle illustrated is illustrated from above. The coccygeus muscle is a thin triangular sheet of muscle continuous with the iliococcygeous. The coccygeous muscle combines with the levator ani m to form the pelvic diaphragm.
Symptoms from the coccygeus include sensations of a ‘golf ball’ in the rectum, anal pressure and pain and intestinal fullness. Trigger point deactivation can be undertaken in the same way as for other pelvic trigger points including electro acupuncture to help with central modulation of pain and discomfort.
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