Pain in the perineum in men

Pain in the perineum in men is observed in inflammatory diseases of the genitals, STIs, non-specific infectious processes, volumetric formations, pelvic congestion. It can be detected in coccygodynia, proctological and urological pathologies. The cause of the symptom is determined by the results of a survey, rectal examination, ultrasound, laboratory tests. Treatment includes antibiotics, immunomodulators, antispasmodics, NSAIDs, hormones, anticoagulants, physiotherapy, prostate massage, surgical techniques.

Why there is pain in the perineum in men
Prostatitis
Other inflammatory processes
STIs
Volumetric formations
Pelvic congestion
Chronic pelvic pain syndrome
Perineal hernia
Other reasons
Diagnostics
Treatment
Conservative therapy
Surgical treatment
Prices for treatment

Why there is pain in the perineum in men
Prostatitis

Pain in the perineal area is a constant sign of prostatitis, combined with increased urination, sexual disorders, discharge from the urethra, pain in the genitals, rectal area. The features of the clinical picture are determined by the form of prostatitis:

Sharp. At first, the soreness is insignificant, there is a feeling of pressure with irradiation in the sacrum. Then the pain progresses rapidly, becomes unbearable, supplemented by dysuria, chills, fever.
Chronic. The pain is mild. Unpleasant sensations are characteristic during defecation and urination, scanty discharge from the urethra during the discharge of fecal masses. Against the background of sexual disorders, emotional disorders occur.
Stagnant. A man is worried about constant minor pain in the perineum, sometimes increasing when sitting, giving into the penis, scrotum, coccyx, sacrum, lower back. Hemospermia, difficulty in starting urination, weakening of the jet, frequent urges, urgent incontinence are detected. Depression is possible.
Calculous. Dull aching pain is considered the main manifestation of the disease, localized in the perineum, sacrum, coccyx, scrotum, above the pubis. It increases with prolonged walking, sitting on a hard surface, physical exertion, defecation, sexual acts. Dysuria, hematuria, hematospermia, prostatorrhea are determined.
Other inflammatory processes

A serious complication of acute prostatitis is a prostate abscess. The man’s condition deteriorates rapidly, severe intoxication, chills, hectic fever are observed, sometimes – disturbances of consciousness. The pains are unilateral, sharp, pulsating, correspond to the localization of the abscess, they are given to the perineum, rectum. Urination and bowel movement are difficult due to pain.

Chronic inflammatory lesions of the urinary or genital organs are sometimes complicated by prostatocystitis. The manifestations of the disease are variable. There are pains in the lower abdomen, scrotum, perineum, which increase with defecation, physical activity, alcohol consumption. Men complain of cramps, frequent urges, a feeling of incomplete emptying of the bladder, sluggishness of the jet. In half of the cases, sexual dysfunction is detected.

Couperitis develops as a result of injuries, sexual excesses, inflammatory and venereal diseases. Painful sensations occur with the total involvement of the cooper glands. The symptom increases in the sitting position. Dysuria, weakness, fever are detected. In some men, aching or pulling pain in the perineum appears with orchitis.

STIs

The symptom is caused by urethritis and involvement of the prostate gland. It is observed in ureaplasmosis, mycoplasmosis, chlamydia, and other infections. The typical clinical picture of STIs includes pain and burning in the urethra during urination, pain and discomfort in the perineum, more pronounced in a sitting position. There is discharge from the urethra, mainly in the morning.

Pain in the perineum in men

Volumetric formations

The most formidable oncological cause of pain is prostate cancer. There are no specific symptoms, the clinical picture is due to concomitant pathology – prostate adenoma or prostatitis. A man is worried about burning when urinating or ejaculating, aching pain in the pelvis, perineum and over the pubis, erectile dysfunction. Pain in the lower back indicates the development of hydronephrosis, in the ribs and spine – the formation of metastases.

Large prostate cysts are accompanied by pain in the perineum during sexual contacts. With immune disorders against the background of concomitant pathologies, it is possible that the cyst suppuration with transformation into an abscess. The pain increases to unbearable, chills are observed, severe hyperthermia. A similar clinical picture is found with the rapid growth or suppuration of dermoid pararectal cysts located in the perineal region.

Pelvic congestion

Stagnation of blood in the veins of the pelvis develops due to insufficient physical activity, portal vein pathologies, tumors, connective tissue dysplasia. Some sexual habits play a significant role: too frequent masturbation, delayed ejaculation, lack of regular ejaculation, leading to the development of orgasmic dysfunction, pain in the perineum.

Against the background of prolonged stagnation of blood, the walls of the veins of the small pelvis expand, varicose veins develop (VRVMT). Men complain of moderate aching pain in the perineum, lower abdomen, which increases when walking, lifting weights, sexual intercourse. A distinctive feature is the increase in the symptom when changing the position of the body. Visually, some swelling of the scrotum and perineum may be detected.

Chronic pelvic pain syndrome

SHTB is a polyethological condition that develops with ischemia, congestion, inflammation, after operations on the pelvic organs. It resembles prostatitis in clinical manifestations. Painful sensations in the pelvis, genitals, perineum and lower back can be constant or periodic, vary from dull, aching to acute, intense, appear at rest or during movements.

Perineal hernia

Pathology develops gradually. Initially, an elastic bulge is formed in the perineum. There are periodic pulling pains. Subsequently, the pain syndrome becomes permanent, accompanied by irradiation in the leg or lower back. Large perineal hernias cause discomfort when walking. Other manifestations are determined by the contents of the hernial sac. When the bladder is involved, dysuria occurs, when it gets into the protrusion of the rectum, chronic constipation is noted.

Other reasons

Pain in the perineum often develops against the background of diseases of the pelvic organs and lumbar region, can be provoked by the following pathologies:

Urological: urethritis, cystitis, urethral cancer, passage of calculus in urolithiasis, ectopia of the ureter’s mouth, urinary retention.
Proctological: proctitis, paraproctitis, proctalgia, rectal cancer, hemorrhoid thrombosis.
Other: coccygodynia, bruises and fractures of the coccyx.
Diagnostics

Diagnostic measures are carried out by an andrologist. If necessary, a urologist, proctologist, and other specialists are involved in the examination. During the conversation, the doctor determines the circumstances of the appearance of pain, the presence of other signs, changes in symptoms over time. To clarify the nature of the pathology , the following methods are used:

Rectal examination. It is carried out to assess the shape, size, consistency, structure of the prostate. It makes it possible to detect bulky formations (tumors, cysts, abscesses), to assume inflammation by soreness and an increase in the volume of the organ.
Sonography. Ultrasound of the prostate confirms the presence of cysts and neoplasms, helps to determine their structure and prevalence, differentiate prostatitis and other prostate pathologies, identify signs of cuperitis. Ultrasound of a hernia provides information about the contents of the perineal protrusion and its organs.
Endoscopic methods. Urethroscopy, cystoscopy and rectoromanoscopy are indicated for suspected diseases of the urethra and rectum. Confirm the presence of inflammatory processes, neoplasia, ICD, obstacles to the passage of urine.
Prostate biopsy. It is necessary with a high level of PSA, the detection of tumor-like formation during rectal examination, visualization of areas of reduced echogenicity during ultrasound. The material is obtained transrectally or through the perineum, sent for morphological examination.
Laboratory tests. Men are tested for PSA. To determine the nature of inflammation, identify specific and non-specific pathogens, urine and prostate secretions, PCR, ELISA are seeded. To exclude infertility, a spermogram is prescribed.
Consultation of a urologist

Treatment
Conservative therapy

Men with uncomplicated inflammatory diseases are observed on an outpatient basis. Pronounced intoxication, sharp pains indicate the formation of a purulent process, are an indication for immediate hospitalization. With chronic urinary retention, catheterization is performed. The treatment regimen for inflammatory and infectious pathologies includes such techniques as:

Antibacterial therapy. In non-specific processes, the antibiotic is selected according to the results of sowing, taking into account the sensitivity of the pathogen. Tetracyclines, macrolides and fluoroquinolones are effective in chlamydia, ureaplasmosis and mycoplasmosis.
Immunomodulators. Means of general action are necessary for a decrease in immunity. Rectal candles with immunostimulants are sometimes used to provoke sluggish STIs.
Other medications. Depending on the nature and characteristics of the course of the inflammatory process, a man is prescribed antispasmodics, anti-inflammatory, analgesics, desensitizing, diuretics and hormonal agents.
Prostate massage. It is indicated for chronic prostatitis. It stimulates the release of accumulated secretions into the urethra, improves blood circulation, ensures a more active flow of medications into the gland tissues, prevents the development of stagnant phenomena.
Physiotherapy procedures. Electromagnetic vibrations, ultrasound and laser exposure are effective. If there are contraindications to physiotherapy, the use of microclysm is possible.

The tactics of treatment of SHTB in men is determined by the genesis of pathology. In case of infections, antibacterial, antifungal or antiviral agents are prescribed. NSAIDs, alpha-blockers, testosterone and antioxidants are used for aseptic inflammation. Neuropathic pain is recommended neuroprotectors, vitamins of group B, with myogenic – muscle relaxants.

Men with mild VRVMT are prescribed phlebotonics, vitamins and anticoagulants. Patients are advised to eliminate provoking factors, and dynamic monitoring is carried out. Cancer patients may require radiotherapy, chemotherapy, hormone therapy. In inoperable cancer, medications are used as the main method of treatment, in operable tumors, medications are prescribed after surgery.

Surgical treatment

Acute urinary retention of various genesis is considered as an indication for the installation of a cystostomy. Taking into account the etiology of the pain syndrome , the following operations are performed for men:

Prostate abscess: transurethral or transrectal autopsy, drainage.
Cuperitis: removal of bulbourethral glands with suppuration or absence of positive dynamics against the background of conservative treatment.
Prostate cancer: brachytherapy, cryoablation, radical prostatectomy, bilateral orchiectomy.
Prostate cyst: drainage, transurethral resection, laser marsupialization.
Dermoid cyst: excision using perineal and other approaches.
VRVMT: angioplasty and venous stenting, embolization of altered vessels.
Perineal hernia: hernioplasty with defect suturing, auto- or alloplasty

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