Sarton Physical Therapy

Hope and healing for pelvic floor dysfunction

The Male Patient | Sarton Physical Therapy

Hope and Healing for Male Pelvic Pain, Incontinence and Pelvic Dysfunction

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Contrary to popular belief, pelvic floor dysfunctions are not limited to females.

The physical therapists at Sarton Physical Therapy have extensive training in both female and male pelvic floor dysfunctions and routinely treat males who have pelvic floor dysfunction.
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The female and male pelvis, while they may differ in shape, size, and structure, are relatively similar in terms of their musculoskeletal and neuromuscular components. Most pelvic floor muscles are the same in both males and females. Even when pelvic floor components differ, they have analogous components in the opposite gender.
Read one man's transformation at Sarton Physical Therapy
"I am 95% pain free, off of the Vicodin, back to gardening and ready to surf this summer."
This may seem a bit dramatic but Sarton Physical Therapy has changed my life. Two years ago, I had my third back surgery, a 4-level fusion. Within a week of the surgery I developed a pain in one of my testicles. My urologist said I had Epididymitis and put me on antibiotics, three different antibiotics over an 8-week period made no difference in my symptoms, the doctor recommended removing the testicle. The thought of another surgery and the possible side effects drove me to look for another urologist and to search for other solutions. Over a 6-month period I visited another urologist, physical therapists and a specialist in men’s health. Never was the pelvic floor mentioned, in fact I was not aware of the muscle group involved in the pelvic floor nor what they actually do. I had given up after a year of pain, discomfort and frustration. I was taking Vicodin daily, had stopped all my activities, like surfing, bike riding and gardening and was becoming a couch potato. I decided to have the surgery and take a chance this would rid me of the constant pain.
By a strange chain of events my wife ended up at a hand therapist’s office because of a broken finger. My wife mentioned that I was schedule to have surgery and the therapist mentioned Sarton Physical Therapy. I made an appointment and met with Julie Sarton. To make a long story shorter I have been visiting the clinic for 5 months. I am 95% pain free, off of the Vicodin, back to gardening and ready to surf this summer. Julie and the therapists at Sarton Physical Therapy have saved me from another surgery, from the side effects of pain medications and given me my life back. I can’t say enough about the wonderful therapists and staff at Sarton.
My family doctor and my new urologist were both amazed by the results from treatment at Sarton. The pelvic floor and its importance to good health does not seem to be a topic of much importance in medical school.

San Clemente, CA

Common Dysfunctions Successfully Treated in Males with Pelvic Floor Dysfunction

Pelvic Pain and Sexual Pain Dysfunctions

  • Pelvic floor tension myalgia/ pelvic floor muscle spasm
  • Chronic pelvic pain syndrome
  • Chronic Prostatitis
  • Pudendal neuralgia
  • Pain with ejaculation or erection
  • Testicular, scrotal, penile, or groin pain

Musculoskeletal Dysfunction

  • Coccyx or tailbone pain
  • Pubic symphysis pain
  • Lumbosacral strain
  • Abdominal wall hernia
  • Piriformis syndrome
  • Low back, hip, groin, or pelvic pain that have not responded to conventional physical therapy

Bowel and/or Bladder Dysfunctions

  • Interstitial cystitis
  • Urinary urgency and/or frequency
  • Urinary retention or incomplete emptying
  • Urinary incontinence
  • Fecal incontinence
  • Chronic Constipation/Outlet dysfunction

Post-Surgical Pain or Dysfunction

  • Post-prostatectomy urinary incontinence
  • Adhesions / scar tissue after urologic, intestinal, or cancer-related surgeries

Enter the name for this tabbed section: Pelvic Floor Tension Myalgia/Muscle Spasm
Chronic muscle spasm of some or all of the pelvic floor or pelvic girdle muscles. Internal muscles commonly involved are: puborectalis, iliococcygeus, obturator internus, piriformis, coccygeus, and urogenital diaphragm muscles. Perineal fascia can also be commonly painful and hypomobile causing dysfunction and spasm of the pelvic floor muscles.
Enter the name for this tabbed section: Chronic Pelvic Pain Syndrome
General term that is interchangeable with pelvic floor tension myalgia and/or pelvic floor muscle spasm. Common function deficits from chronic pelvic pain syndrome are: pain with sitting, difficulty urinating, urgency or frequency of urination, and urinary hesitancy.
Enter the name for this tabbed section: Chronic Prostatitis
Prostatitis Syndromes are categorized into three types -- Category I: Acute bacterial prostatitis, Category II: Chronic bacterial prostatitis, and Category III: Chronic prostatitis.

Some prostatitis syndromes are also characterized by pelvic floor muscle spasm and can lead to pain and urinary symptoms.
Enter the name for this tabbed section: Pudendal Neuralgia
Painful neuropathic condition often distributed throughout the nerve field of the pudendal nerve. Most common functional deficit is an inability to sit due to a foreign body sensation in the perineum or rectum. Pudendal neuralgia or pudendal nerve irritation can manifest in many ways and most always has a component of pelvic floor muscle spasm contributing to pudendal nerve irritation.
Enter the name for this tabbed section: Sexual Pain
Pain with ejaculation or erection - some males may experience sexual dysfunction due to pain as a primary symptom or as a result of another diagnosis. Sexual dysfunction is a complex mechanism, of which the pelvic floor muscles play an integral role.
Enter the name for this tabbed section: Male Groin Pain
Testicular, scrotal, penile, or groin pain - some males may experience pain in the genital region even in the absence of positive diagnostic tests. When this is the case, pelvic floor muscle spasm, SI joint and low back dysfunction, pudendal nerve irritation may be contributing to testicular, scrotal, penile, or groin pain.
Enter the name for this tabbed section: Interstitial Cystitis (IC)
Chronic and often severe inflammation of the bladder wall/lining. IC can also involve suprapubic pain related to bladder filling accompanied by other symptoms - such as increased urinary frequency in the absence of proven urinary infection or other obvious pathology.
Enter the name for this tabbed section: Bowel and Bladder Dysfunction
The pelvic floor and associated pelvic structures can play an important role in bowel and bladder function - dysfunction here can manifest in one or more of the following.

Urinary urgency and/or frequency: increased daytime voiding of greater than 5-8x/day with small volume of urine output or increased nighttime voiding of greater than 1x/night disturbing sleep.

Urinary retention or incomplete emptying: inability to fully empty bladder despite urge to urinate, slow stream, and may also be accompanied by urinary hesitancy.

Urinary incontinence: involuntary loss of urine.
Fecal incontinence: involuntary loss of feces.

Chronic Constipation/Outlet dysfunction: any decrease in normal (specific to the patient)bowel movement frequency or inability to evacuate with the urge to have a bowel movement. Chronic constipation is also usually accompanied by straining to have a bowel movement with increased bloating and gas as a result from a non-relaxing pelvic floor muscle group.

Enter the name for this tabbed section: Back and Hip Pain
Piriformis syndrome: trigger points and/or muscle spasm of the piriformis muscle with or without sciatic nerve irritation that may involve the entire lower extremity.

Low back, hip, groin, or pelvic pain that has not responded to conventional physical therapy: if you have undergone extensive conventional physical therapy without results, and your pain and symptoms are accompanied by any other pelvic floor related diagnosis (i.e. urinary urgency, coccyx/tailbone pain, etc.) you may benefit from a pelvic floor physical therapy assessment to rule in or out pelvic floor muscle spasm as a contributing factor to your pain and symptoms.


Our comprehensive evaluation by our expert physical therapists will help to identify the causes driving your pelvic pain. An extensive medical history and physical exam reveals whether poor posture, faulty biomechanics, tight muscles, trigger points, weakness, or nerve disorders are part of your problem. Pelvic floor muscles will be specifically evaluated as well - as they are an essential part of the physical therapy diagnostic process. Additionally, restricted scar tissue or adhesions, connective tissue and fascial restrictions are evaluated to assess their involvement in your pelvic floor dysfunction.


Manual therapy such as myofascial release, joint mobilization, nerve gliding/tension release and visceral manipulation creates the cornerstone of our treatment. Correcting abnormal movement patterns and posture via neuromuscular re-education, therapeutic exercises and core strengthening is an integral component of treatment as well. Additionally, utilizing pain reducing strategies combined with cutting edge modalities such as warm laser therapy facilitates faster healing.
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Patient Testimonials:

Male Pelvic Pain/ Chronic Prostatitis
Roughly four years ago while on a business trip, I found myself faced with a terrible case of urinary frequency (had the urge to go every 20 minutes). That led to groin and pelvic pains, and a general ill feeling. I made it home to my family doctor, who checked for a urinary infection. Although that test was negative, he prescribed an antibiotic saying it was likely prostatitis. After a couple of weeks, the symptoms subsided. Over the next year, I had a couple more attacks. Each met with the same negative urinary infection test, prostate examines and antibiotic prescription. My family doctor finally sent me to a urologist, who also said I had prostatitis and likewise prescribed antibiotics. Another two years passed by and my urinary urge and pelvic pains got worse. My urologist put me on long term antibiotics. By then I had gone through five different antibiotics and a run of no less than nine straight months on antibiotics. After my own research I was concluding that I had a pelvic muscle problem - which in turn led to the pains and urinary urgency. I went to another urologist for a second opinion and he told me to immediately stop the antibiotics. He said my conclusion was right, but had no recommendation for treatment other than anti-inflammatory drugs like Motrin and possibly finding a pelvic pain therapist - but he cautioned that most in this area only treat women. After continued problems and searching, I finally found Dr. Julie Sarton. After my first meeting with Julie, I was hopeful as she seemed to understand what I have been through and the cause of my problems. Julie's first treatment showed me my pelvic muscles were a real mess - very tense and tender. I was amazed at how treating the pelvic muscles would replicate the urinary urge and pains. After a few treatments I observed clear improvement. Now I am nearing two years later and I have been very successful in that I have been able to control and nearly eliminate my symptoms. Moreover, I have been antibiotic free since starting my treatments with Julie. It took me a long time to find Julie but I am thankful I did. She has saved me from a very frustrating condition. Better living through chemistry is not the solution to this very common problem for men. I want to help other men learn that there is a better solution than antibiotics and their root cause is something much different than the common diagnosis of a prostate problem. For me, my pelvic pain is caused by too much time on the freeway coupled with days full of siting in meetings and too much stress. The physical therapy treatment and advise that Julie provides is the answer for me - and it is the answer for many men suffering from this condition. I have learned to appreciate the complexity of the pelvic muscle structure. I am living much better than I had been and I hope the family physician and urologist community learn to understand the real causes for many of these cases. SS

Pudendal Neuropathy/ Neuralgia
My journey with pudenal neuralgia began when I noticed a persistent tingling sensation in the perineum associated with sitting. The longer I sat, particularly when driving or riding a bicycle, the symptoms became more intense and after 30 to 40 minutes became almost intolerable. For the first several weeks, I was certain it was a temporary problem and (like so many other injuries I’ve had) would eventually go away. As the problem persisted, however, I grew increasingly concerned and began to research possible causes and diagnoses.

With the help of Julie Sarton as well as Dr. Jerome Weiss I came to understand that my symptoms were a form of pudendal neuralgia, likely caused by a combination of factors, including a history of intense involvement in athletics and cycling as well as long hours on the computer for professional writing and research. I also came to understand that, unlike other injuries I had experienced, nerves are complex and take a long time to heal. This was not going to improve with a few weeks or even months of medication, therapy, and rest. It was going to be a long journey requiring patience, persistence, and commitment over a period of years.

It’s now been almost two years since the initial onset of symptoms and over 18 months since I began a consistent and diligent treatment plan with Julie.... I have increased my sitting tolerance from 5 minutes to 90 minutes and have made numerous lifestyle adjustments which have allowed me to maintain a sense of normalcy in my daily work and activities.

Among the many things I have learned from Julie, perhaps the most important has been to accept and even embrace the process. I’ve learned to make pudendal neuralgia my hobby—to study it, be fascinated by it, and to learn as much as I can about my body and how it’s responding to various treatments. I tracked my condition and progress with three different tools: (1) a simple journal with 2-3 entries per week regarding observations or patterns with my symptoms; (2) a monthly spreadsheet with a daily entry regarding the level of pain tolerance (on a scale of 1-10); and (3) a spreadsheet where I capture data from weekly functional sit tests, timing how long I can sit without symptoms in relationship to the various changes in treatment or other circumstances.

I attribute my progress to a combination of  lifestyle adjustments (standing work station, bar-height tables at restaurants, carpooling and lying down in the back seat, swimming instead of running and biking, etc), dietary choices (avoiding lactose which was causing some distension and placing additional pressure on the pelvic floor), physical therapy (weekly appointments for both internal and external work),  and independent exercises (skin rolling, perineal massage, deep diaphragmatic breathing, careful stretching).  There is no easy answer or quick fix other than the daily commitment to avoid compressing the nerve and reverse the cycle of muscle spasms that is causing this neuropathy.  While I can’t predict the road ahead, I’m committed for the long haul and thankful for the knowledge I’m gaining each day to influence my own health and recovery process.

As John Wooden (legendary UCLA basketball coach) writes in one of my favorite quotes: … “When you improve a little each day, eventually big things occur. . . .Not tomorrow, not the next day, but eventually a big gain is made. Don’t look for the big, quick improvement. Seek the small improvement one day at a time. That’s the only way it happens–and when it happens it lasts.”

Fecal Incontinence
I would like every doctor in South Orange County specializing in the disruption to the normal flow of nutrients through our bodies to know of the tremendous transformation I've just encountered through the efforts of Mona, Espanola, DPT of Sarton PT. I have gone form 6 bathroom calls a day, with all the attendant toilet paper, wipes and diaper ( fecal incontinence) to only 2 ( with a tremendous cost savings in paper products) in a period of only 4 weeks and 4 treatments.

For any physician who works in this area, the strengthening of the pelvic floor muscles is the answer for a normal life. Ms. Espanola, though tiny displays tremendous strength and sensitivity in this delicate area of our bodies. I strongly recommend your services below to all my doctors and their colleagues. SP

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Did you know??

Cyclist's Syndrome is a common term for symptoms of pudendal nerve irritation or pudendal neuralgia. Symptoms can include: pain in “sit bones”, perineum, genitals, and/or anus, pain with sitting/cycling, urinary, bowel, and/or sexual dysfunction, and/or feeling of foreign object in rectum or perineum. Cycling can lead to pudendal nerve irritation by compression (on the horn of the bike seat) and tension (through repetitive hip flexion).

Chronic pelvic pain in men is commonly referred to as Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) and is also known as chronic nonbacterial prostatitis. Men in this category have no known infection, but do have extensive pelvic pain lasting more than 3 months.

Chronic pelvic pain is a complex and debilitating condition affecting up to 8% of men in the United States.

The incidence of Pudendal Neuralgia (estimated by the International Pudendal Neuropathy Association) is 1 in 100,000 of the general population but some sources report up to 4% of the population. More women affected than men (7:3), but most health care practitioners that regularly treat patients with pudendal neuralgia believe the actual incidence is significantly higher than reported in the literature.

When the coccyx is injured from trauma, such as a fall, it can be misaligned or immobile. Due to the fact that pelvic floor muscles attach onto the coccyx, they can also become impaired. Injury to these muscles often causes them to become hypertonic with trigger point presence which can cause pain in and around the coccyx. A pelvic floor physical therapist can successfully treat coccyx pain by releasing the pelvic floor muscle trigger points and then mobilizing the tailbone.

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