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Dear Dr. Roach: My son was diagnosed with pelvic floor dysfunction (PFD) by a urologist. He went to another doctor who never found anything conclusive. My son has complained of stinging and burning in his urethra, as well as an uncomfortable feeling when trying to sit. He's on his feet most of the time.
He quit his job because of the problems that he encountered with this condition. He's had two MRIs, a cystoscopy and an ultrasound. The problem persists. He uses a hot tub, which offers some relief but not much. According to his current doctor, the tests are inconclusive without a diagnosis. Should he seek a new doctor? -- Anon.
Answer: Chronic pelvic pain is found in both men and women, and the diagnosis is frequently delayed for both as well. Patients can suffer for a long time, and both men and women can also be misdiagnosed.
The underlying cause can be a wide variety of issues, so a thoughtful diagnostic approach is wise. Only a few physicians have the expertise to do a careful physical exam of the pelvic floor, so I refer my patients to specialized pelvic pain referral centers. For men, these centers' experts may include urologists, surgeons, physiatrists, gastroenterologists and physical therapists.
I can't speculate on what's causing his pain. It's likely that he's had an evaluation for prostate problems, which is a frequent cause of male pelvic pain. Often, a variety of treatments are recommended simultaneously, like pelvic floor physical therapy. Even in men without clear prostate problems, a trial of alpha blockers (a common treatment for an enlarged prostate) can sometimes yield pain relief.
However, my experience with my few male patients with PFD has shown that a skilled pelvic floor physical therapist provides the most benefit in helping relieve symptoms.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.