Wed | Dec 1, 2021

Belly bottom pain in men

Published:Wednesday | May 5, 2010 | 12:00 AM

Men suffer from recurrent 'belly bottom' (pelvic pain) too. This pain in the lower abdomen is often associated with frequent urination and pain in the groin area and private parts. When investigated these men usually do not have infections, but there may be a link to emotional stress. The cause of the
pain is usually not known.

The typical complainant is a young-to-middle-aged man. Initially he tells me about problems sustaining his erections, but eventually he mentions a recurring pain in his belly bottom. He describes the pain as moderate-to-severe. It affects the testicles, between the testicles, the rectum, the tip of the penis, the lower abdomen, and the lower back.

Pain index

In order to describe the problems of chronic pelvic pain, the United States National Institutes of Health collaborative panel has designed the Chronic Prostatitis Symptom Index (NIH-CPSI). This index contains a series of questions which help the urologist to organise the patient's complaints in a standardised fashion. The index addresses the nature of the pain, urinary complaints, the impact of the symptoms and the effect of the pain on the man's quality of life.

Cause is not known

The cause of this condition is still being studied. Some doctors have proposed bacteria that cannot be easily identified with routine tests. These bacteria remain hidden, causing a chronic infection. Other scientists propose a kind of nerve or muscle injury in the pelvic area that leads to the pain.

No specific tests

There are no tests available for diagnosing chronic pelvic pain in men. Doctors usually do investigations on the urine. If the urine contains pus or bacteria, this would suggest the need to do checks for bacterial prostatitis. The prostate-specific antigen test may be elevated in men with 'belly bottom' pain but it is also elevated in men with prostate cancer, and bacterial prostatitis.

Psychological stress and depression are associated with flare ups of pelvic pain in these men. This has led some doctors to mistakenly conclude that chronic pelvic pain in men is only psychological. But it is now recognised that emotional distress actually increases pain mediators resulting in an exacerbation of pelvic pain symptoms.

Medical care

Any man who suffers from long-term 'belly bottom' pain should visit his doctor for an assessment. Most times the man must be referred to a urologist for a complete evaluation. This is a well-established condition which is difficult to treat. Once the diagnosis of chronic pelvic pain syndrome is made, the man can be reassured that it is not life-threatening and is not cancerous. He can be treated with various modalities to control the symptoms. Like arthritis or hyper-tension, there is no cure for the condition.

Dr Pauline Williams-Green is a family physician and president of the Caribbean College of Family Physicians; email: