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1999 Selected Abstracts from American Urological Association annual meeting

Chronic Prostatitis Caused by Iliopsoas Muscle Dysfunction

©1999 James R. Noyes

I have suffered from chronic prostatitis and/or prostatodynia for six years. The symptoms of my particular case of CP have, at one time or another, included the following: Urethral pain, severe pain in the epididymis and testicle, post-ejaculate pain, post-urination pain, post-bowel-movement pain, "groin" pain, knee pain, "hip joint" pain, abdomen pain, and back pain. Pain was of the "burning" or "tingling" type as well as the "pulled muscle" type.
Other symptoms included a weakened urine stream, weakened erection, and weakened orgasm. Various treatments of these symptoms have, at one time or another, included the following: Massive doses of antibiotics, muscle-relaxants, antidepressants, painkillers, and hot baths. None of these "treatments" were effective in relieving my symptoms--not one! Does this sound all too familiar?
Standard treatments for CP are ineffective because they fail to address the root causes of CP. The root cause of my CP (and many other cases from what I've seen posted) appears to have nothing to do with the prostate itself, but everything to do with the muscles around the prostate and around the male sex organs. The muscle problems are more severe than can be helped with muscle-relaxants, however. The good news is there is a very effective treatment for this.
My hypothesis is that chronic prostatitis and/or prostatodynia is caused by dysfunction of:
  1. Iliopsoas muscle
  2. Pectineus muscle
  3. Muscles (and nerves) surrounding the above
My hypothesis is that chronic prostatitis and/or prostatodynia is aggravated by:
  1. Extended periods of sitting (especially driving)
  2. Tight jeans/pants, tight belts, tight underwear
  3. Sexual activity when the above muscles are dysfunctioning
Some evidence to support such a hypothesis is found below: The iliopsoas muscle is known as a "hidden prankster" due to the fact that it "serves many critical functions, often causes pain , and is relatively inaccessible." Referred pain occurs from the "thoracic region to the sacroiliac area, and sometimes to the upper buttock. Pain is referred similarly from the iliacus and often also to the anterior thigh and groin ."
The iliopsoas muscleruns from the lower back down to the pelvis and borders, among other things, the ureter, spermatic vessels, genito-crural nerve, and the colon.
It appears likely, that if the iliopsoas muscle "often causes pain," these highly sensitive border areas could very well be affected. If this conjecture seems wholly improbable, consider what is known:
  1. Ililpsoas minor syndrome is easily mistaken for appendicitis
  2. Scrotal pain (epididymis, testicle, etc.) has been linked to the iliopsoas muscle
The iliopsoas muscle (a.k.a. the "hidden prankster") is a muscle that can cramp up from sitting (especially if the knees are above the waist). If you sit for long periods of time (at the computer, desk, driving, etc.) your iliopsoas muscle is in a constant state of contraction, which, over time, can lead to pain. Tight fitting pants exacerbate this situation tremendously. Since the iliopsoas muscle is also active while standing, running, and is "vigorously active through the last 60°ree; of a sit-up," these activities could also, if overdone, trigger pain.
The iliopsoas muscle can trigger the pectineus muscleas well. Persistent painfrom the pectineus muscle can occur from "tripping or falling on a staircase, may follow fracture of the femoral neck or a total hip replacement, or may occur in a situation that causes strong resistance to adduction of the thigh, such as sexual activity or gymnastic exercises."
To test this muscle dysfunction hypothesis on my own, I tried the following treatments:
  1. Deep-tissue massage of the iliopsoas, pectineus, and surrounding muscles
  2. Daily stretching of above muscles and tissues
  3. Hot sauna therapy (also steam/whirlpool/bath therapy)
While my treatment is still ongoing, the great news is I'm feeling 90-95% recovered from what was once a rather debilitating, demoralizing, and depressing condition. It's taken nearly two years and the recovery is gradual-not overnight.
Presently, most days are symptom free! Since stretching on its own will show only limited results, sessions with an expert deep-tissue therapist are an absolute must! Look for:
  • NCTMB -- Nationally Certified in Theraputic Massage and Bodywork;
  • NMT -- Neuro Muscular Therapist; or
  • Any therapist trained in the "St. John Method" of Neruomuscular Therapy
For those of you looking for a "quick-fix," don’t expect any improvement without extreme diligence on your part–stretching (long, deep stretches which last 30 seconds to 10 minutes) must become a daily routine. One must be aware that, at times, the pain may worsen before it gets better (one step backward–two steps forward). These therapies have helped me immeasurably and it is my sincere hope, these therapies will be of help to those of you serious about finding relief from chronic prostatitis and/or prostatodynia.
A special thanks to my deep-tissue massage therapist, Deborah Bamford, NCTMB, for her knowledge, dedication, and unwavering support in my ongoing search for a life without chronic pain.  
Sources: Myofascial Pain and Dysfunction: The Trigger Point Manual, volumes 1 & 2, by Janet G. Travell, M.D. and David G. Simons, M.D., and Gray’s Anatomy, by Henry Gray, F.R.S. Send questions/comments to Please don't write to the webmaster about the contents of this page. If you want to discuss whether this page belongs on the website, then write. .

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© 2002 The Prostatitis Foundation
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