Running is a simple and invigorating cornerstone of many men’s exercise routines. Unfortunately for some, it becomes disrupted by an unexpected and frustrating problem: pelvic pain. Pelvic pain in male runners can be felt deep inside the pelvis, around the perineum (between the scrotum and anus), near the tailbone, or can radiate into the groin or lower abdomen. Sometimes it feels sharp or burning, other times it’s a dull, lingering ache that hangs around long after a run ends.
As pelvic health is a topic spoken about less frequently among men, this pain can feel isolating and knowing what to do or where to get help can be confusing. Many presume it’s something they just have to push through in the hopes that it’ll go away on its own - but the truth is, pelvic pain in male runners is common, well understood, and highly treatable, and your physiotherapy team should be your first point of call.
How Common Is Pelvic Pain In Male Runners?
Research shows that up to about one in six men experience chronic pelvic pain at some point, with some developing symptoms as early as their 20s and 30s. Among athletes, especially cyclists and runners, the true rate may be higher, though it’s under-reported due to stigma or lack of awareness. The most frequent culprits include:
- Pelvic floor dysfunction (overactivity, tightness, or weakness): when the pelvic floor muscles don’t coordinate properly, either holding too much tension or not engaging enough, they can’t absorb the repetitive impact of running. This imbalance often leads to pain, pressure, or urinary symptoms during or after exercise.
- Pudendal neuralgia (irritation or entrapment of the pudendal nerve): the pudendal nerve runs through the pelvis and supplies sensation (the ability to feel) to the perineum and genitals. Tight or overactive pelvic muscles, prolonged sitting, or repeated impact from sports can irritate this nerve, causing sharp, burning, or aching pain that’s often mistaken for prostate or groin issues.
- Lower urinary tract symptoms (urgency, frequency, incomplete emptying): tension or dysfunction in the pelvic floor can disrupt normal bladder signalling, leading to urinary urgency, frequency, or difficulty emptying fully. These symptoms often improve once muscle tone and coordination are restored.
- Biomechanical overload (poor running form or core imbalance): weakness or stiffness in the hips, core, or glutes can shift excess load to the pelvic floor during running. Over time, this leads to fatigue and irritation in the muscles and joints of the pelvis, contributing to pain or pressure symptoms.
While these sound complex, they often share one thing in common: the pelvic floor muscles are being made to work in ways they weren’t designed to.
Understanding the Male Pelvic Floor
The pelvic floor is a group of muscles and connective tissue that forms a supportive hammock at the base of your pelvis. For men, it:
- Supports the bladder and bowel
- Assists in urinary and bowel control during running, lifting, or coughing
- Plays a crucial role in sexual and erectile function
- Works with your deep abdominal and glute muscles to stabilise your spine and pelvis
- Helps absorb and transfer impact forces with every stride
When these muscles don’t function properly, whether that’s due to being too weak, too tight, or poorly coordinated, discomfort and pressure can develop anywhere from your tailbone to your groin.
What Pelvic Pain Feels Like in Male Runners
While experiences can vary from person to person, common patterns include:
- A dull ache or deep pressure in the pelvis or perineum
- Sharp, stabbing, or pulling pain near the tailbone, sit bones, or lower buttocks
- Groin or inner thigh discomfort, often worse after longer runs
- A heavy, internal tension or “tight” feeling
- Pain after bowel movements or sitting for long periods
- Urinary frequency or urgency during or after runs
For some, the pain builds gradually as mileage increases, while for others it lingers for hours or even days after activity.
Why Pelvic Pain Can Happen When Running
Running places repeated impact and load through the pelvis. If the surrounding muscles, joints, or nerves aren’t sharing the load evenly, the pelvic floor can become either overactive or irritated. Here’s what we commonly see in male runners:
- Pelvic floor overactivity or tightness: the pelvic floor may become tense or unable to relax properly. This tension can compress nerves like the pudendal nerve, leading to referred pain to the penis, scrotum, or perineum. Overactive muscles also increase bladder sensitivity, creating urgency or frequency.
- Pelvic floor weakness or poor activation: the opposite problem occurs when the pelvic floor doesn’t activate well. The repeated ground impacts can then irritate connective tissues, ligaments, and joints at the base of the pelvis.
- Overstriding, running with a very upright posture, or poor hip and trunk control increases force through the pelvic ring and tailbone.
- Rapid mileage increases or speed work without adequate adaptation can overload small stabilising muscles that protect the pelvic floor.
- Having a muscle imbalance, particularly weak glutes, deep abdominals, and hip stabilisers, means the pelvic floor overworks to try to create stability.
- Irritation of the pudendal nerve from repetitive strain or compression, especially if a runner has tight hip rotators or pelvic misalignment.
- Chronic constipation or straining increases downward pressure on the pelvic floor, which over time creates muscle spasms and pain that can flare with running. Likewise, an irritated bladder or lower urinary tract symptoms (LUTS) can trigger pelvic floor overactivity, setting off a pain-spasm cycle.
Why Rest Alone Doesn’t Fix Pelvic Pain In Runners
Taking time off running might ease the symptoms temporarily, but it doesn’t resolve the underlying problem, whether that’s muscle imbalance, overactivity, or nerve irritation. Without addressing the cause, symptoms often return once training resumes. This is where a physiotherapy team trained in men’s pelvic health can pinpoint the source of your pain and tailor a plan to restore comfort and performance.
How Physiotherapy Can Help
Comprehensive Assessment
When you come to see one of our physios for help with your pelvic floor, we typically start with a detailed history and physical assessment. This may include reviewing your running technique and footwear, going over training changes, performing muscle testing on your core, hip, pelvic floor and other relevant areas, and completing a posture and stride analysis. Doing this helps us identify whether your pain stems from tension, weakness, nerve irritation, or biomechanical overload.
Individualised Treatment
Your treatment then focuses on helping restore optimal pelvic function, not just symptom relief. If you have overactive muscles, we may go over down-training and relaxation techniques - guided breathing, hip and pelvic mobility work, and pelvic floor release. We typically pair that with manual therapy and biofeedback to reduce muscle tone and nerve irritation. We’ll also go over postural techniques, sitting habits and stress-related clenching patterns.
If your muscles are weak or poorly coordinated, we may look at targeted activation training. This is gentle strengthening without over-recruiting glutes or abdominals. We incorporate gradual loading to help rebuild your endurance for running and other high-impact activities.
If your biomechanics are contributing, we may work on gait and running retraining, which could include improving your hip drive, cadence, and trunk control to reduce pelvic load. We’d also likely add core and glute strengthening to better stabilise these muscles, so the pelvic floor doesn’t have to keep overworking.
Load Management and Recovery
We’ll work with you to create a graded return-to-run plan, adjusting mileage, terrain, and intensity to support tissue healing. Your physio may also recommend warm-up routines, mobility exercises, and strategies for bowel health and hydration to protect the pelvic floor during recovery.
Practical Self-Care Tips for Male Runners
If you’re concerned about your pelvic floor, start with these practical steps today:
- Don’t ignore or “push through” pelvic discomfort. Early intervention shortens recovery.
- Stretch and mobilise hips, glutes, and lower back to reduce muscle tension.
- Keep bowel habits healthy. Fibre, hydration, and avoiding straining are key.
- Replace worn running shoes and consult a physio or coach to assess your posture and cadence.
- Incorporate strength and stability exercises twice a week for the glutes, core, and hips.
If you’re a runner struggling with pelvic pain, even if it’s mild, but you’re concerned about it worsening, we’re here to help. We have several male physiotherapists who are highly experienced in this area. Book an appointment online by clicking here or call us on +852 2801 4801