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Men (and those with male anatomy), have you ever typed into Google:
- “It feels like there’s a golf ball in my rectum”
- “There’s so much pressure in my butt”
- “Something feels stuck near my tailbone”
- “My tailbone hurts every time I sit”
- “I can’t drive for long without pain”
If so, you’re not alone—and what you’re experiencing could be related to one of several possible conditions.
Below are some of the most common causes.
What is Levator Ani Syndrome?
The levator ani muscles are part of your pelvic floor. They support the pelvic organs and help lift the pelvic floor. When these muscles go into spasm, they can cause:
- Tailbone pain
- The “golf ball in the rectum” sensation
- Symptoms similar to a urinary tract infection (UTI)
What are the Common Triggers for Levator Ani Syndrome?
- Orthopedic issues: hip injuries, low back problems, falls on the tailbone, or surgery in the area.
- Stress: the pelvic floor often tightens in response to the body’s “fight-or-flight” system, leading to chronic muscle tension.
- Sexual or physical trauma: past or recent trauma may cause unconscious tightening of the pelvic floor.
- Chronic inflammation: ongoing constipation, IBS, Crohn’s disease, or recurring infections can irritate the muscles.
What is Pudendal Neuralgia?
The pudendal nerve is the main nerve of the pelvis, supplying sensation to:
- The lower buttocks
- The perineum (area between the anus and genitals)
- The anus and rectum
- The penis and scrotum
When this nerve becomes irritated, compressed, or damaged, it can cause pudendal neuralgia—a type of long-term pelvic pain.
What are some Symptoms of Pudendal Neuralgia?
- Burning, crushing, shooting, or prickling sensations
- Pain that worsens with sitting but improves when standing or lying down
What are some Causes of Pudendal Neuralgia?
- Compression of the nerve by nearby muscles or tissues (sometimes called pudendal nerve entrapment or Alcock canal syndrome)
- Prolonged sitting, cycling, or horseback riding
- Chronic constipation
- Pelvic surgery
- Pelvic fractures
- Nerve injury during childbirth
- Growths (benign or cancerous) pressing on the pudendal nerve
What about Constipation?
Constipation happens when bowel movements are infrequent or difficult. Stools are often hard and dry, sometimes resembling rabbit pellets. Other symptoms may include:
- Abdominal cramping or pain
- Bloating
- Nausea
- Loss of appetite
Common causes include low fiber intake, dehydration, lack of activity, medications (opioids, blood pressure meds, antidepressants), IBS, or changes in routine (such as travel).
Can Hemorrhoids Also Be a Problem?
Absolutely! Hemorrhoids are swollen blood vessels inside or outside the rectum or anus. They’re common and often mild, but when irritated they can cause:
- Itching
- Pain
- Bleeding during bowel movements (often seen on toilet paper)
Patients will often mention they feel like they’re sitting on a hard pebble.
What is a Rectal Prolapse?
The rectum is the last part of your large intestine, and the anus is the opening where stool exits. With rectal prolapse, part of the rectum begins to slip out of place.
Unlike hemorrhoids, rectal prolapse usually doesn’t go away on its own and may eventually require surgery.
Causes include:
- Straining during bowel movements
- Poor core and abdominal pressure control
- Falls or sudden movements
- Chronic coughing or sneezing
Types of Rectal Prolapse:
- Internal (Grade I): rectum begins to drop but doesn’t protrude outside the anus
- Partial (Grade II/III): part of the rectum protrudes through the anus
- Complete (Grade V): the entire rectum extends outside the anus
Symptoms of Rectal Prolapse:
- A bulge at the anus, sometimes visible as a pink or red protrusion
- Bulging during bowel movements or physical activity
- Bleeding from the rectum
- Difficulty controlling gas or bowel movements in more severe cases
OK, so I Have One (or more) of These Conditions….What are My Options?
Here, at Activcore Physical Therapy, we offer conservative, non-surgical treatments for these conditions, including:
- Myofascial release and massage of tight muscles
- Nerve glides to reduce nerve irritation
- Core and posture training to improve abdominal pressure control
- Toileting technique retraining
- Nervous system calming techniques (like vagus nerve stimulation)
- Stretching of affected muscles
- Visceral mobilization
- Biofeedback for rectal muscles
When Should I Seek Help?
If you’re experiencing persistent pelvic or rectal discomfort—whether it feels like pressure, pain, or that “golf ball” sensation—don’t ignore it. These issues are common but very treatable. Please reach out to us at Activcore Physical Therapy to set up an evaluation and treatment!
Disclaimer: The views expressed in this post are based on the opinion of the author, unless otherwise noted, and should not be taken as personal medical advice. The information provided is intended to help readers make their own informed health and wellness decisions.
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