Sensation Loss and perineal congestion

[ajama484]

hey I'm new on these boards, I just wanted to describe my symptoms to see if anyone is going through something similar and steer me in the right direction as to what's wrong. Since this past summer I've been have A LOT of soreness in my perineum. The muscles just feel congested and weak and sore. What's more is that while I can get erections, the sensation feels greatly diminished. I wouldn't call it numb but its as though the muscles in my perineum don't respond in the fluid strong way they used to. For example when I'm getting an erection, I start to feel a lot of soreness at the base of my penis (the bulb?). During arousal those muscles between my legs used to contract in a quick, reflex like manner, now its as though the muscles are slow and struggle to contract and when they do, it feels like a sharp ache. I can feel the congestion when its flaccid, but during erection when the muscles get bigger it REALLY feels constricted behind my testicles and at that point sensation in my penis is greatly diminished. Moreover, I used to be able to ejaculate just fine (shooting) and I could feel the muscles pumping between my legs, now its as though everything dribbles out. I don't have any post-ejaculation soreness, its just when those muscles are ejaculating, or contracting during sex that I feel it aches the most.

I've gone to the doctors about this because with this I also have really bad constipation where I have to strain and even after a bowel movement I still feel heaviness in my rectum. An ano-rectal doctor found some inflammation in my anus but really didn't look any further, he just told me drink more water and get more fiber. The urologist is baffled by my symptoms, he did a rectal ultrasound to check out the the ejaculatory system but doesn't know what could be causing these symptoms. I'm really at the end of my rope and i'm only 24, I feel like I'm too young to be having these problems.

So my symptoms include:

• perineal congestion and soreness
• decreased sensation penis
• heaviness in rectum (almost like everything in my rectum is sagging)
• and straining to poop

I don't have any problems urinating or frequency or anything like that, just what I described above.

[neue01]

Hi there.

I have had bouts with almost the exact same thing. Essentially a loss of deeper sensation which also interferes with orgasmic sensation at times and always interferes with libido, desire and the good old erection. sometimes it's heightened but more often it's diminished. I suffered with this for many years and it took a long time to find the culprit in my case. For me the main contributer to all this was less the pelvic floor (though I had developed trigger points and tightness here too) but the deeper rectal walls. It sounds like this is the same case for you with the additional rectal issues you seem to be complaining of.

I had to go beyond just treating the more accessible pelvic floor and go slightly deeper into the rectal canal to find where my symptoms were generating from. The problem for me was a collection of tight muscles and trigger points in the rectal walls in close proximity to the bladder and urinary tract. If you do some research you will find a direct connection between rectal tone and function with your erectile abilities. When I found these sore and congested muscles it refereed pain directly. It took me about 6 months of standard pelvic floor therapy before I decided to even venture deeper into the rectum on my own. My therapist seemed to feel there was no reason to do so. Boy was he ever wrong. When I first used a tool to probe this area it was so sore and painful it brought tears to my eyes. This is when I knew I was on to something. I have since been working these muscles for 6 months now. when I started working on them they were simply hard painful inflexible ridges full of layers on layers of trigger points. My initial massages only involved simply getting them used to even being touched because they were that sore. This is the area you will want to focus your efforts on if you are anything like me. It takes time and care though. You need to be fairly careful and handle things with patience.

My theory is that I developed extreme tightness in these muscles over the years. As a kid I semi chronically clenched and held back from going number two. I was essentially a classic case of the anally retentive kid. Needless to say I had developed very strong muscles and tone which also gave me the ability to hold back an orgasm for a fair amount of time. I was sort to a champ at it and it worked well with a lot of women I was intimate with back then. I was also a perfectionistic and intense guy with a bit of OCD for good measure. Then one random day years ago it all just started to go south. It took me a long time to figure out what the hell was happening as it has for many men here on this forum. You're lucky if you have found this forum without having to suffer for too long. for me it has been almost a decade of dealing with this with only the last year being focused on the techniques you will learn about here.

I'm sure you have a bunch of individual questions but I thought I'd just touch base and say hi. I also wanted to let you know that you are not alone with this condition and you can count on people being a great resource for you here on this forum.

[ajama484]

Yeah, you have me pegged with the OCD, holding stool and ability to last long in bed before Now its as though my perineal muscles are just so weak and sore. If I do just one Kegel I'll feel the ache. I've tried the relaxation route, but it just doesn't seem to help. If I try to drop my pelvis it starts to really ache and the sagging and pressure feeling in my rectum worsens.

[Jay]

Hi there,

PFD can definitely have an impact upon the perineal muscles. Many of my trigger points were there. Furthermore, an interesting experience:

One of the first things we did at physical therapy was to assess my control over my pelvic floor muscles. While the PT had her finger inserted rectally, I was instructed to try and contract as best I could, and then relax as best I could. I'd always gauged my ability to do this by the feeling of my perineal muscles moving, thinking it was a sign of good ability. Turns out that I barely registered a 1 of 5 on the scale, both contracting and relaxing!

[neue01]

Yeah, totally. It's because they are sore and lack a full range of motion. This is what contributes to the feeling of congestion. You need to begin treating yourself in accord with the basic information you find here. Simply relaxing will not release the trigger points and tightness you have developed. Like I stated above, when I finally found the muscles that were responsible they were so tight and compacted that they were as hard as rocks. It took me 6 months to release them to anywhere near normal. I am still working on them now and am not cured by any means yet. The other big thing for me personally (like others here) was diet. Certain foods brought about symptoms in a major way and contributed drastically to my situation. So much so that for many years before finding this website I was focused on this set of symptoms alone.

You will need to physically release the muscles that are causing you trouble by internally massaging them and releasing the trigger points. I did this using a tool to reach the area. It is best that you see a physical therapist first but like I said above my physical therapist was only treating more accessible areas in my pelvic floor. He was uninterested and would not listen well when i told him that my pain seemed to be generating from other areas deeper inside. My therapist was Dr. Weiss here in SF and he is regard as one of the best and not cheap. I finally had to take things into my own hands to begin to see real results from therapy of this sort.

[BrettP]

Welcome to the club pal. I have similar symptoms especially with my bowels. Constipated incomplete emptying. I'm right at your age group been struggling for awhile now. The pain comes and goes. Today it's bad. I'm high strung and have a stressful job. All these aggravate my symptoms. It's tough but over time it will slowly get better. Just need to identify stressors and remove them. Easier said than done. You'll be allright.

[ajama484]

okay so i just came back from my urologist follow-up who had done a transrectal ultrasound so see if there was any prostate problems. He told me everything there looked fine and was really apologetic that he couldn't find anything. He said he looked into the tightness, numbness and congestion in and thought that could be a result of spasm or triggerpoints or nerves misfiring. And so told me to keep my appointment with the neurologist to make sure whether it was a nerve problem but to also see a specialist that dealt with pelvic problems. He said he would look into it and try to find one in Toronto for me but that he wasn't sure if there were any around. So far he has me on Wellbutrin to help with both the low feelings and libido. I hope this leads to some improvements.

Anybody know of any specialist that would help with these problems in Toronto?

[neue01]

Well I'm glad to hear you are attempting to find a physical therapist that treats the pelvic floor and work things out from that angle. This is the keystone to recovery. I'm positive that you will see results from pursuing physical therapy over medication or surgery found in traditional methods of treatment. A huge majority of these cases are neuromuscular in nature and not bacterial. This website will be your best link into treating yourself from this perspective. The sooner you can treat yourself from a joint physical therapy and relaxation standpoint the better.

[ajama484]

okay looking through the Mount Sinai hospital site i found a department that might deal with this problem. Its called the wasser pain management center

http://www.mountsinai.on.ca/care/pain_m ... egion-pain

list of what they deal with

Chronic pelvic region pain conditions we have seen include:


vulvar vestibulitis
vulvodynia
lichen sclerosis
chronic vulvar infection
endometriosis
pelvic floor muscle tension syndromes
various neuralgias and nerve entrapments
musculoskeletal pain disorders
fibromyalgia

and they discuss some issues i've gone through

Some men with chronic lower back pain will have pain radiating into the pelvic, and anogenital areas. More important chronic prostate pain (prostadynia or sometimes called chronic prostatitis), testicular pain, (orchidynia), anorectal pain (anodynia and proctodynia), penile pain, and groin pain, various pelvic nerve entrapments and tailbone pain (coccidynia) are common, debilitating causes of pain, dysfunction, disability, and despair in men.

apparently they do physiotherapy for pelvic pain and also do Botox and steroid injections. Anyone else familiar with these guys? I'll ask my urologist about this since they're both at the same hospital.

[ajama484]

actually no, it just stated that as a treatment option for chronic pain so yeah I'm not 100% sure if they do injections down in that area.


here was the quote

Injections
In treating chronic pain, injections of local anaesthetics with or without corticosteroids offer some diagnostic and therapeutic value. Studies show variable levels effectiveness with this treatment. There is a body of evidence for the effectiveness of Botulinum Toxin A injections for headache prevention and for chronic myofascial pain.


Wasser practitioners do carry out Botox injections and some dry needling on-site.

[Howden]

The Wasser Pain clinic is well worth a try. They offer most of the 'clinical' therapies mentioned on this board. In fact it was at the Wasser that I learned of a HITP. Lyrica, prescribed for me at the Wasser, together with the antidepressent I was already using, gave me reasonable pain relief for 4 or 5 years. I stopped using both drugs last June in order to check out my pain levels. Also, at the Wasser, I had the opportunity to try biofeedback and TENS. They didn't work for me, but might work for you. Also went to a PT at the Wasser who did internal tp, but she has left the clinic, I believe. There may be a replacement there by now. I think that was beginning to have an effect, but treatment was not for long enough, probably because demand was great and time had to be rationed. PTs in Canada are not supposed to do internal tp work, I'm told, but I keep looking anyway. If anyone finds a good PT within driving distance, of Toronto please let me know. The Koffler (urology) Clinic across the road from Mt. Sinai is also good; you can get a referral from the Wasser to the Koffler or vice versa. Good luck.

[ajama484]

I've been seeing my physiotherapist for about a month now. I seem to get temporary relief from "triggerpoint" release for a short while before I feel the congestion and tightness in my rectum again. However, I have yet to see any reduction in my main symptom. Originally my problem was reduced ejaculatory dysfunction which I think is a result of constriction. The muscles in my perineum and prostate area seem constantly congested and tight, and this has been going on for over 6 months. Whenever I start to get an erection, the bulb of penis feels extremely sore, its as if when blood rushes in I start to feel an aching sensation. At this point if I try to do a Kegel (just to demonstrate the muscle dysfunction) I get a sharp ache near the perineal body. Moreover, reflex contractions during stimulation whether it be masturbation or sex seem to be diminished because the muscle can't go through their full motions. My physio tried palpating the the bulbocavernosus and ishiocavernosus externally but I don't feel any discomfort. When she checks things out internally she can't find any triggerpoints near points near the prostate. The muscles in that area she says are a bit tight but nowhere near as tight as the posterior portion of the rectum. I have no idea how to resolve this issue. The congestion is tightness are perpetual, they don't ever seem to abate or reduce in severity. Its as though my muscles in that section have been chronically tightened and I can't untighten them. Anyone have any ideas on the best course of action?

[neue01]

I'd bet this is because the muscles that are causing you problems are not near the prostate. In my case they were much further up internally and what you describe sounds very similar to my pelvic issues. For me the muscles that refer to the perineum are about 8 inches up inside. I had to go very far back with a tool to hit the truly sore congested areas. You physical therapist does not have long enough fingers to reach these areas and like mine could advise you against exploring this area. I can say from experience that's because they know they will loose the money if you start treating yourself. I can also say from experience that I only began to see real results form Physical therapy and TP release once I went this far back and began working out the kinks in my rectal walls. I'd advise you to probe the area yourself with a tool and see what you find.

[calman]

I agree with neue01. Learn to do your own self-PT and to work internally. Keep in mind that the walls of the rectum are paper thin so be careful and use lots of lube. The "Slender 7" curved personal body massager" is available on Amazon if you search for it with those words. Obviously, you use it without batteries. Go slow. Be gentle at first. I find that I am progressing much more quickly on my own than with my PT because I get instant feedback about where the pain is and isn't and can work areas accordingly. Take a hot bath before and/or after you work on yourself. I flared a lot afterwards at first but not so much now. Basically, you want to stretch and hold the painful areas with for 30-60 seconds. Then, massage them very gently to get some blood flow to the area. Once you've had a PT do the work you'll know better how to do it. So, even if you have to go to the States for some internal PT go ahead and do it so you'll know how to proceed.

There are stretches in A Headache in the Pelvis you should do. I've had to cut way back on coffee. Someone else on this forum recommended l-theanine for relaxation so I've been giving that a go too. Stein, in Heal Pelvic Pain, also tells how to treat yourself. She suggest starting towards the outside of the rectum and moving in as the more outward trigger points release. She says to avoid the tailbone and the prostate. Be very careful with the tool because you won't have as good of a sense of what you're doing. Really listen to your body. Others can probably tell you more but if you haven't already read Stein's book and Wise's HITP start there.

[calman]

By the way, I found that nerve blocks made me worse, not better.