Painful area above pubic bone / skin rolling / massage

[JammyDodger]

Hi,

Hope someone can help?

I'm undergoing pelvic floor PT and as part of my 'homework' I'm massaging / skin rolling tight fascia / muscles in my ab area & adductor. I'm having some success in desensitising these areas and removing trigger points and freeing up the fascia.

However, I have a stubborn painful area right on top of the pubic bone at the base of the penis.
Whilst skin rolling I've noticed I can get right under this layer of skin (basically entering at the base of the penis and pushing my fingers up towards the belly button). Here, underneath this layer, I can feel painful lumps / veins. These painful bits are almost right on top / lying on the pubic bone. Working in this area seems to increase my pain at the tip of the penis symptoms.

Anybody have any similar experiences to this or know what this could be? I had similar painful lumps / veins on my right abs that were painful at first but are now pain free following a few weeks of massage.

Any advice / thoughts greatly appreciated.

Thanks JD

[Caedar]

I too have painful tissue above my pubic bone, which seems to correlate with pudendal nerve pain. I'm still trying to figure out the innervation in that area, which is proving particularly hard to find.

[JammyDodger]

Thanks Caedar,

My PT thinks its not a trigger point as such and inflammation of the muscles where they attach to the pubic bone - these attachments may be aggravated in turn by the over tight muscles. I've managed to pin point the pain down to what feels like a couple of small hard lumps (less than the size of a pea). Putting pressure on it seems to just aggravate it so I'm trying just to skin roll and massage the area around it to see if that eases things.

Please let me know if you find anything else out.

I think the pain in this area is what aggravates and flares my tip of the penis pain.

[Wolfcub]

It sounds like you have typical trigger points in the lower parts of your rectus abdominis/pyramidalis and/or in the external oblique and/or in the transversus abdominis - which can radiate pain to the scrotum and to the DORSAL aspects of penis. However I don't think this can be related to your tip-of-penis symptoms, but who knows???

I've also been going recently to a PT trained with myofascial release therapy (as you can read on my post: viewtopic.php?f=37&t=7993&start=75 ). She found a lot of active trigger points, especially in my abdominal muscles, the adductors and the iliopsoas (many of them were highly correlated with my right side of the body and the area where I used to have a right indirect inguinal hernia and a scar tissue formed after operation). When she released those in the pyramidalis (very very lower parts of the abdomen just above the penis) I felt pain in the penis - but only in its dorsal aspects. It did not intensify my tip-of-penis sensations, so I thought my constant discomfort in the tip-of-penis (which is 24/7) was due to possible trigger points in pelvic muscles such as the levator ani. The strange finding was in my last session, when she insisted after exploring intra-rectally that I had NO trigger points in the pelvic muscles. I didn't manage to ask her what else could explain my tip-of-penis symptoms (and also the occasional urethral burning sensations), so I'll ask her next time. Another strange thing she told me was that my prostate was felt to be "difficult to mobilize" (?!), and she suspected it might be slightly "pulled" to the right side because of the possible scars due to the hernia and another trauma I mentioned in my post).

For now, thanks to successful releases of my trigger points (especially in my abdomen including the area of my scar, where my fascia been constricted for a long period of time) I have no abdominal pain anymore for the last four weeks when I'm awake (only abdominal pressure built when I go to sleep and it goes away when I wake up/pee). I just have those constant annoying sensations in the tip of penis and the urethra which nothing seemed to tackle them so far.

Do you find any similarities?

[JammyDodger]

Besides the abs my other main areas of focus are the left adductor and pelvic floor esp. left side.

The left adductor is seriously tight and also appears to have caused damage to my knee - just going through the process of getting knee & left pelvic area MRIs - it's free on the NHS in the UK but takes months to get done.

The reason I think the lower ab area is responsible for the tip pain, is that this symptom only came on when I started trying to treat trigger points in this area (too enthusiastically!) 18 months into this. I basically pushed too hard, caused bruising and tip pain too!

I have a number of pelvic floor trigger points that make my main symptom, feeling of urgency, multiply by 10 when these TPs are touched. Most of the TPs have reduced or gone following PT. I am just left with a couple of stubborn ones on the anterior wall around ANC above the prostrate.

The tip pain seems a common one and if I'm correct I think others have indicated its one if the last symptoms to go. I get the mild urethra burning occasionally too.

I will keep updating on my progress - I think I'm taking small steps forward but flares will come on just as I think I'm making progress. Keeping positive as I know when I come out of this I'll be a much better person for it :)

[Caedar]

Do you find the tip/urethra pain and burning to increase with bladder filling or remain constant?

[JammyDodger]

Yes - and bladder emptying gives some relief.
The tip / urethra pain changes from day to day though - sometimes Ok sometimes more sensitised.

Still working on the painful lumps under the skin directly above the pubic bone without causing any flaring so far - I can literally touch them with my fingers and massage them. Hoping if I can work them through and densensitise them it will become another area I can add to the sorted category.

I've also been using Proscure since November which has helped especially with frequency.

[Caedar]

Have you tried hydroxyzine? It's an antihistamine that completely eliminated my pain on bladder filling, frequency, and some associated trigger points around the area (specifically bulbospongiosus). You might want to give it a shot.

[JammyDodger]

Thanks - will have a look at this.

Why / how do you think it helped your symptoms?

Thanks,

Jamie

[Caedar]

Pelvic pain that is affected by the bladder (interstitial cystitis is the classical diagnosis) often has a component of mast cell degranulation, which releases histamines and other inflammatory factors. Hydroxyzine, being an antihistamine, can protect against this effect.

[Wolfcub]

Caedar, I'm happy for you that you managed to control those penile symptoms - so stubborn!

Myofascial release helped me to get rid of my other symptoms (such as the abdominal aches and pain, which I also found to be correlated with the bladder's filling) but not that one. I'm also curious to give the anti-histamine a try. For how long have you been taking it to notice any improvement? Do you still take it on a daily basis? (Aren't you concerned about developing tardive dyskinesia?)

I used to take Quercetin, but honestly I think it's worked no more than a placebo for me.

[webslave]

Antihistamines only rarely cause tardive dyskinesia, and even then usually only in much older people. That said, I wouldn't recommend anyone take antihistamines non-stop for years.

[Caedar]

I'm also curious to give the anti-histamine a try. For how long have you been taking it to notice any improvement? Do you still take it on a daily basis? (Aren't you concerned about developing tardive dyskinesia?)

I've been taking hydroxyzine for about 8-9 months now. I noticed improvement after just a couple days of taking it, and it's seemed to stay at about the same level of relief ever since. I still take it daily because it has helped so much. However, I plan to take Elmiron for ~6 months to rebuild the bladder lining and then remove the hydroxyzine (while still taking Elmiron) and see if any symptoms come back.

[JammyDodger]

Webslave - just read some of your 2003 posts about your experience with AH - in the long run did AH help you??

Thanks

[webslave]

If you mean antihistamines, then no, I was never helped by them unfortunately due to the antimuscarinic effect. But everyone should try them especially hydroxyzine, which has a good reputation for helping people with pelvic pain.

Even though antihistamines did not help me, I do now take 12.5mg Doxylamine (an antihistamine) every night as a sleep aid, because I have insomnia. It's very effective and has no side effects.