Update - My Visit to Pelvic Pain Specialist

[alprost]

I was recently on Holiday in Canada, and whilst there I was able to make an appointment with a physiotherapist who specialises in pelvic pain. I thought that a lot of what she said would be of interest to everyone on this forum who has been diagnosed with abacterial "˜prostatitis' or CPPS:

General:
Firstly, she was very impressed with the treatment I had received from my Physio here in the UK. She also pointed out that I was by no means unique: She frequently sees men like me, many of whom have suffered for years thinking they have prostatitis, when in fact they have little wrong with their prostates, and instead have chronic pelvic pain which is muscular in origin.

Pelvic Floor Examination:
After taking a detailed case history, she performed a pelvic floor exam which consisted of 2 parts: The first was an internal exam of my pelvic floor muscles and prostate. Six months ago this would have been excruciating, but although she noted that it felt somewhat tight, there was no tenderness, and she did not find any trigger points -- a testament to the effectiveness of the treatment I have received form my Physio.

She then performed a computerised EMG assessment of my pelvic floor muscles. Although my condition has improved dramatically over the last 7 months, she found that the tone of my pelvic floor muscles during relaxation was over four times the normal resting value.

This may well be an important point, as it means that even those few forward thinking Urologists who do palpate the pelvic floor muscles during a DRE, may be missing some people who do have increased tone of the pelvic floor muscles which may be contributing to their pain, but do not have myofascial tenderness.

Biofeedback:
Based on the findings of my EMG assessment, I was given a few simple exercises to do whilst hooked up to the EMG machine, including gently "˜bearing down' on my pelvic floor muscles as Rodney Anderson describes in this interview:
viewtopic.php?f=37&t=808&p=3954

I was actually able to reduce my pelvic floor readings to the normal range within a couple of minutes. I was then prescribed some exercises to do on a daily basis, and was given little red dots to stick around my home, car and office. The idea is that whenever I see one of these red dots, I "˜check in' with my pelvic floor, and check to see if it is relaxed.

When I returned home I continued with these exercises, and also purchased a biofeedback machine to ensure I was doing the exercises properly. After a few weeks, my pelvic floor feels significantly more relaxed, and my EMG readings are normal.

Like Dr Wise, the physiotherapist was also very critical of some of the biofeedback protocols given to male pelvic pain patients where they must perform hundreds of contractions each day to fatigue the muscle and force it to relax. She stated that some patients resting tone will actually increase after contracting the pelvic floor muscles (Dr Wise has also stated this), and that pelvic floor rehabilitation exercises must be individually prescribed, based on the findings of the patients pelvic floor assessment.

I noted a lot of parallels between her approach and that of the Stanford Team, although there were some differences.


Sensitisation:
I am now at the stage where I feel I have little wrong with me physically -- my ongoing pain is due to nerve sensitisation. I'm just starting a course of Neurontin -- I'll let everyone know how I get on.

Summary:
Again it comes back to this point: All chronic prostatitis / chronic pelvic pain syndrome patients should have a pelvic floor exam as a matter of routine after having the standard Urological tests. This should include both a manual examination and a computerised EMG assessment of pelvic floor function. If this were standard practice, I believe a high proportion of chronic prostatitis / chronic pelvic pain syndrome patients could be significantly helped or even cured. The recent posts of Dr. Wise's patients on the "˜Success Stories' forum are further testament to this.

Also, in terms of finding a specialist, I was able to find four separate physios in one city who specialised in the treatment of pelvic pain just by using the internet, yellow pages and by phoning around. Therefore, even if you are not lucky enough to live near Stanford, the chances are thay you will still be able to find a physio who can help.

Al.

[Richard.N]

Hi Al

I am now at the stage where I feel I have little wrong with me physically -- my ongoing pain is due to nerve sensitisation

Good news!

[MastCells]

Thanks for the very interesting and informative post, Al. And I wish you continued success with this approach.