My Story. 2 years of suffering. Asking your opinion

[jimmy80]

Hi everyone.

I'm writing from Italy. Here's my story.

The beginning was in March 2016. After ejaculating (masturbation) I felt a pain at the end of the penis, approximately under my gland.

In October 2015 and February 2016 I had two surgeries for penis girth enlargement with fat injection.

The pain episode appeared 1 month after the second surgery and after moving to my parents house because of my divorce. The divorced completely destroyed me psychologically and I think that is one of the main causes of this pain.

I saw a psychologist for 14 months which helped a lot.

After seen an urologist I had urine and sperm tests and the report showed the presence of Enterococcus Faecalis in the sperm.

I've done 2 cycles of antibiotics with no results and then in these 2 years I've seen many urologist, proctologist and pelvic pain specialist.

I've done many tests and regarding the prostate is everything ok, it doesn't show signs of inflammation and the size is normal.

Uroflowmetry ok and I don't have hemorrhoids or fissures.

I've done PNMLT which shows a pudendal neuropathy, but I received many conflicting opinions about that exam. Some doctors say that is not to be considered valid, other that is valid.

I've done also a 3T MRI with a pelvic pain specialist and the report said that there are many pelvic muscles contractions.

I've been visited by a PT specialized in the Stanford/Wise-Anderson Protocol and he confirms that I have many trigger points and pelvic muscle contractions.

I don't have urinary urgency and I don't wake up in the night with the urgency of urinate.

Erection has always been strong. No pain during sex and no pain after ejaculating.

Only in the last month I noticed excessive sensitivity in the penis that causes me premature ejaculation, but for now I don't consider it because could be psychological.

In these 2 years I've experienced a long period of substantial wellness (with some few days of flare ups) from May 2017 to December 2017. During that period I was taking Paroxetine 20mg (1 a day) + Lyrica 75Mg in the morning and 150Mg in the evening.

In November 2017 I stopped Paroxetine (after a gradual reduction period given by the neurologist) and reduced also Lyrica.

I November I felt great, but in December, always after ejaculating everything came back and I'm suffering since then.

I immediately restarted with Lyrica increased to 150mg in the morning and 150 in the evening, but after 2 months I decided to interrupt it because I noticed any effect on the pain.

I tried Amitriptyline 10mg for 2 months but I had no results.

The only pill that give me relief is Diazepam. If I take 5mg in the morning the pain almost vanish, but this "trick" works for 2 weeks maximum, than my body I think starts to adapt and the pain come back.

My symptoms:

Pain appears after and only defecating. If in a day I don't have bowel movements, I have almost zero pain.

But I'm extremely regular and after the morning bowel movements I always start to feel burning in the anal and perineum area that extend to the penis, with slight burning while urinating.

So. Wake up, almost zero pain. Bowel movements and it starts the pain and burning sensation. Next morning I feel ok, bowel movement and it begins again.

If the day before I had an ejaculation, the day after pain and burning are always worse.

Pain increase during stress periods obviously.

My questions are:

1) Do you think that the surgery maybe has messed up my nerve? I wrote to the surgeon with a fake mail pretending to be a potential patient worried that the surgery could damage penis nerves and he replied that is impossible because he works in the area between Dartos fascia and Buck's fascia where there's no nerves. Other urologist confirmed that and they don't think my problem is caused by the surgeries. Whats your opinion?

2) Why do I have this problem only after the bowel movements? What could it be? The myofascial contraction?

3) The fact that Amitriptyline and Lyrica don't work and Diazepam yes, it's a sign that it's not pudendal neuropathy but I contraction?

4) What about Enterococcus Faecalis in my sperm?

It seems that Paroxetine was the best in helping me, but before surrender to taking SSRI I want to try other ways.

Right now I'm doing FES and SANS with Neurotrac Continence device. I just started. I'll sum up a conclusion after at least one month of constant using.

I've scheduled 3 visits to famous pelvic pain specialists here in Italy to hear their opinion.

Any opinion or suggestions are kindly appreciated.

[webslave]

The day after I have an ejaculation, pain and burning are always worse.

That's an absolutely sure sign that you are a CPPS patient. No need to think any further on that score.

The divorced completely destroyed me psychologically and I think that is one of the main causes of this pain.

Probably correct; that was the trigger event.

The only pill that give me relief is Diazepam.

Use it for "benzo weekends" only.
viewtopic.php?t=1611

If in a day I don't have bowel movements, I have almost zero pain.

That's common — bowel movements use deep pelvic muscles that are in spasm. Make sure you are squatting when performing bowel movements, and getting into a hot bath afterwards for 10-15 minutes can help (if this is possible).

Your questions:

1. No
2. Explained above
3. Not significant

[jimmy80]

Thank you webslave for your reply! And regarding the Enterococcus Faecalis? Do you think it's irrelevant?

[webslave]

Yes, especially since it was treated at the time

[jimmy80]

Colonoscopy could be a useful exam to do to reveal some issues that can cause my prostatitis?

thanks

[webslave]

No, not normally

[jimmy80]

I was recently diagnosed with Grade 1 hemorrhoids.

Considering that my main symptom is burning in the anus and perineum area that sometimes (but rarely) extend to the penis, I’m wondering if the hemorrhoids are the trigger.

When I wake up I feel good, with very little discomfort, but after the bowel movement the burning starts and stay till the morning after.

I guess that the hemorrhoids cause irritation and then pelvic floor muscles spams in a vicious circle that ends with prostatitis symptoms.

What you guys think? Today I’ll buy some hemorrhoids cream or suppository and see how it goes.

Unfortunately the doctor didn’t give me any medication and wanted only to sell me a course of treatment with a machine patented by him which supposed to cure pelvic pain with a sort of magnet...

I will take appointment with other proctologist to check the treatment options.

[webslave]

I've never heard of hemorrhoids being the trigger for CPPS, but I suppose if they are frequently painful, they could be. However, I think it's highly unlikely, and your post-defecation pain is almost certainly linked instead to the pelvic nerves and muscles.

Creams and suppositories won't help hemorrhoids. You should see a surgeon about having them removed.

[jimmy80]

I did the colonoscopy and the response was: diverticulosis of the sigma, non-specific sigmoiditis (Sigmoid colon inflammation), hemorrhoids.

The doctor prescribe me Mesalazine 1200Mg (2 cps per day after breakfast).

Any thoughts? Could be the cause of my symptoms?

[ChgoGuy]

Any thoughts? Could be the cause of my symptoms?

It's still a mystery to me how horribly both CPPS and the issues on the other side aren't playing very well together with many of us. I felt that after I did the prep the day before my last colonoscopy, I felt that the cleanout relieved many of my CPPS symptoms for at least a week. All the bowel movements during the cleanout didn't help with my CPPS symptoms initially, but things significantly calmed down for many days afterward.

"Could be the cause of my symptoms?" I'm not sure anybody would be willing to make that claim for sure, but there is definitely a link between CPPS symptoms and other activity happening in the bowel.

[webslave]

I did the colonoscopy and the response was: diverticulosis of the sigma, non-specific sigmoiditis (Sigmoid colon inflammation), hemorrhoids.
The doctor prescribe me Mesalazine 1200Mg (2 cps per day after breakfast).

Mesalazine is usually prescribed for ulcerative colitis or Crohn's disease. Surprised they are giving it for sigmoiditis. Please report back on how you go.

[blasteen]

Hi Jimmy,

I can relate to your post defecation symptoms. It went on for me for a long time. But I think I know what it is caused for me at least. I have developed/had many food intolerances and after a lot of trial and errors. I have found that for me the post defecation pain in areas you suggested are as result of foods I eat..

If I eat these stuff I all get the problem I know it feels very bad

1. Chicken
2. Loads of tomatoes
3. Hot and spicy foods, best to stick just salt. And little black pepper but when things are bad even pepper could be bad so get rid of it
4. Pasta
5. Cheese
6. Almonds. Too much fiber bulks up your
7. Tuna
8. Bulk forming foods
9. Too much onions

Fix your diet for a while

I have found loads of relief from consuming these

1. Turkey
2. Potatoes
3. Carrots
4. Toast
5. Chips
7. Choc spread for breakfast
8. Banana
9. Blue berries strawberries raspberries

6. Simple salads no dressing. Lettuce. Etc..
Green tea

Try to cook for yourself and keep it simple if you want flavour just add some fresh herbs while you cook.... Stick to it for a week and see how you feel

[ChgoGuy]

Blasteen - I'm surprised by your mention of chicken. It's been a safe food for me in regards to bowel movements.

[webslave]

Food intolerances are highly specific to the individual. I have heaps of them. The only way to find out if you have them is to do an exclusion diet, also known as an elimination diet.

Read this: https://integrativemedicine.arizona.edu ... atient.pdf

[blasteen]

Chicken was a big surprise for me too... at one point I took a course of strong antibiotics for a finger infection. Didn't have much issues with chicken for few months but came back again