Stubborn trigger points (Ramana's Case)

[ramana]

Physio now opines that I have to start strengthening my abdominal muscles to reduce pain. I have returned to baseline pain level after a flare in the past 2 month. He has asked me to do leg raises (10 times) and similar exercises. Of course, anything that remotely looks like crunches (e.g. he asked me to hang the upper torso of the bed and then come up horizontal) starts rectal pain. He has suggested stretching and then doing the strengthening exercises
I understand that theory does say that weak muscles create more pain. However, in the case of CPPS, pain is because of the high tone of the pelvic floor. In this case, is it counter productive to strengthen ab muscles.

[ramana]

I am happy (and grateful to God) to report that I am now past a relatively symptom free six month mark (i.e. I experience some pain post ejaculation and if I sit for 1+ hour without moving at all) . The pain which started from the rectal and testicular region in 2007 is now restricted to left abdominal region (and restricted mostly to psoas).
I don't have access to physical therapist specialized in pelvic pain where I live now. However, I am able to do get by with a combination of external trigger point, stretching and meditation. The physical therapist now opines that I should begin strengthening my core. My symptoms are right side back pain (piriformis) left sided abdominal pain (psoas) Plus surprisingly after reducing medications (I am on 10 mg of Elavil and that;s all), I have gained 4 pounds in 6 months with 2 inches gain on the abdomen.

So I do agree with physio on working to improve the core but am not sure how. What kind of exercises (or exercise routine) one should follow? HITP has stretching routine only. I do the following:

1. Pelvic bridge
2. Alternate One leg raise while lying down
3. Psoas stretch
4. Should I do squats (or modified version of it). I was told that one should work the glutes because they are the largest muscles in the body and provide stability.
5. Pigeon pose
6. Adductor stretches
7. Walking with wrist weight at around 3.5 miles / hour with 1 lb wrist weights for 30 minutes. At some point, I guess one has to strengthen also to reduce chances of recurrence. Please advise. I tried running but get knee pain after 2 minutes.

[ramana]

So it has been 4 months and am bedridden once again after 2010, with no improvement, my doctor this advised me to take as much Lyrica as I can possibly tolerate along with tramadol hundred milligrams. I am right now on 150 mg Lyrica and tramadol 100 mg without much success. I have problems with constipation and therefore get into a vicious cycle of more rectal pain. Right now I'm able to somehow deal with it.

I'm wondering if anyone has been able to take 300 mg of Lyrica and hundred milligram plus of tramadol simultaneously and what are the side effects on if it is even safe.

[MajorSky1]

Sorry you're going through these tough bouts.
By now, I would maybe consider looking at your picture of stress/anxiety and mental pressures in your life, and try to remove that stuff because those things are the head of the snake. You can treat muscle, myofascial tension and irritated nerves until you're blue in the face, and it is necessary as part of the treatment, but unless you take care of the stressors in your life that are on your mind then the pain and tightness may keep returning. Those stressors and anxious way of thinking are driving the problem. I'm not saying you can help the way you think directly, as general anxiety takes some work to get out of. But with work, you can manage, or even abolish the manifestations of pain and tightness.
It looks like you've tried all the physical tools. Maybe try now dealing with the things that are affecting your mind and thinking on a daily basis, as it may be something obvious, or something hidden.

[ramana]

I am having an exact repeat of 2007 once again except this time I am much older and the pain is more severe and the medical facilities are limited. I had an anal fissure on January 25th 2020 that healed by February 21 2020 and the pain actually increased. MRI shows no problems in the rectum. The pain increases tremendously after defecation and if I am able to do trigger point therapy successfully after defecation then the pain reduces for the remainder of the day and then increases again the next day after defecation

Most of the trigger points are internal. I manage to remove them and then they're back again the next day. Any insight into what can be done during defecation to avoid pain starting or any other treatment. Did an unsuccessful ganglion impar nerve block in early March. That time pain was only left rectal but now spreading to left testicular area as well..

[webslave]

Jump into hot bath after defecation for 30 minutes, or apply heating pad under buttocks after toilet. That should interrupt spasm.

[ramana]

Doing that already. Not working at all. Thanks for responding as alway

[webslave]

Are you squatting rather than sitting during defecation? Squatting is much easier on the pelvic floor.

[ramana]

Always squatting. Started it in 2007 itself. I have run out of idea to deal with pain. Relaxation for several hours. Physio says not many trigger points. Tried ganglion inpar nerve block. No hard stool. Making mmmm sound during defecation so that abdominal muscles work. It helps. But the pain remains

[ramana]

I did ultrasound in January. Report was mildly thickened urinary bladder wall edematous. What does that mean? Doc said ignore it and my burning urine symptoms did go down after that

[webslave]

Report was mildly thickened urinary bladder wall edematous. What does that mean?

It means your condition is bladder-centred and that you should follow an IC diet strictly.
viewtopic.php?f=13&t=8733

[ramana]

Mri done. Shows no problem with urinary bladder. So I guess back to trigger points that return within hours of getting released

[webslave]

How do they explain the different results from U/S and MRI?

[ramana]

Just that there is a 2 month gap so it may have healed... I am having Trigger points almost on the anal sphincter on the left side in the 9 o'clock position I believe for the 3 o'clock position depending on how you read it. I remove them they come back within an hour the physiotherapist remove them they come back within half an hour.

[ramana]

I have been bedridden for a year now. Out of 14 years I have been bedridden for 6 years with this condition. I tried it trial for the pain pump but it did not work due to urinary retention. The neurostimulator it seems is not an option because the pain is much more widespread. I am no longer in US because of the expensive medical care so I also cannot get supplements easily. But looking for any kind of ideas for improvement. Physiotherapy always helps but only for a couple of hours please advise if there are any other ideas