Sleep-related painful erection (SRPE) and CPPS

[Slangsta24]

Hello guys, hello webmaster,

First of all thank you webmaster for running this site. I have benefited from your tips page, especially the tip regarding frequency of ejaculation helped.
I have been reading through many posts in this forum for many month and now thought to start my own thread.

I am suffering from CPPS and/or SRPE for the last three years. The strange thing is, I have never had any issues from an urological or muscle related perspective. It all started in 02/2019, when I got a acute bladder infection from too long swimming in the cold sea. The pathogen bacteria here was e-Coli. The bladder infection got treated wrongly with Amoxicillin for only 10days. Then of course the bladder infection and acute prostatitis came back after around 20days. Following this it got treated with 14days Cipro. After that I was healthy and everything was fine for over a year until 04/2020.

Then mild symptoms of prostatitis came back. It all started with only one symptom - - > painful erection during the night, which only stopped when I went to the toilet. This happened and is still happening around 3-5 times per night. A couple of weeks later other symptoms also appeared during the day and are still present up to now, such as:

• painful erection during the night, up to 4 times.
• pain in urethra/penis/perineum, I can kind of feel a painful "string" in the perineum and penis it pains specifically when I pull or twinch like you do on guitar (I know this is very weird)
• painful urge to pee and sometimes higher frequency but not all the time
• Sometimes pain while ejaculating, however not all the time.

I have tried following things:

1. Many antimicrobial tests on semen (found many different bacteria, most of the time e-Coli was present sometimes more sometimes lesser amount)
2. Lots of oral Antibiotics (no help)
3. Direct antibiotics injection in the prostate by a doctor in Rome (no help)
4. Ibuprofen, Diclofenac, Novaminsulfon (no help)

And currently doing following:

• Stretching (maybe very little help)
• PEA (not sure)
• Quercetin (not sure)
• MSM (not sure)
• external triggerpoint (not sure)
• internal triggerpoints with therawand (not sure as very painful)
• Amitriptyline 25mg (not sure)
• Paradoxical Meditation (no help yet but feels good)
• Magnesium and Procain Infusion once a months (not sure)
• Shockwave therapy on external triggerpoints (not sure)
• warm bath (not sure)

Things I know which are helping me:

1. No sex/ejaculation for minimum a week, the longer the better but too long is also not good.
2. On the other hand I noticed the ejaculation can be actually very pain relieving, especially after having a long time no sex. It seems weird but actually sometimes the ejaculation makes things worse and sometimes it relieves pain.
3. Hot and cold in shower and especially very cold on perineum with shower head (the only things which immediately helps, takes pain from 8 to 1 but only temporarily)

Got prescribed but not started yet:

1. Tramadol
2. Celexocib
3. Baclofen

My main questions are, does anybody else have some of these weird symptoms and this sleep-related painful erection sometimes??

I think/thought maybe the internal triggerpoint therapy could be the key however it is extremely painful exactly where the prostate is. So not really possible to do any pressing there.

Kind regards from Bavaria

[webslave]

The sensitivity of the pelvic musculature and the post-ejaculatory pain point to UCPPS. The frequent painful erections are unusual, but may be a male analogue to what is called Persistent Genital Arousal Disorder (PGAD) in females.

I suggest you get your pelvic floor assessed by a suitably trained physical therapist.

[Slangsta24]

Thanks for your reply. Yes this my plan for January, I have an appointment with a specialist to check pelvic floor muscles. I will update afterwards...

The difference is though: The pain is only there during ejaculation. I dont have post-ejaculation pain. It is actually quite the opposite, after ejaculation I feel very often much better, but of course only temporarily. What are your thought on that?

Also when I do external and internal triggerpoint massage, only the prostate is very painful when pressing on it, and this is the pain which actually refers to perineum and penis. In your experience is this quite common or unusual too?

[webslave]

Pain associated with ejaculation is a UCPPS symptom. Pain during is less common than pain afterwards, but the clearing of trapped secretions can lead to short-term symptom alleviation in some men, so it's not that unusual.

When you press on the prostate, you are also pressing on the levator insertions behind the prostate, and that is a common site for trigger points.

[Slangsta24]

I am currently doing lots of stretching, paradoxical relaxation and triggerpoint massage. Regarding outside triggerpoints, I do once a month shockwave therapy which actually works quite well for outside triggerpoints. However I have never had a pain referring to the penis/prostate. All of the pain from treating outside triggerpoints was more or less local or referred somewhere else into the body (i.e. groins). I believe my greatest issue are the internal triggerpoints in the levator ani and also hyptertonicity in the fascia/connecting tissue around the prostate, as the prostate and the area left and right of it, is incredibly painful during triggerpoint massage with the pelvic wand. Does anybody have an idea how to:

1. stretch the levator ani?
2. treat triggerpoints in the levator ani and around the prostate in a more effective way than with the pelvic wand?
3. Is it possible to reach the levator ani also with the shockwave machine?

[webslave]

I believe a shockwave machine has been used on the pelvic floor with some success
https://ucpps.men/search.php?keywords=shock-wave

[Slangsta24]

Hello all, hello webslave,

I would be interested in knowing how many men had actually a bladder infection as the initial cause? And in regards to those men, what is their action plan to cure this? Is it just strictly following all aspects of Stanford/Wise-Anderson Protocol + time or anything else/different? I am following the Stanford/Wise-Anderson Protocol for almost a year, doing stretching, pelvic breathing, paradox relaxation and external triggerpoints with shockwave. I don't really experience much progress though unfortunately.

I believe my issues are at the levator ani, the tissue around prostate and potentially the prostate it self. I am came to this conclusion as only pressing on the prostate seems to trigger the exact pain I have? Also after internal triggerpoint treatment around the prostate the pain is much worse on the next day or so.

Do I have to adjust the Stanford/Wise-Anderson Protocol somehow, as nothing else in regards to my muscles and connecting tissue is involved? Can it be purely prostate and surrounding tissue related?

I am also doing once a month shockwave treatment of triggerpoints with a specialist in Munich, he seems to follow as one of the only ones in Europe the Stanford/Wise-Anderson Protocol. I am currently questioning though if it would make more sense to solely "shockwave" the prostate and surrounding tissue as all the other muscles (piriformis, adductors, psoas....) don't really trigger anything and also didn't relieve the symptoms so far.

Thanks for your answers in advance :-)

[webslave]

Do you have access to a sauna, perhaps through a gym? It sounds like you have some very resistant trigger points in those levator muscles. Meanwhile, long, hot baths.

[Slangsta24]

yes, there is a gym with sauna just about 10min from home - will give that a go too. Do you think sauna has more effect on triggerpoints than hot bath?
One improvement I have noticed though, the sleep related painful erection have pretty much diminshed over the last couple of months. The key I believe is amytriptilin and baclofen which I take daily just before bed.

[webslave]

Saunas (gym), steam baths (gym), hot baths have all proved very effective for some of our members. Amitriptyline is also very useful.
https://ucpps.men/viewtopic.php?p=36256#p36256

[Slangsta24]

Hello Guys,

An update from my side. From May 2023 to November 2024, I felt great and CPPS diminished. I would despite some flare ups in that time, I was 85% healed which is great. This week is now again a bad week with a strong flare up every day. Taking Tramadol and Baclofen against the pain. I am not sure about the trigger, but I think it could be the frequent sex lately as we are trying for a second child. Another factor could be less sport at the moment.

In October 2023 I went to the Urological Clinic in Gießen, Germany, which is specialized for CPPS/Prostatitis. They found during their analysis a huge amount of leukocytes in my prostatic fluid, during a 4-glass test. This lead them to the conclusion that I have "Chronic Pelvic Pain Syndrome with inflammation". Apparently there are four times as many leukocytes compared to normal men. And as I already knew, the did not find any sign of infection, so no bacteria at all and therefore no bacterial prostatitis.

So it seems I still have an inflammation somewhere down there, despite following the tips from this forum for around 2 years, and taking a lot of anti-inflammatory supplements. Basically taking quercetin, hot bath, sauna, internal pelvic therapy, relaxation and abdominal breathing, stretching, magnesium, vitamin C, Curcumin, NAC, Amitriptyline...

Does anybody else have an idea, what I can do against this inflammation in my prostate/pelvic floor?

I am also not really sure if I do the internal trigger point pressing right, using the pelvic wand. Shall I press on the area of the Prostate and left and right or rather not? And if so, any specific method you guys do?

Because apart from prostate area I never found any painful triggerpoints in my pelvis. Only the prostate area is hurting very crazy and referring to the penis and perineum.

Merry Christmas to all of you.

[webslave]

This week is now again a bad week with a strong flare up every day.

What has changed? Are you experiencing more stress than usual? Are you eating or drinking in a pattern that is not usual for you, or items you do not normally consume? Playing a lot of computer games? What's going on?

[Slangsta24]

Hello webslave, thanks for your follow up. Nope, there was nothing really specific I would say... maybe a bit more chocolate due to Christmas time.... anyway the good thing is, I am now again pain-free for the last 7 days and I am hoping that this continues :-)

What I have noticed in general in the last year, when I went to work to the office I am 95% symptom free. However when I do homeoffice in my house, I would say I am only 40% symptom free. So really weird, when I am working alone at home, I experience more pain.
Also on the weekend and on holidays, I was 95% painfree in the last 6 month.

Does anybody have something similar like this? How I can handle this in the best way? relaxation or meditation or any other Idea?

And webslave one more question to you in regards to internal triggerpoints. I only have a painful prostate, but never found anywhere else a triggerpoint. Shall I just stop this as I am not sure how much it helps pressing in the prostate??

[webslave]

1. Chocolate is high in caffeine, a known trigger for UCPPS. Be aware of the IC Diet https://ucpps.men/viewtopic.php?t=8733
2. Do you have a better chair at the office? If you site badly at home, you could be putting pressure on lower spine nerve roots, which is also a known trigger. Look for the differences between home and office generally. Do you drink more caffeinated drinks at home? Is the home office cooler while the actual office is properly heated (cold weather can cause flares) etc.
3. Pressing on the prostate is not how it works. Trigger points anywhere in the pelvis can cause inflammation in the bladder and/or prostate through nerve cross-talk. You need to be assessed by an expert in this.