Starting pelvic treatment after 4 and a half years

[LivingRoomFanatic]

https://www.theguardian.com/society/202 ... ronic-pain

Just to add my 2 cents to this. I take Duloxetine (a SNRI) for anxiety and pain. I find it to be excellent and has been a life saver. I recently tried to switch to an SSRI instead to see how I’d fare and I’ve had to go back to Duloxetine as I was having additional symptoms return.

Before anyone takes Duloxetine it is important to point out it has more potential for, or a higher incidence of, side effects (e.g. liver damage, particularly if you drink alcohol), than SSRIs and even other SNRIs. There can be a temporary discontinuation syndrome for about half of those who take it and stop (I didn’t get anything like that myself thankfully). So, my view is that it’s an excellent option, so long as you have properly read up on the potential issues and understand them.

Admin comment: Useful information, thank you!

[JuanMilo]

Yes, a small, tender prostate is common in UCPPS. Also, pressing on the prostate puts pressure on the insertions of the levator ani muscles, so it's difficult to know where the pain is coming from, prostate or muscles. Your problems with the back passage could be the source of the hypertonic pelvis. It's like a system of dominoes, when one falls, others are affected. Whatever you need to do to cure the rectal/anal issues, do it, including surgery, is what I would suggest.

Hi Webslave. I have quite a bit of info for you here, so I’ll try to be succinct. The ultrasounds showed that I have a 3mm varicocele on the left side. I recently went to another country and slept with a new partner, I had a massive 13 hour flight with major anxiety as I don’t like flying at all. I also got ill from the plane. Back home now and my abs are burning really badly, I also have some increased pelvic pain (testicle sensitivity, irritation with urination). I think I must have some kind of ab strain that’s having an impact on the pelvic pain.

I don’t believe that I have any kind of infection, but I would like to be tested for STDS just for the sake of good practice. Aside from that, I’m a little bit concerned that I have this slight testicle discomfort on the left and now the ab pain. I think the ab pain is likely some kind of strain from coughing/sneezing, or perhaps things locked up a bit on the flight back. The slight testicle pain is a slight concern due to the fact that I don’t know if the varicocele is causing it and whether that would eventually need to be treated. I never had any pain before, the testicle pain was only during the acute phase of the illness for me, when I’d literally never had anything show up on any test, it was the same testicle too.

I had the ultrasound before I went away because I asked for an investigation due to having CPPS for so long. Now they want to send me for a CT scan on Monday and tbh, I don’t really want to go. Every test I’ve ever had has come back normal, including a previous CT without contrast. This one is with contrast and I’m worried now that it’s a needless risk when no other test has shown anything wrong. What do you think about my situation webslave? Any advice would be much appreciated.

[webslave]

1. I think the CT scan will be a waste, and expose you to unnecessary radiation.
2. 3mm varicocele is an unremarkable finding and may be subclinical (symptomless and hard to palpate), although varicoceles CAN produce testicular pain, and if you are having distinct scrotal pain on the affected side it may be worth treating surgically, especially if the pain persists reliably.
3. Abs can contain trigger points, as shown in Dr Wise's books. See if you can find them.
4. You have just been through a psychologically testing time, stressful, so I would wait a while to let things calm down before taking any action.

[JuanMilo]

Thank you so much Webslave, I appreciate your advice greatly. It seems like this testicle pain/discomfort is related to a groin pull in relation to the adductors. I think all the coughing and sneezing during a time when I was extremely run down caused me to possibly pull or overuse these muscles.

Apart from this I’ve arranged to talk to a PT who is trained in pain psychology and I will be seeing my pelvic PT later in the month. Everything’s slowly improving, I think it’s just going to take a bit of time with the groin injury and hopefully I’ll just get on the other side of anything structural/psychological with the help of the PTs I’ll see.

[JuanMilo]

Hey Webslave, so it started becoming clearer that this is pretty much all likely down to a groin strain, long story short, the injury to the inside of my thigh became pretty apparent over the space of a week or so. I’ve been to the pelvic pain PT and she diagnosed it is a groin strain. She didn’t find a hernia or anything like that, but she did want me to go to the GP just to confirm there’s no hernia. The GP didn’t find anything but said it would need an ultrasound to confirm there’s not a small hernia. He’s not in a rush to send me for a scan as he agrees with the diagnosis of a groin strain and says it’s 6-8 weeks to heal, which is basically what my PT said. He said the testicle feels good and didn’t think there was an infection, but wants me to do a pee test for peace of mind as I’ve been with a new partner.

I’m just a bit bothered by this testicle pain on the same side as the groin pain (the side with the varicocele). It’s not the testicle itself but the structures around it that are sensitive and achy. It does seem to be that I have all the symptoms of a groin strain and that sometimes they can cause testicle pain due to the proximity/connected nerves etc. (it’s literally right next to my left testicle, very tender muscles in the crease of my thigh next to my scrotum, my PT felt it on internal/external inspection and said it’s the adductor that’s injured) but I can’t deny that there’s an amount of catastrophising. I’m basically in a relationship with a girl from another country and I was planning on going back in early May (about 6 weeks from now). This has been going on for about 3 weeks and I’m just a bit bothered about it potentially taking a long time to get better/causing lingering issues, or that the testicle pain could be unrelated. But I suppose I need to get some perspective as testicle pain hasn’t been part of this condition for me for about 10 years, so I don’t think it’s the CPPS as such (although I do think I’m mildly flaring as a result of this strain). The varicocele has probably been there for ages, so doubt it’d suddenly start hurting, especially being so small. And apart from that it’s very unlikely I have an infection, I’m not really bothered about that, but I’ll do the test to rule it out.

I suppose I can’t put pressure on myself to get better and both the PT and the GP think that the most likely course of this is that the groin strain heals and the testicle pain gradually eases along with it, it’s just a case of waiting it out and rehabilitating it. I’m mostly relaxed about it, but the doubts creep in from time to time and I get a little bit worried.

What’s your perspective on this webslave? Apologies for all the info.

[webslave]

There is a tendency for PTs to diagnose groin injuries and strains where none exist, because some of them know little or nothing of UCPPS. Unless you can identify a clear event where you experienced a strain, I would disregard that diagnosis. But if there was an event, that's different.

Ultrasound to look for a latent or subclinical hernia is a very good idea. I highly recommend that. A hernia can cause pain in the testicle area. An inguinal hernia is one type of hernia that can push into the scrotum, causing testicular pain and swelling

[JuanMilo]

Thanks webslave. There’s a few potential triggers, I did carry heavy things down some stairs, I was also very stressed and tired then came down with a virus that caused a lot of coughing and sneezing. Perhaps being so run down on top of that straining could be have the straw that broke the camel’s back, leading to a groin strain. I don’t seem to have any testicular swelling though, so that’s good.

I’ve just booked a private ultrasound scan here for next Monday, so hopefully I’ll get answers pretty quickly. The NHS will have me waiting weeks just to see if the pain goes away, then weeks for a scan, then who knows how long if it’s a hernia. Hopefully I can have it ruled out and have a bit of peace of mind

[webslave]

Coughing, sneezing, carrying stuff, none of those are typical causes of what is usually a sporting injury. Groin strains make walking, lifting the knee, or moving the leg away from or toward the body difficult and painful. Is that what you have?

Good work getting that u/s organized!

[JuanMilo]

I did notice that before all this developed that my left groin felt a bit tight so I decided to stretch the groin. It was sore after the stretch so perhaps that’s what did it.

Yes I do have pain with walking and it can go right down the inner thigh, I can’t take big strides as that aggravates it and makes it quite a lot worse, so I’m having to walk slowly at the moment. When I go to kick as if I’m kicking a football, I can feel it in the same area. Having my legs open when sitting (like cross legged) also causes pain in the same area. The pelvic pain PT thought it was the adductor from external and internal examination, when she touched it internally it was very tender and she said it was the adductor.

[JuanMilo]

No hernia on the scan in the end thankfully. It does seem to be some kind of adductor strain, I’ve got all the classic symptoms and none of this has been part of pelvic pain for me in the time I’ve had the condition, which is now quite mild and causes few issues.

I’m going to get to another physio who can help me rehab the issue, I think it started off mild and I’ve basically been continuously aggravating it without realising, which is why it’s still sore at this point. I’ve started resting it and using topical ibuprofen and it’s already improving, but it feels like it’ll be a long road to be fully better. Hopefully some decent physio will get me on the right track. I’m pretty disappointed with the pelvic PT I saw that encouraged me to walk 30 mins every day, I’ve been pushing through acute pain thinking it was normal.

I’m also going to have to stay on top of the mental side of things as it’s quite testing, I can’t walk very far at all at the moment due to the muscle pain. But as the muscle on the inside of the thigh is becoming less sensitive, my testicle is also feeling better, so that’s positive at least.

[JuanMilo]

Hi Webslave, went to another PT last week and has diagnosed it as a minor strain with tendinitis from over use. Basically when I went away I was incredibly active, I went from years of being sedentary to walking miles and miles, dancing, sex etc I think having an enflamed tendon right next to my left testicle must be the source of the pain. I don’t usually have any testicle pain these days, until this all started. The PT thinks I should be a lot better in 6 weeks, but I can tell that it’s only getting better very slowly and I’ve seen that 12 weeks is the recovery period for tendinitis. I hope not, but I’ll just have to see. As always, compulsive masturbation is a problem. I stupidly flared it up the other day and I’m going to have to get a complete handle on that during this recovery period. I think I need to avoid everything that hurts it for several weeks, the trouble is that abstaining drives me a bit crazy. Not sure if you saw my other comment, but the scan ruled out a hernia. I’m sure I’ll get over this with patience and consistency.

Admin comment: You're on the right track, hopefully. It could all just be tendinitis — unusual case.

[JuanMilo]

Coughing, sneezing, carrying stuff, none of those are typical causes of what is usually a sporting injury. Groin strains make walking, lifting the knee, or moving the leg away from or toward the body difficult and painful. Is that what you have?

Good work getting that u/s organized!

Hi Webslave, so the tendinitis is improving and the testicle pain has basically completely gone as the groin improved. The thing is that I’m now in another situation that I’m pretty bothered about and I’m dealing with it alone, so I wanted to reach out.

Masturbation was aggravating the groin tendinitis so I was abstaining. I have problems with compulsive masturbation, and this has happened once before after masturbating for an extended period of time after abstaining. Basically on the side that hold my penis, I seem to have irritated the veins in my foreskin. I did feel it during masturbation, but I carried on, which was a bad idea. I’ve held off masturbation for a few days and it’s slowly improving, but basically I was supposed to be going back to see the girl I met in about a month, moving to another country to be with her long term. These days I’m usually okay in regards to catastrophising, but with everything being so high stakes now, I’m pretty bothered about it. It’s getting better slowly but I don’t know how long it’s going to take. I remember last time after I did this, I stopped masturbating for about 3 weeks and it did get 95% better.

I was hoping to buy the tickets this weekend to go back and be with her for the foreseeable future. I’d still have another 5 weeks to improve before I go back and I feel that I need to move on with my life and not let this stuff hold me back. I just can’t lie that I am afraid currently, and I know that’s the worst thing for nervous system based pain. No doubt I’m interpreting it as a threat towards the relationship and my prospects for being happy, getting sucked into that catastrophic mindset. I just feel that I need to be confident I’ll be ok before I go back.

The past couple of days I’ve started to engage with the curable program which is based on Sarno’s work and the stuff that has come after him. When I was there with her I had sex without much pain and basically had no chronic fatigue. I think a lot of this is nervous system based for me, although this does currently feel like a physical irritation that I’ve caused, and the fact that it’s the veins kind of affects me worse psychologically, like it feels more serious than if it were just the skin or something else like that.

What do you think about all of this? Sorry for the long post.

[webslave]

SSRIs are very useful for controlling the OCD symptoms that you are experiencing and also subdue the compulsive urge to masturbate. See if you can get a course prescribed over this next difficult period.

[JuanMilo]

Thank you webslave, I will have to talk to my GP about starting them. I suppose as well that because I’m suffering alone and it’s hard to talk to people about it, I was seeking your opinion. It’s getting better day by day and the irritation is quite mild, it’s just that it’s somewhat persistent. Do you think I should be a lot better in a month when I go back? I just want to be in a good position to enjoy sex and not have to worry about the irritation. I feel like this is a kind of manually provoked flare of this CPPS symptom. I’ve decided I’m definitely going back there as planned as I don’t want to let this stuff rule my life. I’m feeling more positive mentally as it’s settling with rest.

[webslave]

Yes there's a very good chance that you will feel better as time passes, especially if you take the sort of proactive steps that I have described and more of which you can see in ourTips thread in the FAQ subforum