Question about my case (ahmedqman)

[ahmedqman]

My PT today actually felt that point right below the prostate (she wasn't vigorous or anything) and said that the connective tissue in that area felt tight, so she stroked it and massaged it (which could be causing the urethral symptoms). Was this safe? is this normally a problem area in males?

Okay, I'll admit I'm overreacting here. I guess that's a bit of that anxiety. Massaging shouldn't do too much, right, as webslave said, you'd have to press pretty hard.

[carld]

The area below the prostate is my troubled area and can create frequency. If properly palpitated by your PT, you are fine. You can do it your self by facing the bathroom sink and with your right foot on the counter with no socks (your foot will slide) and your gloved lubricated middle finger, you can reach from the side palm facing your butt cheeks and gently insert and press the area below the prostate...It's key to drop the pelvis and relax because your will naturally want to clench and you will notice that the prostate will raise up in the rectum... So relax and drop it so you can press on the muscles and release the tightness.

Best

[ahmedqman]

So, this morning, I had some nasty general pain perineum, causing me to want to go to relieve the pain.... had problems starting urination and my stream was super weak and couldn't empty fully.

Then, I have my bowel movement 20 minutes later and wham, stream is completely fine, just some dribbling afterwords.

The day before, my PT did some heavy stretching of the puborectalis muscle (we discovered recently that this is pretty much the source of all my issues). That might have caused it...

[DMcU]

Try to squat! This causes this muscle to relax. When passing a BM squat as well. In the sitting position this muscle doesn't relax and this can make BM's harder to pass leading to constipation and worse. The puborectalis forms a sling around the colon maintaining continence in the bowels so it's important that it functions properly. Some people have 'non-relaxing puborectalis' and I think one way of combating it is to simply do squatting exercises. I know you haven't mentioned whether you are constipated or not but still, if this muscle is problematic, then it's worthwhile trying some of the simplest drug-free approaches to relieve the tension in it or help it heal.

[ahmedqman]

Constipation is definitely an issue, and I feel it is mechanical. I've adjusted the diet side of things, and my stools have definitely bulked up, but I definitely feel that I have to evacuate in parts.

Is there a way to do self internal on the puborectalis without a wand? What squatting position do you use on the toilet? I can't say I'm entirely comfortable with my feet on the toilet itself.

I also know there's a correct way to squat and an incorrect way.

Man, this is so frustrating. My main symptom is aching in the base of the penis, urethra, perineal warmth while sitting, and constipation. The aching in the base of the penis is even intensified on erection. The ache is always there, but bladder filling intensifies it and causes me to want to go empty my bladder.

It has to be that puborectalis muscle... however my PT is having a hard time finding trigger points. She found tight bands but they were having a hard time releasing. And as far as trying to locate those trigger points higher up.... it's a bit tough for her. I'll try to talk to her, but if not, if I'm going to try to go to California for the Wise Anderson protocol, I can't go until April after my second year of medical school is finished.

Is it still possible to reduce symptoms and gain some improvements even if those unreachable trigger points are not found for awhile? I heard you can't relax the muscle until it's all gone.

[DMcU]

Hi,
I don't use a toilet to pass a BM anymore. I line a shoe box with tissue and pass the stool into that. I have haemorrhoids a lot so I really have to be very careful that I don't attempt to pass a stool that isn't ready to be passed. At least your PT found some tight bands. They will release over time with continued treatment. Just keep it up. Continued improvement from my own experience was actually movement. I was teaching for 2 weeks, I usually do this in the summer as a break from the office environment. I was kept busy and my mind wasn't thinking of chronic prostatitis / chronic pelvic pain syndrome as it usually does. I have a love for the Irish language and I am probably an animated teacher when I'm teaching it. My body would have been happy and I would have felt purposeful to some extent. After one week of this my symptoms reduced noticeably. After 2 weeks I felt very good. But as soon as I came home the burning came back, worse than ever. What does this say about this condition? Probably that it's muscle and mind related. I felt normal as I played sport in the evenings with others etc. I was still fairly constipated though, but apart from this, and the haemorrhoids, which I feel are probably a separate condition, I was doing good. Magnesium Citrate should help you.
Any more q's just ask.

[ahmedqman]

Quick question:

I had some anxiety issues and tried Lexapro for a day. It kept me up all night and I threw up, and I had some nasty vomiting and made me feel all anxious and horrible. The next day, I had some urinary hesitancy (it took me like 10-15 seconds to start peeing). I decided to not continue with the med and I'm gonna use other ways to control anxiety. However, it's been almost two weeks and the urinary hesitancy has stuck around even though I only took the med for one day.

What the heck happened? Should I go to a doctor, or is it just a chronic prostatitis / chronic pelvic pain syndrome flare that won't go away?

[webslave]

What dose did you start on? Usually the dose is titrated up. Remember, one SSRI may affect you badly, but another may not. Don't give up on medicating anxiety, even if you have to use benzos.

[ahmedqman]

10 mg. How could one dose literally cause hesitancy for almost two weeks? Maybe it was the straw that broke the camel's back, I had been neglecting physical therapy for awhile.

Gosh I hope it's not a new medical issue that came up. I had flow issues this morning, then they completely resolved after I drank a ton of water. Still have that hesitancy though...

What do you think?

[webslave]

I'm not sure what's happening with you, to be honest, but perhaps the Lexapro provoked a flare that caused some swelling in the prostatic ducts and which is slightly constricting the urethra, and which will then reverse as the flare dies down, or perhaps it caused hesitancy directly as a side effect (urinary retention is listed as a rare side effect) and you are maintaining it, even after the drug has left your system, because of your own anxiety about it, or perhaps it's completely unrelated and you are drawing an association where there is none.

[ahmedqman]

I mean there is no way to know precisely, but the above explanations are very plausible. Do you think there's a need to get a fully re-evaluated by a urologist, or should I consider it part of the CPPS?

The thing is, I've certainly felt like this before, just not being a consistent symptom for at least a year or so.

I'm going to get back on stretching and PT.

[Jay]

If you feel alarmed enough to need another visit to a urologist, then we'd encourage you to go with that. It's the only responsible answer a bunch of internet laymen can give. :)

Whether a urologist will want to do another *full evaluation* or not remains to be seen. Speaking from experience, the dysfunction of muscles and nerves that comes with our condition can produce some freaky (but usually temporary) symptoms.

[robertpagen]

If taking anxiety medications perpetuates your anxiety then you should not take them. Listen to your own physiology.

[ahmedqman]

Well I get alarmed by everything, that's just the way anxiety goes. Anyway, I'm learning to calm myself down over these things. I don't want to jinx it, but I'm willing to just consider it an extension of the CPPS, since I've felt this way before (just not in awhile). Why would anything change? It would just be a waste of time and money.

I'd rather go do CBT.

I started seeing the PT and she definitely felt that I had tightened up severely, and my adductors and perineum externally had definitely regressed. Sometimes it's probably better to go with the most likely explanation.

It's only hesitancy. If it were a real issue, like a stricture, consistently altered flow would be the major symptom. Yet flow issues wax and wane (today I had perfectly fine urinary flow).

[robertpagen]

I will restate that if every intervention makes you more anxious, regardless of whether there is reason to be so, then the intervention is counterproductive.