big breakthough after six months

[johnnyblotter]

I've had some recent developments involving the lower lumbar area that seem to possibly be providing some clues as to additional ways to deal with this issue of rectal tightness (in addition to the regular trigger points and paradoxical relaxation).

A few days ago I did a rather odd stretch to basically push my lower back out and away from my body. Sort of like the way a sprinter will bend down with the hands in front before the race starts....I did a pose like that and pushed my lower back up and out. It sort of works the same area as a child's pose, but I guess at a different angle.

The first time I did this, I noticed what felt like a significant abatement in pressure. For the next day or so I felt like the tightness was dramatically reduced.

But then last night it kind of returned. It seemed like I what I had done was kind of move the tight area around. It felt sort of closer to my perineum and testicles than to its usual location in the back of the rectum. It didn't really hurt much...the same tight sort of uncomfortable feeling, but a bit displaced.

As I've mentioned before I had back surgery at the L5 - S1 level about 2.5 years ago. I'm now starting to wonder how much of the musculature and nerves running through the L5-S1 are actually responsible for the sensation. There's definitely a direct correlation between pushing my tailbone out and feeling the sensation of tightness moving.

I can't really tell if what I'm doing is really making the tightness better or just burying it deeper. And I also know that being too aggressive with child's pose and especially with that sprinter's pose thing I did is not the safest thing I can do for my back. This morning I woke up with some weird tweaks in there...I get those from time to time, but they're definitely not much of a good sign.

I'm thinking that perhaps I should have Freedman talk to the physical therapist I had who was pretty helpful with me with making good improvements after back surgery. Perhaps there are connections between the lower spine and this condition that need to explored in a professional setting. Freedman is great for what she does but maybe I'd do better with another P.T on the case as well.

[webslave]

That stretch may have helped either by relieving pressure on a nerve OR by stretching a spasmed muscle. Difficult to say.

[johnnyblotter]

Well, I saw Freedman today and had a good session. I'm quite determined to relax and be as aggressive as I need to be with these internal trigger points and the whole anal/sphincter area is much looser and more relaxed now.

That said, right now I find myself in a fairly advantageous situation to be working on this issue. It's the summer and very warm, I've managed to arrange my work situation to about 3-4 hours a day from home, and I have a little money saved that I can put toward this without worrying too much.

I've fully embraced the Wise Anderson protocol and have been putting a good 1-2 hours in a day on both the P.T and the relaxation. And I'm getting much better at all of it.

The thing is though, at heart I'm a sporty kind of a guy who, if I sit around and don't exercise long enough, even with my stupid back, it's just not good for me.

What's kind of interesting is that although I've had these types of flare ups in years past, not nearly this bad, I've always beaten them by treating them as hemmorhoids. Tons of hot sitz baths and creams, after some months, seemed to always eventually work. This time I tried and tried without success doing that, thus ending up at the Wise Anderson stuff which, after many years of confusion, has provided me with the answer as to what actually has been going on.

But as I'm a squirmy type of guy I think, since I have time, it's worth trying other approaches in conjunction with the Wise Anderson stuff. I can't really help it. I'm working hard at getting extremely relaxed but then it's just in my nature to just go try some stuff. So today I decided I'd go running. And I think I learned something from it. I actually FELT the muscle that was in spasm while I was running, on the right side and up in the back..what I'm assuming is the levator ani muscle. This was a pretty significant lightbulb for me, because all I'd really felt before was just the tightness which I couldn't really place the location of, which was annoying. But after doing the work with Freedman today and then while doing this run, I actually felt the specific muscle.

This actually made me feel better about the situation. So thinking now is that doing the internal trigger point work on a daily basis (properly, without overdoing it), especially on the right side, is going to be very key to improving. The main challenge I have is that without a table that inclines, I don't seem to be able to reach the spot on my right side with my left thumb. Freedman taught me how to do it....thumb all the way in, bend it until it touches the prostate, then extend it around the whole side, holding on tender points....and I could JUST reach it on the incline table in an awkward position, but on a flat surface at home I can't quite get there.

I think I'd rather try to MacGuyver some type of piece of wood or find some other way to do this before I go about looking for a cheap wand type of device. Freedman had one but I think it was the Therawand. I'm not totally sure about that.

The other issue, and this is pretty unique I think, is that when I was a kid I had three urethral stricture surgeries over a period of years. For many years it hurt to pee and I think the sensitivity of my penis was somewhat messed up, and made me think I had E.D for years (which I really didn't). Subsequently, in my thirties, after working that stuff out mentally, I think I overcompensated for lost time and overdid it with the masturbation and sex. And the masturbation part of it really involved clenching the pelvic muscles in a major way. That's a big part of how I got pleasure from it. When I read on here today about ejaculating while leaving the pelvic floor in a dropped position, I realized just how impossible (seeming) it is for me to get off that way. So I tried masturbating today while putting a finger up in the anus a bit (we're getting pretty graphic, I know) and it was like, the whole pleasure of it is based on the clenching...I could control it to some degree while in the act of getting there, but in the five seconds leading up to orgasm, and then orgasm itself, absolutely no way. The whole system just goes into a total clench automatically.

Fortunately I believe that having sex is much less strenuous on my pelvic floor. I think I probably still clench during orgasm, but I have more control of it, and there's definitely a lot less clenching during the act. So, I have to really, really stop masturbating for the time being (I'm down to about 2-3 times per week currently, and maybe 2-3 times having sex per week as well).

With all the surgeries I've been through I think my actual case of CPPS is a struggle but it could be a lot worse. I think no masturbation and figuring out how to hit these internal trigger points is what I'm going to focus on next.

This was kind of a rant, but I guess I'm just sharing these ideas as they come to me.

[webslave]

the whole pleasure of it is based on the clenching...I could control it to some degree while in the act of getting there, but in the five seconds leading up to orgasm, and then orgasm itself, absolutely no way. The whole system just goes into a total clench automatically.

viewtopic.php?f=34&t=627

[johnnyblotter]

Jeez. That's pretty interesting. I can't actually finish that way, except perhaps in rare circumstances where I'm being more aggressive in that position.

I also cannot ever get off from a blowjob or handjob. I came from a blowjob once in my life, maybe twice. This is why I think I suffered sensitivity problems with the stricture and urinary issues as a kid, and it's definitely why I got into the clenching thing..that was where the pleasure is.

So, I'm not sure what I'm gonna do. I have a strong sex drive and a satisfying sexual relationship with my partner. I don't know how I'm gonna re-program all this.

At the least I think a few weeks off from everything is probably a good start.

[Caedar]

Ultimately, I've found that ejaculatory and post-ejaculatory pain can be largely solved with proper trigger point therapy and treatment of other organs that could be irritating the innervation of the genitals.

In my case, treating with antihistamines relieved bladder pain, which helped relieve ejaculatory pain. For post-ejaculatory pain and pain on erection, treating trigger points in the ischiocavernosus and connective tissue restrictions around the perineum were most helpful. In the long term, it's likely you'll be able to support greater levels of pelvic floor contraction while orgasming. Why? Because right now your muscles are in a chronically shortened state, which means they cannot contract to deliver full power (a shortened muscle = a weak muscle). Normalizing the muscles will mean better orgasms.

[johnnyblotter]

Well, that's a bit different than what I experience...I don't actually have ejaculatory or post ejaculatory pain. It's just that orgasming this way is probably just not helping my pelvic floor to relax. Doing it is like the opposite of the relaxation and pelvic drops, you know? But I do think the initial spasm was either caused or exacerbated by too much clenching during masturbation. So, In any case, getting some regular and proper treatment on internal trigger points as you suggest is what I need to be doing, and for now I'm just going to cut down on sex and masturbation.

[johnnyblotter]

Argh. I just can't quite get in far enough to really get deep trigger points. I think I'm doing some good, but to really do this properly unfortunately I think I'm gonna need some type of a tool. My fingers just aren't that long.

This is too bad as I feel like doing with this a finger daily would really be the best way to go. I feel like I have a good understanding, but I'm like a quarter inch short with both my thumb and my index finger.

[johnnyblotter]

Webslave, I've seen you address the issue of wands here but I'm a little confused...I have a Theracane, but surely THAT'S not meant to go up the rectum? Do they have a smaller one? I'm a bit confused. I think I need to get something though and start doing this.

[webslave]

A poster called CPPSdad successfully used a Theracane. The diameter of the Theracane is small, well within what a normal anal sphincter will allow through. Not sure why you find this confusing. The wand they use at the Wise Anderson Clinic is a bit narrower.

[johnnyblotter]

I guess I'm not confused, I'm just looking at the thing and not mentally prepared to put it up there that far on my own right now I guess. I would feel like it's a little dangerous. I suppose I've only recently gotten comfortable with a finger going as far in as it can go, and that ball on the end of the Theracane is quite a bit bigger. Figuring out how to get that between my prostate and the levator ani area on my own...I'm not ready for it.

My finger seems plenty wide enough to apply pressure to the muscles, it's just not long enough. I think Freedman had the Therawand in her office. I wish I had like...a thing that was like my finger, with another inch on it.

Can you remind me what device you recommend? I saw a post on it somewhere but I can't seem to find it.

[webslave]

I recommend the device that Dr Wise gives you at his clinic. That's the best there is.

Failing that, the Theracane or Therawand
http://www.amazon.com/TheraWand-Essenti ... 00C2AO2QY/

[johnnyblotter]

I will probably try Therawand.

I think I'm in good hands with Marilyn. If I can't make progress over the next few months I'll probably seriously consider the clinic.

[johnnyblotter]

Man, I'm so frustrated today and I feel like I'm stuck.

The feeling I have sort of like there's a muscle "hitch" or just a muscle that's slipped under another muscle. At any rate, it's just too high up there to the back right for me to reach. It feels like an undescended testicle...like it's just too high up there and needs to slip down.

I tried something unusual yesterday that gave me some minor relief. Since it felt like the muscle is just glitched up there, and needs to push out, I laid down on my right side, sucked my breath in to the top of my chest almost as hard as I could and used the air to push the pelvic floor down.

Doing this, I got the sensation that this muscle started to drop down and move out of the very awkward place it's sitting in. So I did that for about twenty minutes, holding for about ten seconds and then releasing, not trying to really push it, more just holding the air in and letting it push down on this area.

I was on a valium last night and after I did this I really felt like the muscle had moved down a bit and it was about 40% less annoying.

The other thing with this was that once the muscle dropped down, doing a contraction of the anus felt more...fluid and together, for lack of a better description. Like the lower muscles at the bottom of the rectum and the higher muscles were closer together...although it also felt heavier to clench the muscles, like I was lifting up a mountain of gum, but at least I didn't have this spasm way up high in the back of my ass.

This morning I tried playing around with this again, I got it to drop down a bit but now it's sort of reverted and annoying.

I am not sure what muscle this is...I was looking at diagrams last night but as someone who is a bit spatially challenged I couldn't really figure it out. I thought maybe it was the ischocavernosus. I wonder if it's just a trigger point that needs to be properly reached. I worry that with a tool I would just push it up higher, but I guess, how high up can it go? Hopefully it's something that needs to release and neither Freedman or I have hit it yet.

Anyway, the major frustrating thing is that this muscle hitch is basically the only symptom I have, and other than holding my breath in really high I can't seem to do anything about it. Thursday will be my fourth visit to Freedman and other than a significant improvement after the first visit I feel like I'm stuck. Despite being very commited to the relaxation audio and the internal work Freedman showed me, I'm stuck, and I can't seem to really get through the day or go out and do anything without a small hit of valium. And even then it's no fun.

I know I'm very frustrated and doing things that I guess I'm not supposed to, but I just can't seem to make forward progress.

[johnnyblotter]

I'm starting to become curious as to whether I should consider myself diagnosed with CPPT or only with Levator Ani Syndrome, or as I guess some others call it, Chronic Proctalgia.

It is true that six months prior to this current bout of issues (also six months) I had a brief problem with IC, which was intense, but lasted only a week and never came back.

Within the last six months though, my problem has been 100% pain and discomfort in the rectum. I have no urinary issues, and no additional pain with intercourse, although I feel that masturbation has likely created the muscle spasm issue I feel I have. It seems I'm missing a few hallmarks of CPPS...that is, I have no pain after ejaculation, and the pain is only limited to the rectal area.

I found a few articles which have been mentioned before which seem to point toward biofeedback as an effective therapy for LAS.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2847007/

In particular:

Patients were first taught to strain more effectively by holding their breath, lowering their diaphragm, and contracting abdominal wall muscles.

Interestingly this is exactly what I was messing around with yesterday.

The other study supporting the idea of biofeedback is here:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3218134/

However, among patients with highly likely LAS (Rome III levator ani syndrome) adequate relief was reported by 87% for biofeedback, 45% for EGS and 22% for massage at 1 mo follow-up.

These articles suggest that one is "highly likely" to have Levator Ani Syndrome (and correspondingly do better with the biofeedback) if they report significant tenderness upon traction of the levator muscles. Otherwise it's "unspecified".

All I know is everything was tender and painful in there at first, so I can't answer that question.

However what I am curious about is the distinction between CPPS and simply LAS, and whether perhaps I have LAS and should therefore be looking towards other treatment options.