Intra-muscular injections? other questions!

[lookouth]

Hey, some of you may recognize my name I posted a while ago, boasting I'm afraid a little prematuraly of my journey down the road to success and being cured. chronic prostatitis / chronic pelvic pain syndrome has really worn me down- I have had it for about two years and only just turned 18 two weeks ago, I am the youngest person I know to suffer from this which is also a little disconcerting, and now with the prospect of having to deal with this through college (recently accepted to yale!) I have become more and more desperate to get rid of this awful illness. I have been visiting a physical therapist (amy stein in nyc) for about three months now, with some marginal improvement over my original symptoms- I feel like now I can relax my pelvic floor muscles most of the time through breathing and stretching. I am glad to say that for the majority of my days I am for the most part pain and discomfort free now, yet the symptoms return when I do any of these three things.
1. Urinate (the pain here is pretty mild, and is mostly at the very end of urination when I feel like I hafta push and my flow starts and stops a bit, and then for about 10-15 minutes afterwards when the area around my pelvic bone feels congested, this can usually be mostly allievated by deep diaphram breathing and relaxing of the muscles and or a few reps of kegels, also I feel a hightened sense of nerve pain where my pudendal nerve comes up on my pelvic bone on either side at hte base of penis)
2. Make a Bowel Movement (here the pain is markedly more intense after passing my stool I feel like the muscles around my spinchter are clenching up and when I try to relax them they almost immiedatly 'snap back' and tighten. Afterwards, for upwards of an hour or two I am left with sore muscles all in and about my pelvic floor- concentrated on what seems to be my levitator ani muscles and the bulbospongiousus muscles in the periuem)
3. After I ejaculate (the pain immiedatly afterwards has gotten better since I started PT, but even when I stretch immiedatly afterward the shaft of my penis gets extremely tender, like the whole muscle is very sore (as if I had ejaculated 3-4 times in one day) also the urethra seems to be inflamed or atleast very sore itself, the next day this pain usually subsides but I am left to with a pain in the same areas as after a bowel movement but of a more tight muscle or acute pain sensation, as if the nerves at the base of my periuem, are contracted and sore)

My PT recently reccomened I contact a doctor she referred me to ( an ostiopath who apparently specializes in these types of injections (his name is Dr. Juhl, any experience would be greatly appriecated)- and seemed to indicate they would be of some sort of local short term anesthetic such as lidocane or procane or something to that extent, and be injected into various trigger points she has noticed- probably two on my lower back and one in each levitator ani muscle, and maybe one on my inner thigh. She said that these injections are usually quite painful, and though I am not easily dissauded by such caveats when it comes to possibly allievating CPPS, I was wondering if anyone had any information on such injections or personal experience, what is the sensation like? How long does the anesthetic last and does it impair function in any way? ALso any other points of advice about helping me cope with my symptoms would be greatly appriecated, I should probably add that I have tried rather unsuccesfully Celebrex, Amytriptline and Ativan (valium) the latter two helped with relaxing my muscles a lot and in pain management but were making me unbearably tired so I had to stop using them and I am currently taking no drugs whatsoever.

I cannot express how much this forum, and the people on it have done for me, it has been incredibly difficult for me to share my chronic prostatitis / chronic pelvic pain syndrome with my friends or even family and you guys have been such a great community I cannot thank you enough. Posting, and reading others stories has become very cathartic for me. Please feel free to contact me with any advice, comments, or just to talk about chronic prostatitis / chronic pelvic pain syndrome I know how much better it makes me feel to talkt to someone who has shared my experiences.

[email protected]

[webslave]

David Wise told me that he thinks only a handful of people in the USA know how to do pelvic floor massage for male chronic pelvic pain properly. He specifically thinks female therapists are a little inhibited from being sufficiently forceful and assertive inside the male rectum. I'm not sure if that is a result their shorter, weaker fingers or the psychological aspects, as DW thinks.

Kegels are not a good idea.

Injections should not be necessary.

[lookouth]

I appriecate the input, but have to say it wasn't exactly in the constructive vein I was hoping, though I am interested in the first part of what you said I believe my phyiscal therapist may be exception- I know she speaks on the phone with Dr. Wise often, though I will we be looking into possible alternative therapists in the NY/CT area if anyone including Wise had reccomendations. Your last two statements are far from helpful "kegels are not a good idea' I understand there is some debate over this and Dr. Wise for the most part thinks they are not helpful, but I have seen a significant drop in my resting tone by doing them, I usually try to do them to exhaustion, to wear out the muscle, on behest of my doctor about 5 reps 15 seconds each. and usually feel more relaxed and less discomfort afterwards. I used to be under the impression that there are a lot of like magical hidden factors indicating whether or not something works for chronic prostatitis / chronic pelvic pain syndrome but more and more am coming to realize it is ver ymuch contingent on if I feel better or not. Also "injections should not be neccesary", why do you think so? I'm curious on ohter peoples opionons- I dont seem to be responding terribly well to physical therapy and I'm not sure how many more options there are for me?

[webslave]

Intramuscular injections are not cited as helpful in anyone's account of getting better, as far as I know. If you have something to disprove this, let me know. I'm open to new ideas.

[hodologica]

lookouth,
I'm currently gathering info on the efficacy of kegels, trying to decide whether to continue with them. How did you judge them to be useful in reducing your resting tone? Is that a subjective impression or one measured by EMG?

In my case, the one time that I did kegels during an EMG session I had only a 15% drop in my EMG value immediately afterward. (I might add that Wise believes EMG values primarily reflect the anal sphincter, and are little influenced by what happens in the rest of the pelvic floor. My PF-specialist physio disagrees.)

Have you been pairing your PT with focused relaxation as Anderson and Wise call for? In a recent statement quoted on this forum, Wise announced [edit: emphasized, I should say] that he considers PT alone a potentially inadequate [edit: "usually inadequate," he says] treatment. Check out the long quote halfway down the page on this topic:
viewtopic.php?p=8253

[hodologica]

I think you want to especially examine the last 3 paragraphs of that very extensive David Wise quote found at the above link. (But if you consider his opinion to be somewhat more authoritative than anyone else's - as I do - then youll certainly want to read the whole thing twice.)

[hodologica]

By the way, three months is not very long to have been in physio. I dont have refs, but I've heard more than one person here remark that their progress with PT was very slow and that they had no real appreciation of its efficacy until looking back and realizing that their worst days were now about like their best days had been around 3 months prior. They spoke as if this was the rule, despite some people's being helped faster. isn't that what Wise and Anderson say too (I dont have AHIP handy)?

[GS]

I agree that the physical therapy can take a long time to see results. I have been doing the PT for 8 months and still have symptoms and trigger points. But looking back, I am better now than when I started. Dr. Wise reports that it can take 2 years for complete improvement. Patience seems to be key.