Webslave please help .....here is my story

[tw2484a]

Dear all,

First I would like to thank Webslave and other moderators who keep this site running. It has been extremely informative and helpful.

I have been a chronic prostatitis / chronic pelvic pain syndrome sufferer for more than a year and I am writing to see if any of you have any comment on my condition. My current symptoms are as follows;

1. Urination
-Frequency- every 2.5 to 4 hours
-Sense of incomplete bladder emptying
-After urination- my muscles in the rectal area contract and then causes discomfort for hours
-Urge to urinate sometimes still accompanies with pain in the front (abdominal or bladder)
-Sometimes not sure if it is time to urinate (sometimes always have mild pain/urge to urinate)
-Pain during urination
-I do not need to urinate at night. I can sleep through 6 to 7 hours.

2. Bowel Movement
-It always aggravates rectal pain (soreness), which usually subsides within 5 hours. It affects urination. (frequency, urgency, abdominal discomfort)

3.Pain/sensation
-Abdominal muscles (transverse and rectus abdominus) uncomfortable. I suspect I have reactivated some trigger points on my abdominal muscles.
-Perineal pain(suspect the pain originates from inside the rectum)
-Burning sensation on tip of penis (especially after bowel movement)
-bladder pain (abdominal) sometimes (only discomfort when pressed)- sometimes reminds me to urinate (urge)
-After urinating the feeling the need of urination doesn't go away and this sensation increases as the bladder fills.
-Sometimes rectal pain and other sensations interfere with the urge to urinate
Before urination, there is a "˜lockup' in the muscle which is like what it feels before ejaculation.
-Tenderness in my prostate and pelvic floor muscles
-Sometimes I feel like urine is about to come out when I change my posture.
- Pain while sitting

I have a pretty long history so please bear with me;

In around 1993, I accidentally landed on the floor and hit my tailbone. I developed pain around the tailbone but I did not have urinary or defecation problems. My pain around tailbone lingers till this date and it seems to co-exist with my current symptoms at times.

In around 1995, I developed urinary frequency after an ejaculation. I could feel that I was unable to empty my bladder. There was no bowel movement problem. Urine culture was negative. I was put on a round of anti-inflammatory. My problem resolved. A few weeks later, I had a cold and my problem flared up again. This time, medication was not helpful. However, my problem waxed and waned over the next 7 to 8 years.
Last year, I began to experience stabbing pain in my rectum after ejaculation, bowel movement or simply sitting down. However, I had no urinary dysfunction.

In July, all hell broke loose after protected sex, I had urinary frequency, dribbling, poor flow, constant sense of incomplete emptying and prostate pain. STD was negative.

Later, I took any accredited quercetin product which helped tremendously. Then I saw an urologist who prescribed Levaquin. DRE revealed tenderness in my prostate and I emptied my bladder well. Urine analysis was negative. However, no EPS was done. Then my condition slowly subsided.

However, in August, my problem flared up again after an ejaculation. This time, any accredited quercetin product and Levaquin did not help.

In November, I went to see one of the leading urologists in the US. At that time, I was in the middle of a flare. I had severe rectal pain, urinary frequency, strong sense of incomplete emptying, poor stream. Uroflow revealed I had normal stream despite my flow was visibly weaker than before. Bladder scan revealed I had completely emptied my bladder despite I had a strong sense of incomplete empyting. My urologist commented that my prostate was benign and small. However, I did have tenderness in that area. There was also marked tenderness on Lateral pelvic muscle, pubococcygeus muscle. He commented my muscle spasm might be causing the problems. In addition, the culture on EPS and urine did not show any uropathogens. My EPS also did not have any WBC. I was put on Uroxatral and any accredited quercetin product for six weeks which did not help.

In December, my symptoms aggravated. My rectal muscle contracted vigorously after bowel movement which was extremely painful. It felt like a rubber band was stretched to the fullest and then it was snapped back to its original form and I had incomplete bowel movement.
In January, I pursued pelvic physiotherapy and my condition improved. My PT and my doctor found trigger points in my pelvis, abdominal and I was treated with myofascial release and trigger point injection. They also found tenderness in my prostate and my pelvic floor in general. My condition has improved 60 to 70 % after 2 months of physiotherapy.

However, I had to go to back to my home country in April and my condition has worsened the past couple of months even though I have been doing the stretches daily. I have listed my current symptoms in the beginning of this message.

The urologists here are 20 years behind in this area and know a lot less than what I know. I have tried acupuncture which seemed to make no difference. I have found a PT who has some knowledge of the pelvic floor but is not experienced in locating trigger points. She also seems to disagree that trigger points should be treated first in order to address this condition. I have been very frustrated.

I think my condition is associated with sex/ejaculation, intensive abdominal exercises (sit-ups), weight lifting, tailbone injury and difficult bowel movement. I think the above overloaded my pelvic muscles thus causing trigger points and then my symptoms.

I am currently not on any medication and I recently started doing progressive relaxation. I wonder whether I should try ProstaProtek and muscle relexant (perhaps flexiril or Valium) even though any accredited quercetin product failed to work.

I apologise for writing such a long email but I am really desparate. Any input or advice would be deeply appreciated.

Many thanks!!!!

Best,
David

[webslave]

A quick comment (on my way somewhere), is that the best bet for someone in your situation, far from the USA, is to await the self-massage instructions Wise & Anderson may supply soon. They may also publish a "rectal atlas" for PTs with landmarks to help locate typical triggers, I have heard. Be patient, try the reaxation techniques. More later. Anyone else?

[tw2484a]

Thank you Mark. I really appreciate your input and I welcome input or questions from others as well.


Many thanks.

Best,
Ronald

[alprost]

Given that you have had a Urological work-up which was negative, and that your pelvic floor is tender to the touch, the symptoms you describe are classic for pelvic pain caused by myofascial trigger points. For example, trigger points in certain muscle groups are usually responsible for pain after bowel movements, and the same goes for all of your other pain symptoms.

Read the article below, do your best to relax, and try to see an appropriate PT ASAP.

https://ucpps.men/chronic-prostatitis-is-a-psychoneuromuscular-condition

If you haven't already done so, you MUST get a copy of the stanford book:
https://ucpps.men/the-wise-anderson-protocol

This can be beaten, but only with appropriate physiotherapy and relaxation.

Good Luck.

[Guest]

My problem now is that my pelvis and my symptoms have been unstable the past few weeks since I finished my PT in the US 4 months ago. It took quite some time for me to find a PT who is knowledgeable about the pelvic floor but she has not heard of the Stanford/Wise-Anderson Protocol. I also have a feeling that she is not very experienced in locating trigger points. However, she is basically the best I can come up with. She seems open to new things so hopefully we can work something out.

My goal now is to keep my symptoms under control. Thats why I am hoping maybe PT combined with progressive relaxation, and medication (muscle relaxant, Prosta Protek) can calm down my pelvis.

I am also thinking about ordering the Travel, Simons TrP flip charts and Trigger point Workbook by Davies to see if I can address it myself.

[tw2484a]

Sorrie the above guest is me, tw2484a

[alprost]

My problem now is that my pelvis and my symptoms have been unstable the past few weeks since I finished my PT in the US 4 months ago. It took quite some time for me to find a PT who is knowledgeable about the pelvic floor but she has not heard of the Stanford/Wise-Anderson Protocol. I also have a feeling that she is not very experienced in locating trigger points. However, she is basically the best I can come up with. She seems open to new things so hopefully we can work something out.

My goal now is to keep my symptoms under control. Thats why I am hoping maybe PT combined with progressive relaxation, and medication (muscle relaxant, Prosta Protek) can calm down my pelvis.

I am also thinking about ordering the Travel, Simons TrP flip charts and Trigger point Workbook by Davies to see if I can address it myself.

There are possibly 2 key issues here:

1 - not all trigger points have been located or treated. Read these threads:
viewtopic.php?t=1778
viewtopic.php?t=1800

2 - You may not have removed the initiating factor in your case. If you do habitualy tense your pelvic floor, then the trigger points may be recurr. Read the info from Dr Wise on this thread:
viewtopic.php?p=8244&highlight=#8244

(BTW - Sorry, I deleted some of your above post by mistake!)

[tw2484a]

Thank you Alprost.

I have read those posts and I agree that there might be trigger points that have not been addressed. There also might be initiating factors that I have not removed. I will contine to investigate those possibilites.

However, I have another question about tenderness vs trigger points.
I did a DRE in 95 (for details please check the first post) which revealed no tenderness in my pelvic floor. My doctor was pressing my prostate and I did not feel a thing. There was no tenderness inside my pelvis.

I did another DRE after the flare up last July. My prostate was tender to touch. Then I did another DRE in November. My prostate was again tender to touch and my pelvic muscles were also tender. But EPS showed no uropathogens nor WBC.

Another dr who treated me for the myofascial pain did another pelvic exam in late March this year. He said I had no more trigger points in pelvis. But I had tenderness in the entire pelvis, eg levator ani, obturator and the prostate. My PT here also said I had tenderness in my pelvis but she couldnt find any more trigger points. She did comment my pelvic floor had a high tone. Thus, my questions are as follows;

1. how come I still have muscle tenderness in the pelvis when there are no more trigger points inside, according to my dr and PT here? My dr in the US is one of the leading physicians in treating myofasical pain.

2. Why is there muscle tenderness in my pelvis (without trigger points) and how should it be addressed?

Many thanks....

[webslave]

David Wise has a very poor opinion of most PTs' skills in this area, and MDs know almost no nothing about it. You can't assume anything about your pelvis based on a PT's comments, especially female PTs, who are often ill-equiped with short, weak fingers, and are usually too tentative inside the male pelvis.

[Guest]

Yes, I agree with what you said. However, I emailed Dr. Wise about my physician and he told me my physician is "an experienced and
respected physician who understands myofascial pain and trigger points". Maybe he missed out certain spots. That is why I am confused. Do I still have trigger points in my pelvis or I merely have tenderness in my pelvic muscles?

[webslave]

I'm not sure what answer you're trying to get. You tell us about a prostate exam you had in 1995, almost 10 years ago. What relevance does that have to your current situation? Answer: none. By bringing that up, you indicate that you may have the sort of obsessive personality that tends to lead to increased pelvic muscle tone in some men. I suggest you see a psychiatrist who may prescribe medications that can help you out of the tight, self-defeating circles of thought that cause a lot of anxiety and tension, and therefore lead oftimes to pelvic muscle tension.

[latte]

Well put Webslave, I agree. I am really surprised how similar my condition is to Guest's and I am very empathetic to your condition. Early on I had pelvic pain/spasm and never knew it then. This lead to a very caustic prostate feeling worsened by sex/urination/defecation which has improved greatly with time and prostaprotek and Flomax. I still have pelvic pain everyday but really relaxing, hot baths, and general well being help a lot. I also was very compulsive regarding my condition but after reading Wise's book I have improved. Early on the uro also checked my pelvis and he said it was not tender but I know, because I have palpated my pelvic muscles, that a muscle near my rectum has caused most of the problem and three world class uros all missed it. Flexeril helped me on occassion but Wise puts it best when he says it is an inside out fix, that is, we have to calm our minds to help relieve the pelvic tension and it doesn't happen right away, it takes time.

[johna]

Have you had a high definition MRI of your tailbone? You may have some neurolgic issues as the base of your problems.

Good luck.

John A