My story and what works really well for me now.

[MC]

Hello, I'm new to joining the forum but have been viewing it for the last year. My story starts like many of yours. Started with slight pain while urinating in the shaft of the penis for a week. That went away but re-emerged as a burning sensation at the tip of the penis about 8 hours after sex (decided to test the goods when I felt the original stinging pain went away). Over a period of only a few days the burn had slowly moved down the shaft and into my testicles. A severe burning feeling at this point and extreme urination (every 15 minutes sometimes). All the extreme pain subsided about a week and a half after the inititial urination pain but I was left with the swollen perineum pain you all describe and occasional penis burning but always after ejaculating.

For the last year that perineum pain as well as the moderate burning has "waxed and waned." I should also mention that I did visit doctors during this time but no one could really help. Just the usual antibiotics that appeared to be helping until I stopped taking them. I also tried prota-Q and other generic products like that but it didn't really make a differance. And of course the painful scope in my penis, I'll never allow that again! The only thing that did make a differance is religously stretching my legs and groin. Initially that knocked the pain down almost 50 percent and got better over time. So I began to get more atheletic like I used to be but that brought the perineum swollen feeling back. Even with the stretching I just couldn't do any atheletics without pain and I both lift weights and take martial arts.

After about 6 months of only occasional moderate burning but a really swollen perineum I found the Trigger Point Therapy Workbook mentioned so many times on this site. I read it and decided to try some of it myself. The external massages worked great and I could do them myself. They really relaxed me which helped reduce the tension in my pelvis. But the results were very limiting. I eventually tried internal work on myself while standing and using my index finger because the extreme exercise (martial arts) began to not only make my perium tight but also my rectum felt extremely tight. So I started by stretching out the rectum all around the opening with a gloved finger and lubricant. It worked great. A few weeks later of doing it 2 times a day the the tightness was nearly gone! But the perineum pain was only slightly reduced. So I went in further into the rectum and felt for trigger points. It took weeks to find the real problem. I finally stumbled upon a muscle that seems to run between my legs in my pelvis. It runs parallel to my back rather than parallel with my penis. And it seems to be one of the muscles that makes up the perineum area. If I put my finger in my rectum I must enter towards the penis rather than straight up into the rectum. It seems like I am just under the prostate and pressing down on the floor of the perineum. But I must go about an inch in a half in (from the anus) to find the very tight muscle. It feels like a super tight rubber band stretching across between my legs. So tight that it felt like a bone at first. And unlike all the other slightly sore muscles I found in my pelvis, this muscle actually hurts pretty bad when I press on it. So I just kept relaxing and pressing harder which did really hurt but as I pressed it felt like it was getting stretched out. After I was done stretching it out by pressing on it with my index finger (I'm pretty flexible), the pain was gone. Sure it felt uncomfortable down there after because I had been moving stuff around but not painful anymore. During the day (if I did it first thing in the morning) the tightness would come back resulting in pain and swelling in the area but I'd just do another session before bed and it would go away again. I followed this program for a about 3 weeks and it has now reduced all my symptons 75-90 percent depending on the day. The most dramatic differance in symptoms is post workouts or martial art class. That used to mess me up pretty bad but now the pain is less than I'd feel from only sitting around the house for a few hours.

I now feel that I may have found the solution to this problem for me. But only time will tell. It may continue to get better or I may have already reached my limits on internal work. I'll give it a few months and if I don't get completely better I have at least learned that it is in fact a muscle problem. Of course, I will then have to find a therapist that is willing to do internal work in order to find the rest of the injured muscles. If I were on the West coast I'd just go to Stanford but I'm on the East coast.

I would like to know if any of you have found that internally pressing on the perineum muscles has fixed your problem. Especially if it sounds like I described the exact muscle that has troubled you. And for any of you wanting to try this, you should read the Trigger Point Therapy Workbook first so you have some idea of how to find your tightened muscle(s). Or much better yet, just go to a physical therapist that does internal trigger point work if you have one nearby (unfortunatley I don't). I'm no doctor just someone wanting to solve my problem that doctors couldn't solve.

Thanks for reading this and good luck to all of you.

[Tomass]

I would like to know if any of you have found that internally pressing on the perineum muscles has fixed your problem.

For more than 6 months I have been doing internal work very similar to yours. The last three months I feel 90-99 % improvement. The impact on pain is huge. However urinary symptoms tend to reduce slowly.

[MC]

I am very excited to hear that. Did you find pain in the muscles that make up the perineum or more around the walls of the rectum? It seems that more people find pain in that area (rectum walls) when massaging internally but all those muscles seem pretty loose to me. Like I said, I stumbled upon what felt almost like a bone (because it is so rigid) running along my perineum and pretty deep in. That was the only muscle that was really sensitive and felt tight (like a rubber band about to snap). I have looked at some anatomy pics that are linked on this site but I can't seem to identify this muscle. If anyone knows please respond.

[Tomass]

I am very excited to hear that. Did you find pain in the muscles that make up the perineum or more around the walls of the rectum? It seems that more people find pain in that area (rectum walls) when massaging internally but all those muscles seem pretty loose to me. Like I said, I stumbled upon what felt almost like a bone (because it is so rigid) running along my perineum and pretty deep in. That was the only muscle that was really sensitive and felt tight (like a rubber band about to snap). I have looked at some anatomy pics that are linked on this site but I can't seem to identify this muscle. If anyone knows please respond.

I am not sure which muscles I work on. Earlier I did trigger point release of the muscles which were deep and as far as I understand closer to prostate. From Mark's pictures I presume they could have been Levator Any or Coccygeus muscles:

viewtopic.php?t=2112

The muscles were not as rigid as in your case but they did hurt when pressed.

Now I work on muscles very close to the anus, just opposite the perineum (different location than yours). Everyone is different. Apparently Trigger points in different muscles can produce CPP symptoms.

I also noticed that the trigger points may reappear when you think they are already gone.

BTW, I had internal muscles examination performed by neurologist more than a year ago. Now I understand that he did not examine all possible muscles and used too little force when pressing the muscles. Of course he did not find anything wrong. As a consequence the "muscular component" was rulled out. I wasted my time on thinking about other causes of my symptoms (bacteria, autoimmunity etc.) till I decided to look into muscles once again. Very frustrating...

[MC]

Man it is tough to tell even with the pics which muscle it is. The levator ani is so large that I would think it is part of that muscle but who knows. Does the levator ani only run along the sides or does it also form the base of the inside (perineum)? I know the culprit muscle is between the prostate and the anus on the floor of the perineum. And that it runs from leg to leg rather than from the front to the back of the body. Like I said, it feels like an extremely tight rubber band running bettween my legs. Well lets see if anyone has some answers. I'm going to keep searching the anatomy pics. Thanks again.

[MC]

I found some better pics searching on this site that has helped me identify the perineum muscles better. Though it is still really hard to tell just how far in my muscle is that I press on to relieve the pain in relation to the scale of a pictures, it seems to be the superficial transverse perenial or the bulbo cavernosous muscle. The fact that the muscle appears by touch to be running transversely makes me think it is the first choice. But it seems the bulbo would be the most likely culprit to cause my symptons due to the actions the bulbo perform. The other option is that it could be a ligament. I believe there is one in the bulbo and could be the reason why the muscle I found is so tight, could it be a ligament??? It seems nearly impossible to know for sure without some sort of 3D model of the area shown from the inside. The reason why I'm so interested in learning which specific muscle (or ligament) is causing the problem is so I can deeply research the muscle's funtions and understand why it creates its symptoms. This would certainly help some of us out that have found this muscle to be the problem and don't have the ability, time, or money to visit a physical therapist trained in internal trigger point work. When I learn more I'll post again.

Thanks

[cr2]

See viewtopic.php?t=2168.

To slightly elaborate on my description, feeling externally in the perineum, the tight band or cord I describe is about half an inch wide and runs all the way from right behind the testicles to the anus. Would you say this is the same muscle?

[Gettingbetter]

I have exact the same problem. I feel a supertensed band of muscle just before I reach the prostate. It's hard as steel. About a half a year ago I tried to press on it and it loosened a bit, but the day after I had the worst flare-up I ever have had and it lasted for weeks. I haven't dared to touch it since in fear of that horrible pain in the perineum and penis.
But I guess the flare-up was a good sign that I was hitting the right spot or am I wrong?
Do you guys think I should begin massaging this muscle again and just ignore the flare-ups?
I don't seem to have any tension further up the rectum, but only in the external anal sphincter and in the muscle I mentioned above. I never had that golf-ball feeling.....

[MC]

In reply to cr2-
I don't think that is the same muscle I'm having problems with. I looked into this last night. My tight band which is, like yours, only about half an inch or so wide runs laterally (side to side) about an inch or so in (my best guess) from the anal opening. Search for "perineum anatomy pictures" and you'll find some good pics. I also tried to reach further in last night but that is as far as my insides seem to go. Right after the taught band I seem to be against another muscle that runs up the front of my body intead of along the perineum floor. When I touch that muscle I can feel it in my penis but it does not hurt. So my conclusion is that my problem seems to be still the first muscle I mentioned in the above post. But I'm not only guessing this muscle as the problem because it is tight. When I begin to press on it I feel the same as I do after martial arts class. Which is a really tight slight burning feeling in that perineum area. But as I press harder and hold the pressure the pain goes away for 8-12 hours (not totally but 85 percent on average). Good luck with you muscles.

[MC]

In response to getting better-
Well I'm certainly no doctor so I don't want to give advice that causes you pain but from what I have read on this site the pain you feel after is OK. The pain seems to be the body's response to you manipulating the damaged area. If you massaged any body part that was hurt, like a sore leg from working out, it would hurt more after but by getting the blood circulating as well as elongating the muscle, in our case, it will make the muscle better over time. When I started doing the internal massage I started with the outside around the anus and gradually built up the confidence to go slightly inside and stretch out the anus from the inner walls. Within a week the anal muscles seemed back to normal as long as I focued on relaxing them throughout the day after the massage. So I'd say that was step one for me, to rehab the anal muscles. Second I started to work further in but nothing really hurt, it just felt a little tight especially after workouts. Finally I stumbled upon the tight band that we both seem to be describing. Now that certainly hurt when I pressed on it (the anal muscles never hurt, just uncomfortably tight). The pain was the same pain I had been experiencing since the end of the acute phase (which is described in my first post above). Now a month later it seems significantly better. But for the first 15-45 minutes after the massage of that muscle I do have a slight flare up. I don't really care because I know that it will gradually go away and the rest of my day and night will be mostly pain free. At worst it may feel tight and uncomfortable but not the golf ball feeling that I had in the beginning. So I leave it up to you to decide whether you want to attempt this again. It certainly works for me and several others on this site. That is all I can say for now. Hopefully we'll all continue to get better with the trigger point techniques.

[ZR]

MC the pain u described sounds like me the pain I have. I have had this pain which has got worse in the perineum over time. I have the frequency over urinating that u said all the time waxes and wane the urinating. DO you have a feeling that your perineum is tight and just needs to lossen up like a stimulated feeling in there and in your penis as well? When u sit does the pain in the perineum just get worse and feels like something pressed up against the out side of the perineum? U said u get pain in the testicles is it in the left hand side of the testicle where u get the pain? Kind of personnal does your pain in the testicles as well as perineum and increase in urinating get worse after you have a bowel movement? How long have you been doing this internal work on yourself?

I have just started to look for info on these muscles perineum I looked into the bulbospongiousus and ischiocavernosus muscles as a problem but I do not know I am no expert far from it and with no help from any doctors it makes it hard to. But u people that are doing this work your self are very brave. I am looking into a trained therapist to do the work and if I should do it my self have them show and train me myself I am just to scared and worried to do it my self in cause I make a mistake and hurt myself for ever because I do not know jack about how to do this messaging.

If you could responed any one in this topic I would like it to the questions I asked.

[chewymix]

i've been following this thread and have been 'poking' around myself although so far only externally I have found that I also seem to have something that is about half an inch wide or so running from the base of the penis to around the cocyxx area. It feels like a ligament as it is pretty solid but I guess this could also be the muscle that you guys are referring to. I fould that after I had manipulated this muscle a bt from the outside I got wierd pain/tingling sensations running into my buttocks and groin etc. I think that this is a major factor in my condition and I will certainly be investigating it further :)

thanks guys....

[doverwhite]

no way I'm fingering my ass... but I'm so happy it works fou some

[MC]

In response to ZR.

I don't have the pain in the testicles anymore. That pain only happened in the first couple months. Also, sometimes after a very strenuous workout. But it goes away if I sit down for a while. I have been doing the trigger point therapy on myself for about a couple months. I learned how to do it from the Trigger Point Therapy Workbook which I got at Borders Books. It can also be ordered online. Certainly it took courage to do it and I never thought I'd do something like this a year ago, lol. I just started outside my rectum first until my confidence built up enough to work inside. Luckily I found my problem was only an inch or so in along the perineum so it really isn't that big of a deal. I also always start easy then progress to pushing harder but never too hard. If you have a physical therapist that is willing to do internal work and you are comfortable with someone else entering your body then that would be your best bet. I don't have anyone within an hour of me and even still I don't know if they are any good at treating this problem. If my problem does not continue to get better over the next few months then I'll have no choice but to find someone to apply the trigger point therapy. This is because I do realize I can only go so far into the rectum and even if I could go further I am nervous, like you, of damaging something, like the prostate. So my conclusion would be for you to read the book I mentioned above and decide for yourself what is best.

[cr2]

With regards to the perineal muscles, are there any other ways to work on them externally apart from massaging? For example, do any of the stretches mentioned in AHIP specifically help the perineal muscles and/or are there any other stretches?