My setback

[inflagranti]

I have been living with chronic prostatitis / chronic pelvic pain syndrome for nearly 10 years now, though I only realized what it really was during the last 2 weeks; thanks to this forum and the great work by Wise and Anderson (the book is on the way). Unfortunately, also thanks to the worsening of my condition in the last weeks. Before I knew about CPPS, I always attributed my pain to my shy bladder/paruresis. My assumption was that because I went to the toilet to early, being afraid of that I may not have a chance to go next time, I developed bad toilet habits and couldn’t void correctly, and because of that and the fact that I always drank too little, there was discomfort and pain in the penis and the bladder.

Therefore my main way of attacking the problem was to overcome my fear of public urination, which I managed to learn during the last years. Being able to control my bladder and being less afraid and anxious of urination, I got much more relaxed, which of course helped my chronic prostatitis / chronic pelvic pain syndrome symptoms. I still had to go to the loo during the night each other day or so or had urgency episodes, but they were manageable and I didn’t really care for them. I could sleep well and had nearly no pain. Also I could control my erections nearly as well I could before my CPPS. Then I met this lovely women and I had sex again in ages. That’s when I realized that I still have some problems with the thing down there, though thinking back now, it probably was just because I was nervous and hadn’t done it in ages. Anyway, we spent lovely 6 days of fun and sex, until she had to go back home. That has been 6 weeks ago and my chronic prostatitis / chronic pelvic pain syndrome symptoms have worsened dramatically since then. I attribute this to three things:

• I was very anxious about not being able to perform next time she came here. Also we did some stuff on the webcam and I was nervous and anxious before that each time, so that I started getting tense and contracted my pelvic before each Skype call.
• I masturbated a lot as I had to ensure that everything is still working all the time. So I did it up to 4 times a day!
• Every time I did it and had great wood I was depressed that I was alone and couldn’t use it on her. Also I was depressed in general as I missed her. And finally, I got depressed as I got afraid again it might not work and I may have to go to the loo all the time and all the things that I had to endure in the past.

This all lead to the problems getting worse and worse, me getting more anxious by the day and more scared and hopeless. And now the symptoms are as bad as they were years ago. At least my shy bladder is still under control. The things I’m battling right now are:

• Erectile dysfunction (hard to get it up, once up hard not to come)
• Pain in penis, softened glands
• Severe pain in perineum (feels like there is urine stuck there!?)
• Severe pain just above pubis (is that the bladder or muscles?)
• Sometimes polyuria, where I have to go piss out a liter or so in an hour
• Troubles sleeping (when I dont sleep enough the pain and anxiety levels increase massively)

If it was only for the feeling of urine stuck in the perineum, then I could handle that, because that’s what I had even when I felt great. But the additional pain above the pubis, that makes u feel that ur bladder is full all the time, that’s really hard to deal with right now. Maybe somebody has some good tips to get rid of especially that feeling or to stretch those muscles.

Also, I think I could get much better pretty soon if I could control my anxiety. Yesterday for instance, I was in no pain and was feeling great for about 4h (drinking a bit of alcohol) till suddenly I started to get tense and felt that I started contracting my pelvis. I was pretty sure this was because I got anxious that may pain would return (which then of course it did), but I still couldn’t get rid of it. Has anybody any idea how to relax the pelvis in such a situation? Or could it also be brought on by dehydration through alcohol?

Furthermore, for me it always gets much worse when I'm not able to void well during urination and I feel like there is a bit of urine held back in my perineum. Could that be the case or is it probably just the muscle down there that maybe has a trigger point that gets activated each time urine passes through?

Any comments regarding my story and problems would be highly appreciated.

[webslave]

The feelings of urine stuck and full bladder have to do with inflammation and nerves and not actual urine. Stop using alcohol. Get treatment for your anxiety, which is quite severe. You also may have obsessive tendencies, as in OCD, and may need treatment for that too (psychologist). Don't masturbate so much; it's overstimulating the pelvic nerves. Others may have more extensive comments.

[inflagranti]

Thanks for your fast reply. I know I should get treatment regarding my anxiety; on the other hand, I was also anxious some weeks ago and I lived relatively well. Right now I just seem to tense my pelvic muscles whatever I do (even when I write on the computer I sometimes feel myself tensing). The question is, how can I stop that tension and contraction of the PC muscle? Also, is it possible that I cannot control this as it is not neurological anymore but a deficiency (say because I drank to little)?

Also I may add that as I said I lived with this well I always got that feeling of urine stuck in the perineum after ejaculation or when not voiding the bladder (because I couldnt relax my urethal sphinxter enough), but it generally subsided pretty quickly. The main difference from now to then is pain-wise that I always feel like urinating because of pressure coming from either the bladder or the muscles above the pubis; if I would now what it was and how to fix that I think i could take a huge step to getting better.

[webslave]

You're "tensing your pelvic muscles whatever you do" because of anxiety. You should try a short course of benzodiazepines at the very least, and see if that does not change the tensing. Of course, long term you must learn things like Paradoxical Relaxation (you do have Wise's book, don't you?)

The feelings of "stuck urine" are symptoms of allodynia, where nerve impulses are heightened and perceived differently. This will subside if the condition is properly treated.

[inflagranti]

I don't have the book yet, but its on the way. So if u could give me some main indicators what stretches to do or how moment-to-moment relaxation works that would be great.

A question regarding trigger points: Could it be that there is a trigger point in my perineum that radiates pain to the muscles above the pubic? Because that its how it feels like sometimes.

Also, I wonder how much influence fluid intake can have. I dont drink as much as before and if I do my body seems not to be able to store it (polyuria). Is there something I can do to fix that? Or does my body just have to get used to processing more fluid again?

[webslave]

So if u could give me some main indicators what stretches to do or how moment-to-moment relaxation works that would be great.

Really, it's better to get it from the book, which you should have soon.

A question regarding trigger points: Could it be that there is a trigger point in my perineum that radiates pain to the muscles above the pubic? Because that its how it feels like sometimes.

Yes, that's possible, but you need to be properly assessed.

Also, I wonder how much influence fluid intake can have. I dont drink as much as before and if I do my body seems not to be able to store it (polyuria). Is there something I can do to fix that? Or does my body just have to get used to processing more fluid again?

"Polyuria" means 2.5 L over 24 hours in adults. Make sure this is actually happening to you before using medical terms like that.

[inflagranti]

webslave, you're right regarding being careful with those technical terms. It's probably not polyuria; but sometimes I can drink very little and still have to urinate huge amounts in a very short time. It could be that my body reacts to the pain in the perineum and thinks its a congestion there and tries to spill it out by producing more urine. But that's just a theory... :)

[webslave]

You need to measure how much you are drinking and how much you are urinating in a 24 hr period. Otherwise what you think of as "huge amounts" could well be normal.

[inflagranti]

Ok, I think I'm gonna do that over the upcoming weekend.

Another thing I always wondered: Could going to toilet 'too early', meaning with very low volume of urine, aggravate the symptoms? This is always a concern form me, if I'm probably going to toilet to early and should maybe wait before the pressure is stronger!?

[h92]

Hi,

I too have infrequent urinating, ie sometimes I drink a lot and for hours don't need to go, sometimes I didn't drink for a few hours and need to go often (and with real content, I don't suffer from frenquency). I don't think that it's not normal, just that maybe your body just processed the water contained in the food you ate or I don't know what.
Anyway, you shouldn't be so worried about whatever you need to go, or if you're going too early or whatever : if you need to, you go, if you don't, you don't go.
Remember, anxiety is very important for us, no need to stress for nothing. It will reduce your symptoms much more than going early or late.

[inflagranti]

I just realized that I can press some points above my pubic bone, which seem to radiate pain further downwards in my pelvis and perineum. There is one soar point in the perineum, pretty close to the after, that is one of my main pain spots; it seems also be the main source of over-excitement when I ejaculate prematurely. The funny thing though is, that it also hurts very much when I press on it (not on the triggers) and the pain there also gets worse shortly after urination or ejaculation. Is there an explanation for this? Could that spot be the (sore) prostate? (From looking at pictures this could very well be the case)?

[inflagranti]

I have been taking ibuprofen, as prescribed by my doctor, in the last days and it takes the edge of the pain (which I have mainly in the area above the pubic bone). But what's nearly worse than the pain is an itchy-like sensation in the whole pelvic (mainly around the bladder) that most of the time is relieved for a while by urinating; and made worse by bowel movements. Has anybody made similar experiences? Any advise how to get rid of specifically that feeling?

[inflagranti]

Yesterday I went to watch a comedian and he gave nearly an hour of encore and I had to go pee already in the middle of the thing. So I had to hold it in for about 1:30h and I couldn't empty to well (was still pretty tense) when it was finally over. Interestingly though, I could sleep extremely well after that, there was virtually no pain and I the muscles felt relatively relaxed. Also today I was much more relaxed the normally. Is there a physical explanation for that (except for that I was laughing at the comedian) or is it 100% psychological? Would really appreciate if somebody could shed a light on that. Because if its physical, I will continue holding it in as long as possible (not to the extent of yesterday, but still maybe till the actual urge is there from the bladder, not mainly from the muscles); if its purely psychological, then of course I have to find other ways to relax.

[carld]

Two things likely happened here...

1. You were having a good time = relaxation/distraction= pelvic floor releasing= symptoms lesson...

2. You were bladder training by holding the urine...each time you train the bladder by passing urine latter, you were training the bladder to send signals latter to the brain to give off the urge to pee...just my opinion...

Best

[webslave]

Interestingly though, I could sleep extremely well after that, there was virtually no pain and I the muscles felt relatively relaxed. Also today I was much more relaxed the normally. Is there a physical explanation for that?

It's the effect of distending the bladder, a mild form of hydrodistension:
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