Could this really be caused by muscle tension?

[CMT23]

I am just about convinced that this is a muscular issue, but my case seems quite different to most everyone on here. I have no pain anywhere. I have discomfort that varies from annoying to extreme. It's felt in the penis. The discomfort feels like it's telling my brain to urinate even when my bladder is empty.

Everyone else seems to feel an actual pain or tingling or aching of some kind. Nothing abut my symptoms feels like a problem with the muscles, although I understand that the concept is that the sensation is referred from dysfunctional muscles in the pelvis.

I do feel somewhat better (usually) after things associated with relaxation.
Red wine
Valium
Very hot bath and then lie down
Massage (during the massage)

And you can press on areas adjacent to the prostate and within the pelvic floor at 3 and 9 o'clock and exactly replicate my symptoms.

Three months after symptoms started, they went away for 3 months when I was especially relaxed lying in the sun and snorkeling a lot.

Symptoms started during ejaculation, which makes me think it has something to do with the muscles that squeeze the prostate. Perhaps at this very moment, they went past the level of tension that they can handle?

But is possible I have a problem with the nerves rather than the muscles? If not, then why don't I feel any pain, aching, or tingling at all? And why don't I feel any pain or discomfort anywhere else but the penis? After 15 years, shouldn't dysfunctional muscles in the pelvis cause more than this single (very distressing) symptom?

[Burner2k]

CMT23,
I have the exact same symptoms as you have. Feeling to urinate...not all the time but still very annoying. I don't know if this is something which is caused by muscles at the rim of the prostate squeezing or a nerve irritation. My symptoms started too just after ejaculation. I have heard all kinds of explanation from doctors so far...its very frustrating not to have a diagnosis. I would think if it was nerve irritation, one would have pain while sitting among other symptoms.

The spots you mentioned around the prostate recreate the symptoms for me as well. Have you had a complete work up yet? I am trying to get it done...I don't know what a penile & pelvis MRI shows, but that is something I want to undergo through. I don't know if this is something you have, but for me if I squeeze the portion of head just below the urethral opening to all the way down to the corona on the top side of the penis, it recreates the urge sensation for me. For all I know, it could be persistent urethral inflammation. I also have slight inflammation of the meatus. I am doing a lot better than what I was a year ago. Part of the success, I can attribute it to Baclofen medication. Hot baths really help me a lot. If I miss one...I can feel it two days later. Right now, I am on Lyrica and it seems to be helping but totally not curing it.

I suck at self PT. I tried it many times but I just can't reach Trigger points near the prostate. I just have to wait till my PT "returns" from his vacation (which seems to be like for ever).

[Jay]

There is a lot of interplay between muscles and nerves. It's very possible for extreme muscle tension or spasm to impinge upon a nerve, thereby creating symptoms. You also have to consider cross-talk, wherein one agitated nerve transmits to its neighbors. It's a complex area of the body, and an equally complex issue to diagnose.

Regarding MRIs, I had one for the pelvis and lower lumbar spine years ago, in order to rule out other causes. My PM doctor prescribed it at my request alone, as he felt it would show nothing (he was right in my case). Notably, a MRI is not capable of imaging muscle spasm.

[CMT23]

Hi Burner. Interesting that we have such similar stories. Do your symptoms vary in intensity or are they always the same? I have times when it is not much more than annoying and other times when it is so intense that I wonder how I will get by. Only Valium and Xanax and very hot baths get me through those periods, which sometimes last for days.

I've had pretty much everything tested apart from penis and pelvis MRI. I wonder if that's worth doing and if so why no doctor has recommend it. I also never did the test to see how much you are voiding, but two cystos showed nothing unusual.

When I did the self PT, I pressed on the areas around the prostate. My symptoms went from a 4 to a 9 and stayed that way for days. No one around here does the internal work and now I am pretty weary of trying myself again - at least without proper instruction.

I can't recreate my symptoms by squeezing the penis. I can recreate by pressing around the prostate and if you press down hard on the pubic bone, that does it too.

Baclofen sounds interesting, but the withdrawal effects look a little worrying? Maybe I'll give it a try anyway. I tried Neurontin without success. I guess Lyrica is different though, so will put it on the list.

I've pretty much given up on a normal doctor giving me a proper diagnosis. It's up to me to figure it out on my own. I just hesitate to do my own PT and cause these flare ups when perhaps something else is going on since i don't have any if the aches and pains that other people refer to. I'll keep you updated!

[CMT23]

Jay, you're right in that the answer might not be so black and white. It's not like a broken bone that we're talking about.

I guess until I am over this, I will always be looking at possible causes. Muscle tension and anxiety seem to make the most sense in my case just by looking at how my symptoms behave. But sometimes it's really hard to connect a flare up to anything at all. Anyway, it must mean something that you can press on the areas around the prostate and instantly cause a 3 day flare. That's not normal. Those are the same muscles that are active during ejaculation (I think) when my symptoms started.

I'll keep you updated.

[BrettP]

Pretty much feel like you. It comes and goes with varying intensity. Sometimes goes away completely. Gets worse with constipation. I've been here for a while with lots of ups and downs. Every time I hunt this disease down I get nothing. The fact that hot baths and Valium help should tell you something. Those help me too. I swim and try to meditate for 20 min in the spa. All symptoms go away at that point. The hard part to me is accepting there is no solution to the chronic pain and not panicking when a flare gets really bad. I feel relief when I stretch my lower abs. Basically lean my back behind my chair and pull on the Lower abs. I can feel it recreate my symptoms and even feel a pull in the back of my anus!

Sometimes I wonder if it's stools. Lol I don't know WTF. But it helps, just feels like a chronically tensed muscle that needs to be stretched

[CMT23]

Brett, I have the same experiences sometimes especially when I am exhausted, lie down still and just kind of relax for a few minutes. Sometimes the symptoms go down to a 2 out of 10. Then I get up and walk around and the severity of the symptoms increases. Sitting on a plane for 3 or 4 hours I am in so much discomfort that sometimes I think there is no way that I don't have some mysterious STD (even though this started before I began having sex LOL).

But lying down is no guarantee of feeling better. When it flares up, it's very difficult to get any relief. Hot baths and valium still helps a bit though.

Pushing on all the muscles around the pubic bone seems to replicate symptoms as does pressing inside near the prostate. So I guess the more I write the more it seems like a muscle tension problem, but still confused as to why I don't have any of the other symptoms that people describe here.

Doctors, Chiros etc. who I have mentioned the muscle tension theory to have expressed skepticism based on the fact that (they say) if the pelvic floor muscles were dysfunctioning, I should experience pain and discomfort in other areas including lower back, legs, rectum etc. What a great day it will be when all the 'professionals' out there agree on a diagnosis and treatment plan!

I would really like to understand exactly what happens during ejaculation because that seems to offer the biggest clue in my case since this started during ejaculation. Which muscles in particular are involved with ejaculation? I've Googled it plenty, but still a little confused.

[Jay]

I can't say whether you do or don't have a pelvic floor issue, not being a doctor or PT. However, as a layman, I have my suspicions. You've already observed that you are helped by hot baths and Valium, both of which are muscle relaxants. A visit to a trained pelvic floor PT, even if it's your one and only, could lead to a diagnosis and some peace of mind. Nobody can promise anything, but I'd wager that the possibility is there.

The easiest way to explain is ... the entire pelvic floor is impacted by orgasm, which is akin to a giant spasm. Clench the whole thing up like that and you're bound to exacerbate symptoms. That's why it's often preached here that you need to relax the pelvis during ejaculation and sexual activity. For most guys, the instinctive thing is to tense up, which is not good in our case.

Having said that, along with the nervous system, the bulbospongiosus muscle is a major player in ejaculation. The ischiocavernosus is also involved less directly, by way of holding one's erection stable. There are others, but those are the ones I think of right away. I had real trigger point issues around the bulbo.

[Burner2k]

CMT23,
Before I started on Baclofen, the intensity was the same...for me the urge used to build up i.e. after I void perhaps for 1 hr - 1.25 hrs, there would be little to no urge. Then it used to build up to the point I had to pee. Usually the peak was around 2 hrs from the previous void. So far I have never got up in the night to pee.

But now, the urge intensity varies. Like I said, I am doing a lot better than what it was a year ago. Even I am perplexed by penile glans symptom recreation. Many people who have our symptoms lack this one though. That is why I want to go for a penile MRI and/or Ultrasound.

Recently, I had some tingling in my toes, some pins & needles etc. Went to a neurologist and did a nerve conduction study. Apparently I do have some mild neuropathy in my feet. I also briefed him about my urinary problems. He thinks these two might be related. I got some blood work done (WBC differential count etc) and values are with in normal range. He has put me on Lyrica & Antioxidant medication (to bring my B12 levels up...currently they are in low normal) for 8 weeks. If this thing doesn't resolve, we'll proceed with further investigation. I am sure I have inflammation as my ejaculate has yellowish tinge and there was pus in my Urine sample. However, culture of the urine was negative for any bacteria.

I have a PT who does internal work but he isn't professional or knowledgeable like the ones in US. Jay, bulbo is very interesting. Any ideas on how to relax bulbo on my own. I am going to ask my PT when he comes back from vacation about it but since its an area which is easily accessible by myself, I would like to know how to treat it myself.

I usually do well when I am driving...may be I have to focus a lot in India's traffic, my mind gets distracted. Recently, I had to take an overnight bus journey and it was horrible. I had some real bad urgency issues during the travel. Plus lack of toilet facilities on bus made it even worse. Two weeks ago, I took a train and I experienced normal symptoms.

[Jay]

Jay, bulbo is very interesting. Any ideas on how to relax bulbo on my own. I am going to ask my PT when he comes back from vacation about it but since its an area which is easily accessible by myself, I would like to know how to treat it myself.

Well, for me, it's actually one of the easiest muscles to take care of. It's treated from the exterior. My PT simply taught me to gently massage down the middle of the perineum, searching for any knots. You then simply work them out with a more focused massage (I use a circular motion). I'd emphasize gentleness.

[CMT23]

Does anyone else experience something similar to this: Lying down and relaxing and symptoms go down to a 2 out of 10. Stand up and they immediately increase to 4 or 5 like clockwork.

Could this mean that while standing, a nerve is being compressed, or while standing I can not relax the pelvic floor muscles like I can when I lie down?

I'm doing daily relaxation now, changed my lifestyle, taking all kinds of supplements as mentioned on this forum, stretching and doing external PT work. I am too weary of doing the internal work without instruction. So next stop is Santa Rosa.

It's only been 5 days LOL but for sure there are times during the relaxation where I feel pretty good - to the point where if I felt like that all the time, I wouldn't complain too much.

The tension theory makes sense to me, but until I am symptom free, I guess I have the kind of mind that will keep looking at other possibilities.

[webslave]

The Wise-Anderson type approaches do not result in instant cures. This syndrome involves muscles, nerves and a psychological disposition to express tension in the pelvis, so a degree of unlearning has to take place. If you are improving at all with this approach, you know you are on the right track.

Standing up involves a degree of tension in the pelvic muscles and increased activity in the pelvic nerves, versus lying down. When I was at my worst, I could hardly walk from the pain.

[Todd]

Well, for me, it's actually one of the easiest muscles to take care of. It's treated from the exterior. My PT simply taught me to gently massage down the middle of the perineum, searching for any knots. You then simply work them out with a more focused massage (I use a circular motion). I'd emphasize gentleness.

I had a feeling this area was the cause of ejaculation pain issues. When I felt this area I could feel what seemed like a little ball (more like pin head) on the muscle. That must be a knot. I'll have to try massaging it out. Any idea what muscle causes the constant burning sensation that gets worse after ejaculation or urination?

[alprost]

I am just about convinced that this is a muscular issue, but my case seems quite different to most everyone on here. I have no pain anywhere. I have discomfort that varies from annoying to extreme. It's felt in the penis. The discomfort feels like it's telling my brain to urinate even when my bladder is empty.

And you can press on areas adjacent to the prostate and within the pelvic floor at 3 and 9 o'clock and exactly replicate my symptoms.

You also need to check out your Rectus Abdominus (i.e. 6 pack), especially from the parts of the muscle between your navel and your pubic area - trigger points in this muscle can also cause these symptoms, and often co-exist with pelvic floor trigger points.

[CMT23]

Thanks. I don't seem to have any trigger points in the Rectus Abdominus. Pressing in this area does duplicate my symptoms in that it makes me want to urinate, but that's where the bladder and other nerves are and so everyone would experience this, right?

I have been working my psoas for awhile. Started a month ago and felt like a knife when pressing. From reading the trigger point manual, I was really excited that this could be my problem and by lengthening these muscles I might become symptom free.

After a month of massaging, it doesn't feel bad at all to press on the psoas, but I can feel what I imagine look like small marbles/knots along the left side lower down. Pressing here doesn't refer pain though. Could these knots still be causing problems?

The biggest clue to me is that if I am feeling decent (say 4 out of 10), many times I can take a hot shower or bath, lie down, do the relaxation and feel my symptoms go down to about a 1. That's a really amazing feeling. But the moment that I stand up, the sensation of discomfort jumps back up to a 4 or so. (However, when it is flaring up, lying down and relaxing brings very little relief).

It has been like this for over a decade. Many times I avoid going out because I know that if I can take hot showers/baths and lie down that I can keep the symptoms within the discomfort range and out of the level of a sensation so intense I think I must have some mysterious STD (even though this all started before I began having sex and even though no sexual partner of mine has ever had any symptoms).

Anyway, I know most people here will say that when lying down, the pelvic floor muscles will be able to relax, thus my relief. That makes sense to me and that's the theory I am pursuing pretty diligently right now. Just waiting to go to Santa Rosa and get the wand so that I can start that. I have had enough of fiddling around with a prostate massager, not really knowing exactly what I should be doing (and causing some pretty major flare ups).

I still wonder if a nerve is being compressed when sitting and standing. If this was the case, would you expect that I would ALWAYS get immediate and instant relief simply by lying down and lessening the compression?