Been a long time since I posted because i plateaued and didn't have the time or wherewithal push forward but quick summary--I've been using the Wise protocol for about a decade now, everything short of visiting the clinic: relaxation, trigger point PT and self-administered internal release with wand. Despite all best efforts my trigger points (obturator internus, PC muscle) quickly return after being released, brought upon by spasms post-ejaculation.
Recently, I've gotten an MRI of right hip (80% of the pain is on that side) and it shows several signs of Hip Impingement:
small lesion on the anterior part of the cam (head)
severe attenuation of labrum with absorption (signs of chronic labral tears)
a full thickness articular cartilage defect (i.e. worn away cartilage on the contact surfaces of the ball of the hip joint)
My PT and physiatrist (both trained in CPPS) believe my chronic pelvic pain is being perpetuated by the hip impingement. So I'm going to consult with a hip impingement specialist about my treatment options there.
My current plan is to combine trigger point PT and trigger point injections (lidocaine, steroid...maybe Botox) with treatment of my hip whether it be PT or arthroscopic surgery to correct the issues. The idea being to treat to fix the underlying causative problem (hip impingement) and also reset the pelvic floor muscles.
I was wondering if anyone else has gone down this route or what their thoughts are.
The connection between the two seems to be a fairly recent development. (EDIT: I searched the forum for FAI and Hip impingement and came up with basically nothing, I'm surprised it hasn't been discussed?)
I found two recent studies co-authored by my former PT (Stacey Futterman) that link FAI (hip impingement) to chronic pelvic pain and cite some good stats on resolving CPPS by treating the hip in co-ordination with the pelvic floor:
I'll update people on my progress but curious to hear thoughts.
Age:22 | Onset Age:16.5 | Symptoms: Pain with extended sitting, Pain shortly folllowing urination, mostly above pubic bone, Pain after defecation mostly around external sphincter, Pain after ejaculation mostly in Urethra | Helped By: Progressive and Moment to Moment Relaxation, Stretching, Bed Rest (laying down and relaxing muscles), Hot Baths, Hot Showers, | Worsened By: Alcohol (variably), Ejaculation, Urination, Defecation, Stress, Extended Sitting, Sleeping in the wrong position, tensing my muscles while writing or doing anything else stressful/intense, Progress: 65%, basically only dealing with post-ejaculatory pain, onset after about an hour, peaks for 3-6 hours and then remains sore for a day.
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This is very interesting. I also have that C-sign pain, and my pain almost always coincide with tension in the hip area that I try to massage.
Like you, my main trigger is sex. There are some physical exercises that are guaranteed to give me a set back:
The dumbell lunge
Gym stairclimber.
Yes I have given up on many gym activities but whenever I attempt these or the machine leg extension I am guaranteed not to feel good after. These exercises are strenuous on the hips.
So I think you are up to something. Would be great if you can share the name of the physiatrist as really few would know about CPPS and that specific angle.
It sounds like surgery is pretty intrusive... But I would like to do the MRI nevertheless.
Age: 33| Onset Age: 24 | Symptoms: dull ache in pelvic area, tension, feeling the need to urinate, frequency, dribbling after urination, ED symptoms started 6 moths after the onset wrecking my life since, abdominal tension, tension in my thighs. | Helped By: stretching/massage , benzos | Worsened By: Mainly sex, but also sitting and anxiety| Other comments: I have seen periods of substantially less flare-ups, but now I am at a steady state where it comes back almost always after sex.
