Health Organization for Pudendal Education

Alright I'll be more descriptive. So I'd guess your symptoms are like, hesitation when urinating, urgency (kinda always feeling like you have to go pee), burning at tip of penis after ejaculation, maybe pain after drinking coffee, soda, alcohol, not sure if you smoke or not but pain after that as well, golf ball feeling in perineum, hypersensitivity in groin area (making wearing jeans or briefs quite irritating), feeling as though there is an object in your urethra, and there are some more that I cant quite think of at the moment. Anyway basically here is what I believe is wrong, what was wrong with me anyway and, although few in this forum like to admit it, is likely wrong with them as well.

So the muscles you use when urinating to stop the flow, the pelvic floor muscles, the same muscle you use when ejaculation occurs (it spasms and to push semen out of urethra) is likely dysfunctional. When I say dysfunctional I mean chronically flexed (tensed). A way you can test this out is by simply flexing the muscle, as if you were stopping urine from flowing or trying to get those last drops out. Anyway if this muscle is chronically flexed and tight it begins to become unnoticeable, as if it's supposed to be that way, and it's not. So all the nerves and muscles in the pelvic floor (including pudendal nerve[not entrapped but simply "overworked"]) now have an inhospitable environment to live in and they become overworked, tired, hypersensitive and so on. The redness at the tip of your penis are likely irritated nerves, I too have them, also you may notice pale lighter spots.

Alright now fixing this dysfunction is the tricky part, however it can be done, you have to want it and devote yourself to it. You must constantly remember to keep your pelvic floor muscles relaxed. Now that you know the muscle is tight, you should be able to relax it just as you would your hand after making a fist. Doing this will begin your treatment by hopefully reversing the habit of flexing them to relaxing them. Now, that's not all, you must also stretch all throughout the day. You hamstrings, your abdomen, glutes, pretty much everything closely connected to the pelvic muscles. Now I don't know where your located but I'd recommend seeing a therapist who specializes in pelvic floor therapy. Also you must keep in mind this does not treat you over night, this is something you will have to work at. By browsing this forum you will quickly learn there is no quick easy cure for this, no surgery, no injections, just retraining muscles. Think of it like a torn acl, you must take time to treat it so it returns back to normal. Also, stop masturbating for a while, or at least not as often, those muscles spasming is counter-productive. Also I'd recommend not doing any core workouts until you have that muscle relaxed. Great book to get is A Headache in the Pelvis, you dont have to get it but I did and thats where I've gotten all this info from. If you have any questions feel free to PM me.

Oh pretty important is external and internal trigger point therapy. A pelvic floor therapist will know what that is.
(Internal are trigger points on your levator ani, which is only accessible through the anus btw)

Thanks flyer and bobby,

My theory is that due to the injury I irritated the nerve which overtime lead to clinching the pelvic floor muscle and its dysfunction (i am a butt clincher according the my physio). So now the pelvic muscles are in spasm and not letting the nerve heal. This is something along the line what you guys have said if i am not wrong. Before the injury i have never had any pelvic issues. Physiotherapy has not helped me much, i had mostly external, because when ever she tried internal the tip of my penis would get more irritated. I benefited from the chiro immensely but after my car trip (4hr sitting) his treatment stopped working too. He only uses gentle pressure on the spine to correct the alignment, not cracking, twisting etc. I have noticed that with this treatment now i get more burning and the symptoms also transfer to the right side. Also i get bruising pain in my thigh, could it be that the sciatica nerve is very close and the chiro is also hitting that?

Flyer you have rightly pointed out that i have irritated nerve, as well as bruised/busted blood vessels since there is a lump close the site where the nerve is irritated.
Btw, I do not have any numbness.

I emailed my story to Dr. Aszmann, and he replied back that i prob have irritated the nerve during the activity. He has asked for MRIs. I'll keep you guys posted.

Any suggestions regarding relaxation techniques.

Do yourself a favor, before you start spending all kinds of money on expensive MRIs and injections try just constantly relaxing your glutes an pelvic floor for at least a month, if you really stick to it you will see improvement within that time. Your exactly right btw, you likely substained an injury and through that formed the tensing dysfunction and being a "butt clincher" only adds to it. Unless you learn to relax those muscles you will not see improvement through any method. Trust me man, save yourself the money and hassle with the tremendously unsuccessful instant "cures". At least try it for a month or two and you really have to stick to it. Try Yoga Nidra for full body relaxing.

I dealt with these pains for 6 years until I figured out what was wrong, lost my fiancé and my job due the chronic pain. Good thing I'm only 23 and I can correct this before it distrupts my life any further. I'll PM you diagrams on stretches you should do tomorrow. For now work on relaxing.

Think you guys are doing the right thing checking for pelvic muscle tension but do bear this topic in mind (hernia) if you see no good results from any myofascial release.
http://www.pudendalhope.info/forum/view ... 5&start=10
Take care

anon123, Bobby is probably right that your symptoms fit into the rather broad cathegory Pelvic Floor dysfunction than classic PNE.
however, I think MRI is a good step, because it will exclude another possible conditions, which might mimic Pelvic Floor Dysfunction.
If possible, try to get a 3Tesla MRI, which is able to distinguish better possible lession.
Another good tool is high resolution ultrasound (at least 17Mhz) which is able to visualize even the pudendal nerve itself.
Visit to neurologist who is aware of PNE symptoms might be also very important.
However, I agree that PT is the most essential part of your recovery right now, especially if you had such huge benefit in the past.
A lot of good reading is on the hardflaccid.com webpage. and maybe try low dose Amytriptylin (25mg), it migth help whatover you have PN or CPPS.
Keeping the fingers crossed, I am struggling with similar symptoms (more pain than urinary issues) 3 years....
The only thing I regret is that I did not start PT immediately after my problems had appeared...

I already had two MRIs one for lumbar spine and one for pelvic, both came clear. I have emailed them to Dr. Aszmann, since he said that most radiologist don't know how to read them.

Once again, I benefited from Chiro a lot but now it doesn't seem to help. I tried physio for about 2.5 months with very limited improvement. The thing is whenever she tried internal manipulation i would get more pain and burning on the tip of my penis. I'll prob try it once again... so lets see...

I think it is a good step. it is imporatant to have a plan. I am planning to try that PSSD test at dr. Aszmann. Maybe my only luck in this difficult situation is that I am living only one hour driving from his ambulance. Many times I was searching for some positive hope, that at least after his operation and leaving the hospital I will be home in less than one hour....

My pelvis MRI seemed also unremarkable (according to my radiologist) but then dr.Aszmann and dr. Bodner investigated it and found some fibrotic thickening (scar) in right dorsal canal. They showed it to me and even I was able to see it (different when compared to left side). Ordinary radiologist dont know where to seek.
Anyway, still trying to improve my condition by PT, I would like to avoid operation, although am not completely exlcuding it.

anon123 wrote:Once again, I benefited from Chiro a lot but now it doesn't seem to help. I tried physio for about 2.5 months with very limited improvement. The thing is whenever she tried internal manipulation i would get more pain and burning on the tip of my penis. I'll prob try it once again... so lets see...

The reason you didn't get full benefit is because you continued to clinch and flex your pelvic floor and glutes That is the cause of this condition, and as long as you continue to do it, any treatment will just be undone. Trust me, I have no reason to lie to you and I've been dealing with this condition for 6 years. I've felt better in the last year and 4 months then I have in over 7 years. You have to take the time to treat this, there is no instant cure, you'll see that by reading these forums. The reason you don't see alot of successes from physical therapy here is because people give up on it to early and also they assume the pelvic floor dysfunction is a symptom and not the cause so they think it should just go away with treatment, that is wrong, it is the cause and the only way to treat it is too form a new habit of relaxing the pelvic floor rather then tensing it. I really cannot be any clearer. In all my years I don't think I've seen any complete success from surgery and sometimes (more often than not) making it worse. You didn't even say that you had pelvic floor dysfunction and I brought it up that you did and wouldn't you know it, I was right. Anyway, STOP TENSING THE PELVIC FLOOR! ALL OF YOU! I'm not even pitching expensive or exotic treatments, not advertising any books or information databases, I'm telling you how to reverse this condition. I have tried to help so many people and the sheer ignorance of some is maddening.

Bobby things are never that easy and one-sided. There are people who had real entrapment in Alcock or dorsal canal and were helped by operation.
But I agree that most of the people dont have a true entrapment, but rather more general pelvic myoneuropathy, which is treatable best with some multimodal mix of PT, some anticonvulstants, antidepressants, behavioral changes, relaxation, cognitive behavioral therapy etc. agree that PT should play a major role in this process.
I read some of your earlier entries and admire you how you had figthed with this cruel life altering condition.
We all are learning every day. Even from setbacks and failures.