Health Organization for Pudendal Education

In this post I will likely explain why you are suffering and how to reverse the suffering and go back to a normal, pain-free life.

So, a year and four months of daily stretching and trigger point release therapy I am feeling better than I have in 7 years. Yes, alot of my time has been devoted to this remedy but whats a couple years compared to a lifetime of pain and suffering, nothing. Now when this pain became chronic, my symptoms included:

-Extreme burning at tip of penis and mild pain throughout
-Hypersensitivity (jeans, briefs, anything to tight or heavy in my pelvic region)
-Constant feeling of object in urethra
-Heavy feeling in perenium
-Pain after ejaculation
-Pain when urinating
-Constant feeling of urgency to urinate
-Hesitation when urinating (weak flow)
-Pain after a bowel movement
-Tight and constantly flexed pelvic floor
-Irritation after consuming carbonated, sugar filled drinks (alcohol, soda, ect.)
-Irritation from spicy foods
-Irritation from smoking (tobacco, marijuana, ect.)

And these are only the physical symptoms, the psychological effects included:

-Depression
-Loneliness
-Isolation from others
-Chronic Fatigue

So now that you know some of my symptoms, and I'm sure a lot of you are quite familiar with them, I will tell you the manner in which I went to abolish them.

In December 2011 I learned of a protocol, as I'm sure most of you are familiar with and I won't name simply because it seems to be taboo around here. This protocol literally explained why I was suffering and not only that but my personality and traits. People suffering from this condition tend to be responsible individuals, outgoing and caring, but also tend to be anxious, nervous, even a tad paranoid, and also tend to think catastrophically. Now I'm not saying we are all like this but you know who you are. Anyway these, what I refer to as, negative traits are directly linked to why we are suffering from this condition. A guarding mechanism, usually triggered by an injury or even psychological trauma, in the pelvic floor, known as pelvic floor dysfunction is likely the overall cause of these horrible symptoms, I'll explain. For example, say you take your hand and make a fist, and you hold this fist for lets say 2 hours. Now when you release your fist, your hand will likely be sore and tense. Alright now take this example and move it to your pelvic floor muscles and turn two hour to every waking moment, this explains the lack of pain in the morning that progresses throughout the day as when you sleep, your muscles throughout your body are usually in a relaxed state. So the pain progresses throughout the day because when you wake you go back to tensing your pelvic muscles. Now, why is it that I have these symptoms may be your question. Well when your muscles are constantly tightened overtime they become hard and stiff and layered in these muscles are nerves. These nerves are under so much pressure that they become hypersensitive, explaining the burning feeling we know all too well as well as the sensitivity to clothes, also included in these hypersensitive nerves is the pudendal nerve. Now that explains the hypersensitivity and burning pain, what about the urgency and hesitation. Well that is simply explained with the fact that these flexed muscles surround your bladder, so when pressure is constantly being applied to your bladder, you'll likely have to use the restroom often. Okay, what about pain in the rectum, well a muscle, know as the levator ani, which is also part of the pelvic floor muscles, surrounds the rectum on the inside, kinda like a funnel and the end is the rectum. Now the anal sphincter is connected to this levator ani, and when tensed constantly, the sphincter too becomes tight. This explains a possible relief in symptoms when preparing for a bowel movement as when doing do the muscles are being stretched relieving the nerves in this region for a moment. That is the heavy feeling in the perineum.

Ok so I've explained most of your symptoms, I'm sure logic can connect the rest of the dots. Being nervous and anxious causes stress to the body and is the leading cause of muscle tension, so you can put 2 and 2 together and whala, the cycle of pain.

Fear of pain > Anxiety/Stress > Muscle Tension > Pain > Fear of More Pain > Anxiety/Stress > Muscle Tension > Pain... and so on

Now, how to reverse these symptoms, and this is no easy task.

IMO, the most important step is to learn to relax the pelvic floor, because this is what has likely caused your symptoms from the gate and will only reverse any attempt you make at correcting the muscles from their tense and tight state. Personally I started by learning moment to moment relaxation. So basically removing the habit of tensing the pelvic floor and creating a new habit of relaxing it. Use a interval reminder to remind every 10 min or so throughout the day to relax the pelvic floor.

Trigger Point Therapy
I went and saw a pelvic floor therapist, who taught me about trigger point release therapy. Trigger points are spots in the muscles that are hard and usually lumpy with a washboard like texture. They also are sore and when working them can hurt. These need to literally be "smoothed out", this can be achieved by using a tennis ball, foam roller, even a rolling pin.
This image explains the process

There are also internal trigger point along the levator ani, see a physical therapist with experience to learn how to get to these.

Stretching, usually 3 times a day for at least 30 min
These are some basic stretches you must do:
http://www.youtube.com/watch?v=XjwTE2on6oE
http://www.youtube.com/watch?v=2CA23eYwxmk
http://www.youtube.com/watch?v=wHrWmeQV1qA
http://www.youtube.com/watch?v=txIgVw3gwsw
http://www.youtube.com/watch?v=WWJAlAM_ ... e=youtu.be
http://www.youtube.com/watch?v=AXutOxFXwck
http://www.youtube.com/watch?v=DO4CwvVkkrM
http://www.youtube.com/watch?v=st19BLyIC_M

Devotion to recovery, you must stick to it. It's likely you've been damaging these muscles for a while now, even before the chronic pain started. This is a two steps forward one step backwards treatment, do not expect immediate results, doing so will only add to the cycle of pain, anxiety. Also, learn to relax, drop those negative traits, they will only bring misery, physically and psychologically.

Any questions, feel free to ask.

Good Luck

Bobby,
There is no taboo. You mean the Stanford Protocol or Wise-Anderson Protocol.
I did the class. 2 years of PT (including many sessions with Sawyer). 2 years of paradoxical relaxation. Still 100% pain.
I then did biofeedback and the PT could not find any pelvic floor tension. The protocol did help me release the pelvic floor but it did nothing for the pain.
Please explain why I was not pain free at that point?

Hi,
You started out by saying you would explain why we are suffering.
Maybe this was why YOU were suffering (unless you have assumed a fictitious identity to make a sales pitch).
The folks on here have a wide range of pathology. Mine was in my spinal cord, so I could have stretched for a lot of years while continuing to deteriorate.
If you are an actual patient and not a salesperson, feel free to share your experiences. You might have something in common with a person or two who used this board.
But please do not tell us why WE are suffering. tell us why YOU suffered. That is basic respect.

First of HerMajesty, show me one spot in my message where I endorsed anything? Sales pitch? Wanna talk about sales pitch lets discuss these bs surgeries that more often than not fail and cause the patient even more pain. Also you'll notice I use the word likely, I'm not making an assumptions, this is what has helped me and many many others and honestly the only treatment I've seen be successful. The only reason I posted this was as a starting point, something that should be tried before panning out thousands upon thousands of dollars on surgery. There's no need to bash me majesty. This is an affordable treatment. Some folks are to trusting on doctors, well I got sick of spending 5 years while these MDs prescribed me expensive prescription after expensive prescription...
Anyway call it what you want but I've pitched nothing, endorsed nothing, my goal is to simply get people's life on track.

I agree conservative measures should always be tried first, and that the medical profession is not the be-all and end-all of treatment for any chronic condition. Conservative treatment to me is PT which is covered by insurance, and similar affordable, noninvasive or minimally invasive treatment modalities. The problem I have with the post is that what you refer to as "taboo" is obviously Wise-Anderson, and my sympathies are with the people I have met on this board who have been exploited, financially and emotionally, by that particular approach. I believe I recall the Wise-Anderson protocol is not covered by insurance and costs a few thousand dollars. So as to your argument about expense, for those who are insured surgery is actually the less expensive option.

Hi Bobby,
Thanks for sharing your success for less pain with us. I'm sincerely glad this therapy has been a tremendous benefit to you.
I would like to clarify your misconception on one of the statements you made:

Bobby wrote:The only reason I posted this was as a starting point, something that should be tried before panning out thousands upon thousands of dollars on surgery.

If you take the time to read the posts on this board, you'll notice that no one - not even the doctors who perform these surgeries, consider surgery as a first option.
The majority of us have tried several different conservative therapies for years, including PFPT, relaxation, meds, massage, CBT, chiropractor, acupuncture, manual trigger point release, trigger point injections, nerve blocks, RFP, RFA, etc ... I can't speak for anyone else, but I find it somewhat insulting to have spent a significant amount of time and money on these conservative treatments, only to not have them acknowledged.
As Ezer pointed out, there are several community members who have tried this particular therapy with no benefit. Obviously, this works for some people, or else the technique wouldn't be offered as a viable solution. However, as HM has stated, everyone is different and what may work for one person, doesn't mean it will work for everyone.

Bobby wrote:First of HerMajesty, show me one spot in my message where I endorsed anything? Sales pitch?

Well, with all due respect, Bobby, it's kind of hard not to see some type of agenda in your post:

Bobby wrote:In this post I will likely explain why you are suffering and how to reverse the suffering and go back to a normal, pain-free life.

Again, a bit presumptuous given the wide variety of pathologies here. Furthermore, your signature consists of a "view topic link" and Read this post, it will likely explain everything.
I'm happy for you that you found your explanation to everything and hopefully the information you provided will help someone else with symptoms similar to yours.
Best,
Karyn

Hi Bobby,
Really glad that you have found such excellent results with this protocol. I have heard a lot about it but have never read the book you mentioned, although again it has been 'talked about' numerous times here.
Very much in agreement about your comments on surgery, Everyone should try every available conservative treatments before any decompression surgery, it's just that as said above, many of us have been there and done that to absolutely no avail. As for myself I have tried it time and time again, although admittedly a couple of the physiotherapists weren't fantastic.
I read another of your posts where you say it must take some serious trauma to have pudendal entrapment, unfortunately this is an idea also broadly held by the medical community but there is proof that seemingly inconsequential incidents can lead to pelvic nerve entrapment. Maybe it doesn't happen that often, percentage wise. . . . but it happens.
There is absolutely nothing wrong with my pelvic floor for instance. I don't catastrophise, hold any stress there etc, etc although of course I do appreciate that some people can be prone to this sort of problem and may go on to develop pelvic nerve irritation and subsequent pain. (I would tend to need my upper spine muscles relaxed due to any stress) However, I do have pelvic nerve entrapment's including the pudendal nerve. My pudendal nerve symptoms manifest as a totally numb 'saddle' area, pain (burning, electric type shocks) along the course of that nerve, a dense ache in this area; thankfully not all of those ALL of the time, although the cutaneous saddle numbness is constant. I can easily locate much of my pudendal nerve including branches, as pressing certain areas will send the zinging pain directly along it's path. This only happens on one side btw. This was all due to a simple, stupid fall on my bum which caused a haematoma in my piriformis muscle (or 'lump in my bum' as I called it back then, when I didn't have a clue either) and then scar tissue. My nerves seem to be stuck in this scar tissue. I have had nerve conduction studies done which shows 'entrapment' as the results were so bad. There is nothing showing on a spinal MRI to explain why my nerves aren't performing properly, so my entrapment can only be lower down in my pelvis and all I did was fall on my behind! It's a sickener, I can tell you.
Thanks for all of the posts and you tube links I think they will do some people a great deal of good. Unfortunately all trigger point therapy and myofascial 'release' have done for me is give me a medical name for the bits that hurt.
Thanks for sharing your success and enthusiasm for stretching and trigger point release therapy but I hope you can see why others can not identify with this protocol as helpful to them but glad it has been a lifesaver for you.
Take care,
helen

Hi Bobby,


I can identify with many of the points you have raised as a long term sufferer of this condition.

Certainly hard tight muscles do causeba lot of pain and press on the nerve. However as somebody who has spent thousands of pounds on physio of the type which you were referring to with vefy li ited improvement, is it not the case that mus les will react to try and prote t a damaged nerve, bu contraction. I expect most people suffering would much rather be improved by physio rathef than surgery but for many this simply does not happen.


I pursevered with physio for twoyears religiously doing my excercises and eventually opted for surgery, it was not something Iundrtook lightly. I do however see and understand what you are saying and you are right, if it is just pelvic muscle dysfunction with no other pathology.

Regards Molly

Hi Bobby,

So great to hear that you have largely recovered. Success stories always welcome.

Question: did stretching ever make you regress? I have found stretching helps quite a bit. But I also have overdone stretching and aggravated my PN. I usually take several days or a week off and then begin again. What is your experience in this regard?

Question: did you have trouble sitting? Especially that golf ball feeling in your rectal area? That is a symptom that perhaps all PN'ers have

Question: Was there an event or trauma that started your PN?

Sincerely,

kone

I have some very similar symptoms like Bobby. having done PT with internal work since December 2012, I recently had some improvment for let s say 2 months. Now I have some flare-up again. Couple of times I had some mini flare-up day after PT, the improvmenet came always on 3rd or 4th day after PT. Then 1 week ok, then deterioration again...But within this cycle, I had this year some 8 weeks of really good time, with only minor pain/ache and was functionning pretty normal. Dont have any problems with rectum, most of my problems id burning pain at the base of penis and in the proximal part of shaft.