As physical therapists, we often refer to our patients’ last day with us as Graduation Day. I always enjoy Graduation Day because it means the patient has accomplished their goals; their symptoms have reduced, they are able to function without limitations, and they are leaving as happier, healthier individuals. To put it plainly, they don’t need me anymore. It is always particularly gratifying when a patient recognizes their own success, as was in Joseph’s case (name changed for anonymity). Joseph generously offered that I could share his story and has offered his own insight of his experience to add to my clinical findings.
Joseph began his journey at PHRC after an onset of pelvic pain that began approximately one month prior after a particularly intense workout pushing his already fatigued body to sprint on a treadmill at an incline. He reported that over the past few years, he became “obsessed” with getting a six pack and would often do 1000 repititions of various abdominal exercises, mostly sit ups, multiple times a week. Despite feeling very fit, Joseph reported it wasn’t enough and pushed himself past the limits of what his body could handle, until that fateful day sprinting on the treadmill when he felt a “sudden painful cramp/pulling sensation in [his] lower abs and pelvic floor area.” In addition to pain in his pelvic and lower abdomen, Joseph also started to experience urinary and bowel symptoms, and had difficulty getting and maintaining erections.
Joseph went to his primary care doctor for help. He explained his symptoms of pain in his penis, scrotum and perineum. His need to urinate frequently and the urgency to get to the bathroom, followed by a hesitation with his ability to start his stream. Pain with bowel movement and difficulty evacuating. He reported difficulty and pain with erections. His doctor did a lab work up to look for signs of infection and performed a digital rectal exam, all the tests were negative for pathology. Despite negative tests, Joseph was put on antibiotics and diagnosed with prostatitis. After one month on Doxycycline there was no change in symptoms, Joseph was worried these symptoms would never go away and turned to the internet for answers. He found that many men who were experiencing the same symptoms had Pelvic Floor Dysfunction. He brought this information to his doctor, explaining that his symptoms had not improved on the antibiotics and asked about pelvic floor dysfunction. His doctor was dismissive of his claims, stating that he’d never heard of pelvic floor dysfunction in men. Joseph felt defeated, like he wasn’t being listened to and didn’t know where else to turn. Fortunately, he advocated for himself and was able to obtain a referral for physical therapy.
Joseph reported to PHRC in Berkeley for an evaluation, and recalls this of his visit:
“My first appointment with my PT at PHRC, Lis, included an initial exam of both external and internal pelvic floor and surrounding muscles, as well as just explaining my symptoms. What a HUGE difference in being listened to, understood, and reassured compared to talking to my doctor about it. Just feeling like my concerns were being taken seriously and not as if I was making this all up helped immensely, like a giant weight being lifted off my shoulders.”
After completing his PT evaluation, Joseph was able to leave with a new understanding of why he was experiencing his pain and symptoms. His assessment revealed elevated pelvic floor muscle tension, poor ability to control those pelvic floor muscles through contraction and relaxation, trigger points in muscles external to the pelvis, and connective tissue dysfunction in the fascia over his abdomen, thighs, and around bony pelvis landmarks. That first day we discussed our plan of care for physical therapy treatments including internal and external manual therapy to reduce the tension in his muscles, connective tissue manipulation to reduce the restrictions in the fascia, and motor control exercises to improve his ability to relax those tight muscles. We discussed strategies he could implement immediately to reduce his symptoms. He left with tips on toileting posture for improved bowel movements, strategies for calming those bothersome urinary symptoms, soft tissue techniques for addressing those tight external muscles, and how to use breathing as a tool to reduce the tightness in his pelvic floor muscles and bring down his pain. Joseph would also benefit from guidance on how to navigate our confusing health care system, including coordinating with his urologist and advocating for mental health care to address the emotional component that often accompanies people experiencing pelvic floor dysfunction.
Some of Joseph’s goals were to include: improving his urinary frequency and reducing urgency and hesitation; reduced pain and no straining with bowel movements; no pelvic pain with activities of daily living; ability to sit and run without limitations; no pain or discomfort during sexual activities. Joseph’s care at PHRC started the minute he sat down for an evaluation, and that first and and the subsequent visits started him on a pathway to reduce his musculoskeletal impairments and begin working towards his goals. He was diligent about making positive changes he needed to improve his health. He practiced foam rolling to reduce his muscle tone, he made behavioral changes that affected his urinary and bowel symptoms, he got into counseling to help manage the stress in his life which had been negatively affecting his symptoms, and he performed diaphragmatic breathing and pelvic drops regularly throughout the day. These changes combined with the manual therapy techniques at his PT appointments began to really make a difference in reducing his symptoms and he was feeling better and being more active as his sessions progressed.
“I would have sessions every week for manual therapy and eventually every other week for about six months. In that six months, I could gradually feel symptoms becoming less and less. Each sign of progress felt like a life milestone: “WHOA I sat for more than an hour straight and nothing hurt!” Or “WHOA I finally masturbated for the first time since this happened and everything worked like normal and it felt great!” Or “YESSS I actually went running again for the first time and I sweated my ass off and the only thing that I burned were the calories!”
As Joseph’s symptoms reduced and he was able to be more active, he gained confidence in his ability to take control of his life. Instead of coming into our sessions in pain and feeling anxious that his symptoms would never go away, he began to enter feeling grounded, knowing this is a place where healing occurs. Through consistency with physical therapy, compliance with his own home program, and healthy behavioral changes Joseph was able to meet his goals over time. One year after his symptoms first began, Joseph reflects:
“The difference this year is how much I learned from this experience. I’ve calmed down the unhealthy work-out habits, but definitely still exercise and always will. I still run three times a week except I go for miles now, slow and steady instead of intense sprinting for a shorter rushed time. Sexual activity, libido, and functioning is now back to normal THANKFULLY. And I’ve even taken Cognitive Behavioral Therapy classes to learn how to halt the anxious and catastrophic thinking that pelvic floor dysfunction can cause and only make worse. This experience, as terrifying as it was, taught me to love and respect myself and my body more, where rest and recovery is just as, if not more, important as exercising. Symptoms these days are rare, incredibly minor, and highly manageable all due to continuing the stretches, diaphragm breathing techniques, and everything else that Lis had taught me to this day.”
As a physical therapist, my goal is always to get people independent with their own care. We aim to reduce their dysfunction, teach them strategies on how to care for themselves, and give them all the tools they need to lead happy, healthy lives without needing us anymore. Joseph was ready to graduate from physical therapy, and could do so feeling confident that his symptoms were reduced and he had all the tools necessary to keep them away, including a physical therapist who is always happy to be a resource and help him with his care along the way.
A closing note from Joseph:
“To any guys out there reading this, I just want to say I definitely get it. It’s horrible to live in pain or even slight discomfort in the part of our bodies that’s so hard to openly discuss and I know our penises feel like everything to us because we are ridiculous like that. I get you. Try your best not to freak out and know that you can get better. Do your own research on the Internet, but only to find out what steps to take to get help (if you’re reading this blog, you’re already in the right direction). Try to relax, stay focused, and do everything your PT tells you to and before you know it, you’ll also be anonymously writing about your bowel movements and masturbating habits for a success blog too haha!”
-a forever thankful former patient
Additional Resources on Recovering from Male Pelvic Pain:
Our book: Pelvic Pain Explained
Our Male Pelvic Pain Resource Blog that contains podcasts, our YouTube video, and support group links.
Other Success Stories from our male patients:
Why does the area between my butt and balls hurt?
FAQ
What are pelvic floor muscles?
The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.
What is pelvic floor physical therapy?
Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.
What is pudendal neuralgia and how is it treated?
Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.
Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.
What is interstitial cystitis and how is it treated?
Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.
Who is the Pelvic Health and Rehabilitation Team?
The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.
How many years of experience do we have?
Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.
Why PHRC versus anyone else?
PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.
Do we treat men for pelvic floor therapy?
The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.
Do I need pelvic floor therapy forever?
The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.
Comments
Ive had CPPS for 21 years. But back in 1998 when it first flared up, (constant feeling of needing to urinate, soreness in urethra and premature ejaculation), doctors didnt know what it was so i was left to live with it for two decades. Its been tough but I learned to cope. However this year, due to a stressful breakup of a 12 year relationship and loss of home, my symptoms flared up very badly which forced me to try and get my symptoms looked at again. I have now been diagnosed with CPPS and am in the process of being referred to a specialist pelvic P.T – i hope i will have good results as Joseph has, because after 21 years it will be nothing short of life-changing.