By Molly Bachmann PT, DPT, PHRC San Francisco
“Penile numbness, perineum pain, post void dribble . . . oh my!”
*All names and other identifying information has been changed.
Symptom Presentation:
Frank began to have pain in his perineum seemingly out of the blue. The only connection he could make was an instance of loose stool that triggered the need to urinate every 45 minutes. As these symptoms developed over the course of several weeks, Frank developed tingling in his urethra and at the tip of his penis, and pain in his perineum that was an eight out of ten at its worst which prompted a visit to his urologist. The urologist tested his psa levels, which were normal, and prescribed an antibiotic. Halfway through the course of antibiotics, Frank developed pain in his rectum and upper gluteal muscles.
When Frank came into Pelvic Health and Rehabilitation Center, he had just finished his course of antibiotics and continued to experience tingling at the tip of his penis (specifically worsened just after urination), was urinating every hour, post void dribble, was unable to sit more than five to ten minutes without perineum pain, decreased libido, increased reports of tension with orgasm . . . and to make matters worse, Frank was losing weight intermittently without trying, causing much distress.
All of these changes were challenging for Frank to navigate as he had been a cyclist riding at a high intensity multiple times a week and considered himself to be a healthy guy. It was starting to impact his ability to work and even commute to work which really worried him.
Assessment:
When I evaluated Frank, we wanted to first rule out anything that we would consider to be a red flag. For Frank, this meant further investigating his unexplained weight loss. After multiple doctor’s appointments, red flag testing was cleared and they determined there was nothing to fear and that it was likely due to loss of appetite when symptoms flared.
Frank’s exam included assessing hip range of motion and hip muscle flexibility, connective tissue restrictions, trigger points, nerve mobility, as well as assessing the deepest layer of pelvic floor muscles via a rectal examination. Franks presented with significant tightness in his hamstrings, gluteal muscles, pelvic floor muscle tightness, sensitivity along the pudendal nerve, pelvic floor muscle weakness, poor coordination of these muscles with other core muscle groups as well as an inability to release or let go of the tension in these muscles. It became clear that the tension from these muscles and inflammation caused by that tension was impacting his nerve function causing his symptoms of urinary frequency, urgency, and pudendal nerve pain with sitting, and sexual function.
Plan:
When symptoms involve irritation to the pudendal nerve in any of its branches, it can be challenging to reduce muscle tension and address tissue restrictions when the nerve has very clear boundaries of how far it will tolerate a stretch. For Frank, we were able to quickly identify five key stretches and modify them so as not to irritate his pudendal nerves. As his tissue tension released and numbness and tingling diminished, Frank was able to tolerate more advanced stretches closer to end range without exacerbation of his symptoms. Frank worked diligently every day at home on these stretches. We also incorporated foam rolling to his adductors and glutes to improve blood flow. This really helped progress Frank’s tolerance to hip flexion and soon he was able to tolerate walking up hills at a moderate pace with his dog.
While in PT sessions, we worked intensively to release connective tissue restrictions, muscle tension and address trigger points that were making it difficult for his pudendal nerve to slide and glide properly. Within a couple weeks, we were able to trial cupping with various movements as well as nerve glides to improve tissue length and nerve mobility. As his tissues continued to heal, we were able to add in some therapeutic movements to strengthen his gluteal muscles which he had a lot of difficulty isolating. Throughout our sessions and continued evaluation, it was clear that one of the driving factors for his persistent pelvic floor muscle tightness and residual symptoms was weakness in his glutes causing compensatory persistent contraction of his pelvic floor muscles in attempts to better stabilize himself.
At the time this is written, Frank is now able to commute an hour each way to work without symptoms. He is urinating every three hours with the occasional exception, no longer has pain in his perineum or numbness and tingling at the tip of his penis. He even has been able to put on some weight with healthy dietary changes and reduced stress! I am still working with Frank to address residual irritation in his urethra and intermittent urinary frequency. At this time, he reports 80% improvement overall and I expect that he will continue to make a full recovery.
Patient perspective: “I think of myself as a fairly typical guy – work hard, exercise, have fun, enjoy the outdoors, etc. Everything in life was going quite well – or, at least that’s what I thought – until one sudden moment when, out of the blue, I found that I was unable to sit down without intense pain. I also had very strange sensations shooting through my pelvis and needed to urinate very frequently.
When my life flipped upside down with pelvic pain, I visited numerous doctors, urologists and gastroenterologists looking for a solution – and, while they all had suggestions, none of these specialists ever mentioned pelvic floor PT.
Just as I was ready to head out to yet another doctor, one of my friends mentioned pelvic floor physical therapy – and I am so thankful they did. From day 1 at PHRC my life finally began to turn around. It was absolutely amazing to have someone that could truly understand my pain and relate to what I was going through – words cannot state how valuable this was. My therapist offered support that was relevant and effective, both physically and mentally. Prior to pelvic floor PT I was in a very dark space. The lack of answers from the medical community led me to overthink my illness and travel into a very unhealthy place. Once I began PT I could finally begin to see a path forward. With my mind reassured, my body could finally begin to relax and heal.
It’s been a long and challenging journey and I’m still on the path to recovery. I still hit occasional rough patches – but I’ve learned how to cope and, with the help of my physical therapist, I’ve come up with strategies to calm down, focus on the basics and get through the tough moments.
I feel so fortunate to have found pelvic floor physical therapy. I’m now able to put in a full day of work, sit down for an extended period, and take long walks around my neighborhood.
If you find yourself experiencing pelvic pain be sure to check out this avenue. It is worth educating yourself on all the options and – in the least, it is absolutely worth having a conversation about your pain with someone who can truly comprehend what you are experiencing.”
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Are you unable to come see us in person? We offer virtual physical therapy appointments too!
Due to COVID-19, we understand people may prefer to utilize our services from their homes. We also understand that many people do not have access to pelvic floor physical therapy and we are here to help! The Pelvic Health and Rehabilitation Center is a multi-city company of highly trained and specialized pelvic floor physical therapists committed to helping people optimize their pelvic health and eliminate pelvic pain and dysfunction. We are here for you and ready to help, whether it is in-person or online.
Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.
In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page.
PHRC is also offering individualized movement sessions, hosted by Karah Charette, DPT. Karah is a pelvic floor physical therapist at the Berkeley and San Francisco locations. She is certified in classical mat and reformer Pilates, as well as a registered 200 hour Ashtanga Vinyasa yoga teacher. There are 30 min and 60 min sessions options where you can: (1) Consult on what type of Pilates or yoga class would be appropriate to participate in (2) Review ways to modify poses to fit your individual needs and (3) Create a synthesis of your home exercise program into a movement flow. To schedule a 1-on-1 appointment call us at (510) 922-9836
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