By: Lis Thompson
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
Other Success Stories from our male patients: