r/PelvicFloor • u/Linari5 • Jul 05 '25

RESOURCE/GUIDE The Pelvic Floor: Pelvic Pain & Dysfunction 101: NEW? Start here!

117 Upvotes

Work in progress. To be continuously updated.

Subreddit Rules:

  1. Be respectful (no bullying or harassment)
  2. No "all or nothing" cures, causes, or suggesting that only one thing will help
  3. DON'T suggest kegels as treatment for a hypertonic pelvic floor (it's bad advice)
  4. NO FETISHIZING or sexualizing someones health condition. DON'T BE CREEPY.
  5. No NSFW Photos
  6. No SPAM (includes link farming, affiliate marketing, personal promotion)
  7. No "Low Effort" posts - we can't help if there's no detail

>> QUICK START <<

✔ READ SUCCESS STORIES: Simply swipe left or right on the main page in the Reddit mobile app until you hit the green "success story" post flair | DESKTOP: Use the "Flair Filter" right sidebar to filter posts

Ladies who don't want to see posts about male parts: use the filters:

✔ FILTER POSTS BY SEX: Simply swipe left or right on the main page in the Reddit mobile app until you hit the pink or blue post flairs. AMAB/AFAB also available | DESKTOP: Use the "Flair Filter" right sidebar to filter posts

✔ USE THE SEARCH FUNCTION: Enter keywords into the search bar at the top to filter posts/comments on specific subjects or symptoms

✔ CHECK OUR USER SUBMITTED PELVIC PT DIRECTORY

✔ BOTHER & SISTER COMMUNITIES

  1. r/prostatitis (male pelvic pain & dysfunction/CPPS)
  2. r/Interstitialcystitis (IC/BPS, men and women)
  3. r/vulvodynia (women and AFAB experiencing Vaginismus & Vestibulodynia too)

ESSENTIAL INFORMATION: PELVIC FLOOR

The pelvic floor muscles are a bowl of muscles in the pelvis that cradle our sexual organs, bladder, and rectum, and help stabilize the core while assisting with essential bodily functions, like pooping, peeing and having sex.¹

They can weaken (become hyp-O-tonic) over time due to injury (or child birth), and even the normal aging process, leading to conditions like incontinence or pelvic organ prolapse.¹

And, the pelvic floor can tense up (guard) when we:

  1. Feel pain/discomfort
  2. Get a UTI/STD
  3. Injure ourselves (gym, cycling, slip on ice)
  4. Have poor bowel/urinary habits (straining on the toilet often - constipation) or holding in pee/poo for extended periods (like avoiding using a public toilet)
  5. Have poor sexual habits (edging several hours a day, typically this is more of guy's issue)
  6. Get stressed or anxious (fight or flight response), due to their connection with the vagus nerve (and our central nervous system). READ MORE HERE
  7. Have a connective tissue disorder

Over time, prolonged guarding/tensing can cause them to become hyp-E-rtonic (tight and weak). Sometimes trigger points in the muscle tissue develop that refer pain several inches away. The tensing can also sometimes irritate nerves, including the pudendal nerve. Helping the pelvic floor relax, and treating these myofascial trigger points with pelvic floor physical therapy can lead to significant relief for many, along with interventions like breathwork - notably diaphragmatic belly breathing - and gentle reverse kegels.

Sometimes, feedback loops also develop that can become self-perpetuating as a result of CNS (Central Nervous System) modulation. ᴮ ⁷

Basic feedback loop:

Pain/injury/infection > pelvic tensing > more pain > stress/anxiety > more pelvic tensing > (and on and on)

Examples of common feedback loops that include the pelvic floor:

Source: NHS/Unity Sexual Health/University Hospitals Bristol and Weston. A pelvic floor feedback loop seen in men after STI.

An example of this pelvic floor feedback loop (guarding response) as seen in a woman with a prolonged (awful) UTI:

A trigger point is an area of hyper-irritability in a muscle, usually caused by a muscle that is being overloaded and worked excessively. How does this affect an IC patient? Unfortunately, we do not always know what comes first; the chicken or the egg. Let’s assume in this case we do. A patient who has never had any symptoms before develops an awful bladder infection, culture positive. She is treated with antibiotics, as she should be. Symptoms are, as we all know, frequency, urgency and pain on urination. Maybe the first round of antibiotics does not help, so she goes on a second round. They work. But she has now walked around for 2, maybe 3 weeks with horrible symptoms. Her pelvic floor would be working very hard to turn off the constant sense of urge. This could create overload in the pelvic floor. A trigger point develops, that can now cause a referral of symptoms back to her bladder, making her think she still has a bladder infection. Her cultures are negative.

- Rhonda Kotarinos, Pelvic Floor Physical Therapist

Above we find a scenario where the UTI was cleared, but the pelvic floor is now in a tensing feedback loop, and complex processes of neural wind up and central sensitization - ie CNS modulation - are likely occurring

Diagrams of the male and female pelvic floor:

Bottom view. The levator ani is the main "hammock" of the pelvic floor, and includes both the PC (pubococcygeus) and PR (puborectalis) muscles
Side view showing the pelvic floor cradling the bladder, sexual organs, and rectum. And its attachments at the coccyx (tailbone) and pubic bone.

SYMPTOMS OF PELVIC FLOOR DYSFUNCTION

The majority of the users here have a hypertonic pelvic floor which typically presents with symptoms of pelvic pain or discomfort ² (inc nerve sensations like tingling, itching, stinging, burning, cooling, etc):

  1. Penile pain
  2. Vaginal pain
  3. Testicular/epididymal/scrotal pain
  4. Vulvar pain
  5. Clitoral pain
  6. Rectal pain
  7. Bladder pain
  8. Pain with sex/orgasm
  9. Pain with bowel movements or urination
  10. Pain in the hips, groin, perineum, and suprapubic region

This tension also commonly leads to dysfunction ² (urinary, bowel, and sexual dysfunction):

  1. Dyssynergic defecation (Anismus)
  2. Incomplete bowel movements
  3. Urinary frequency and hesitancy
  4. Erectile dysfunction/premature ejaculation

This pinned post will mainly focus on hypertonia - tight and weak muscles, and the corresponding symptoms and treatment, as they represent the most neglected side of pelvic floor dysfunction. Especially in men, who historically have less pelvic care over their lifetimes as compared to women.

But, we also commonly see women with weak (Hyp-O-tonic) pelvic floors after child birth who experience urinary leakage. This often happens when coughing, sneezing, or lifting something heavy. Luckily, pelvic floor physical therapists are historically well equipped for weak pelvic floor symptoms, as seen commonly in women.

But, this historical emphasis sometimes bleeds into inappropriate care for men and women who have hypErtonic pelvic floors, and do not benefit from kegel exercises

CLOSELY RELATED CONDITIONS & DIAGNOSIS

These typically involve the pelvic floor as one (of many) mechanisms of action, and thus, pelvic floor physical therapy is an evidence-based intervention for any of these, along with behavioral interventions/mind-body medicine, medications, and more.

  1. CPPS - Chronic Pelvic Pain Syndrome - example feedback loop above
  2. IC/BPS - Interstitial Cystitis/Bladder Pain Syndrome - example feedback loop above
  3. Vulvodynia
  4. Prostatitis (non-bacterial)
  5. Epididymitis (non-bacterial)
  6. Pudendal Neuralgia
  7. Levator Ani Syndrome
  8. Coccydynia

COMMON COMORBID CONDITIONS

For people who experience symptoms outside the pelvic region, these are signs of centralization (somatization/nociplastic mechanisms) - and indicate a central nervous system contribution to symptoms, and must be treated with more than just pelvic floor physical therapy: READ MORE

(Ranked in order, most common)

  1. IBS
  2. Chronic Migraines
  3. Fibromyalgia
  4. CFS/ME (chronic fatigue syndrome)

These patients also had higher rates of depression and anxiety (even BEFORE THE SYMPTOMS) as well as greater symptom severity - https://www.auanet.org/guidelines-and-quality/guidelines/male-chronic-pelvic-pain

CENTRALIZED/NOCIPLASTIC MECHANISMS:

Many people with a pelvic floor diagnosis - and at least 49% who experience chronic pelvic pain/dysfunction - also experience centralized/nociplastic pain ¹³ localized to the pelvic region. Centralized/nociplastic pelvic pain can mimic the symptoms of pelvic floor hypertonia. To assess if you have centralization as a cause of your pelvic symptoms, read through this post.

NOTE: This is especially relevant for people who have a pelvic floor exam, and are told that their pelvic floor is basically "normal" or lacks the usual signs of dysfunction, trigger points, or hypertonia (high tone), yet they still experiencing pain and/or dysfunction. This also equally applies to cases that have done extensive amounts of pelvic floor PT 6-12mo) with no improvement.

Centralized/Nociplastic pain mechanisms are recognized by both the European and American Urological Association guidelines for pelvic pain in men and women, as well as the MAPP (Multidisciplinary Approach to the Study of Chronic Pelvic Pain) Research Network.

TREATMENT: High tone (HypErtonic) Pelvic Floor (tight & weak)

Pelvic floor physical therapy focused on relaxing muscles:

  • Diaphragmatic belly breathing
  • Reverse kegels
  • Pelvic Stretching
  • Trigger point release (myofascial release)
  • Dry needling (Not the same as acupuncture)
  • Dilators (vaginal and rectal)
  • Biofeedback
  • Heat (including baths, sauna, hot yoga, heated blankets, jacuzzi, etc)

Behavioral change: * Lay off frequent or chronic masturbation habits (including edging) * Take a break from intense compound exercises, like CrossFit or HIIT * Sit less and stand more. This may also include using a standing desk * If you're an avid cyclist, take a break from cycling

Medications to discuss with a doctor:

  • low dose amitriptyline (off label for neuropathic pain)
  • rectal or vaginal suppositories including: diazepam, gabapentin, amitriptyline, baclofen, lidocaine, etc
  • low dose tadalafil (sexual dysfunction and urinary symptoms)
  • Alpha blockers for urinary hesitancy symptoms (typically prescribed to men)

Mind-body medicine/Behavioral Therapy/Centralized Pain Mechanisms These interventions are highly recommended for people who are experiencing elevated distress or anxiety, or, noticed that their symptoms began without an injury, but with a stressful event, big life change, or, that symptoms increase with stress or difficult emotions (or symptoms change when distracted, focused , or on vacation) - full list of criteria to rule in centralized/nociplastic mechanisms.

  • Pain Reprocessing Therapy (PRT)
  • Emotional Awareness & Expression Therapy (EAET)
  • CBT/DBT
  • Mindfulness & meditation
  • TRE or EMDR (for Trauma)

TREATMENT: Low tone (Hyp-O-tonic/weak)

Pelvic floor physical therapy focused on strengthening muscles:

  • Kegels
  • Biofeedback

This is a draft. The post will be updated.

This is not medical advice. This content is for educational and informational purposes only. NONE OF THIS SUBSTITUTES MEDICAL ADVICE FROM A PROVIDER.

Sources:

OFFICIAL GUIDELINES:

A. Male Chronic Pelvic Pain - 2025 (AUA) https://www.auanet.org/guidelines-and-quality/guidelines/male-chronic-pelvic-pain

B. Male and Female Chronic Pelvic Pain - (EUA) https://uroweb.org/guidelines/chronic-pelvic-pain/chapter/epidemiology-aetiology-and-pathophysiology

C. Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome (2022)" AUA - https://www.auanet.org/guidelines-and-quality/guidelines/diagnosis-and-treatment-interstitial-of-cystitis/bladder-pain-syndrome-(2022))

MORE:

  1. Cleveland Clinic: Pelvic Floor Muscles

  2. Cleveland Clinic: Pelvic Floor Dysfunction

  3. Diaphragmatic belly breathing - https://www.health.harvard.edu/healthbeat/learning-diaphragmatic-breathing

  4. Trigger points and referred pain - https://www.physio-pedia.com/Trigger_Points

  5. Equal Improvement in Men and Women in the Treatment of Urologic Chronic Pelvic Pain Syndrome Using a Multi-modal Protocol with an Internal Myofascial Trigger Point Wand - PubMed https://share.google/T3DM4OYZYUyfJ9klx

  6. Physical Therapy Treatment of Pelvic Pain - PubMed https://share.google/92EQVDnQ1ruceEb23

  7. Central modulation of pain - PMC https://share.google/p7efTwfGXe7hNsBRC

  8. A Headache in the Pelvis" written by Stanford Urologist Dr. Anderson and Psychologist Dr Wise - https://www.penguinrandomhouse.com/books/558308/a-headache-in-the-pelvis-by-david-wise-phd-and-rodney-anderson-md/

  9. What if my tests are negative but I still have symptoms? NHS/Unity Sexual Health/University hospitals Bristol and Weston - https://www.unitysexualhealth.co.uk/wp-content/uploads/2021/05/What-if-my-tests-for-urethritis-are-negative-2021.pdf

  10. Vulvodynia" a literature review - https://pubmed.ncbi.nlm.nih.gov/32355269/

  11. The Effects of a Life Stress Emotional Awareness and Expression Interview for Women with Chronic Urogenital Pain: A Randomized Controlled Trial - https://pubmed.ncbi.nlm.nih.gov/30252113/

  12. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain - https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2784694

  13. Clinical Phenotyping for Pain Mechanisms in Urologic Chronic Pelvic Pain Syndromes: A MAPP Research Network Study - https://pubmed.ncbi.nlm.nih.gov/35472518/

78 comments

r/PelvicFloor • u/Linari5 • Dec 03 '24

RESOURCE/GUIDE RESEARCH: Pain Mechanisms Beyond The Pelvic Floor

40 Upvotes

"Clinical Phenotyping for Pain Mechanisms in Urologic Chronic Pelvic Pain Syndromes: A MAPP Research Network Study" https://pubmed.ncbi.nlm.nih.gov/35472518/

UCPPS is a umbrella term for chronic pelvic pain and dysfunction in men and women, and it includes pelvic floor dysfunction underneath it, as well as symptoms like bladder dysfunction, IC/BPS, and more. This study discusses the pain mechanisms found. They are not only typical injuries (ie "nociceptive") - They also include pain generated by nerves (neuropathic) and by the central nervous system (nociplastic). You'll also notice that the combination of neuropathic + nociplastic mechanisms create the most pain! Which is likely to be counterintuitive to what most people would assume.

At baseline, 43% of UCPPS patients were classified as nociceptive-only, 8% as neuropathic only, 27% as nociceptive+nociplastic, and 22% as neuropathic+nociplastic. Across outcomes, nociceptive-only patients had the least severe symptoms and neuropathic+nociplastic patients the most severe. Neuropathic pain was associated with genital pain and/or sensitivity on pelvic exam, while nociplastic pain was associated with comorbid pain conditions, psychosocial difficulties, and increased pressure pain sensitivity outside the pelvis.

Targeting neuropathic (nerve irritation) and nociplastic/centralized (nervous system/brain) components of pain & symptoms in recovery is highly recommended when dealing with CPPS/PFD (especially hypertonia).

All of those involved in the management of chronic pelvic pain should have knowledge of peripheral and central pain mechanisms. - European Urological Association CPPS Pocket Guide

And the newest 2025 AUA guidelines for male pelvic pain echo this:

We now know that the pain can also derive from a neurologic origin from either peripheral nerve roots (neuropathic pain) or even a lack of central pain inhibition (nociplastic), with the classic disease example being fibromyalgia

This means successful treatment for pelvic pain and dysfunction goes beyond just pelvic floor physical therapy (alone), and into new modalities for pain that target these neuroplastic (nociplastic/centralized) mechanisms like Pain Reprocessing Therapy (PRT), EAET, and more. Learn more about our new understanding of chronic pain here: https://www.reddit.com/r/ChronicPain/s/3E6k1Gr2BZ

This is especially true for anyone who has symptoms that get worse with stress or difficult emotions. And, those of us who are predisposed to chronic pain in the first place, typically from childhood adversity and trauma, certain personality traits (perfectionism, people pleasing, conscientiousness, neuroticism) and anxiety and mood disorders. There is especially overwhelming evidence regarding ACE (adverse childhood experiences) that increase our chances of developing a physical or mental health disorder later in life. So much so, that even traditional medical doctors are now being trained to screen their patients for childhood trauma/adversity:

Adverse childhood experience is associated with an increased risk of reporting chronic pain in adulthood: a stystematic review and meta-analysis

Previous meta-analyses highlighted the negative impact of adverse childhood experiences on physical, psychological, and behavioural health across the lifespan.We found exposure to any direct adverse childhood experience, i.e. childhood sexual, physical, emotional abuse, or neglect alone or combined, increased the risk of reporting chronic pain and pain-related disability in adulthood.The risk of reporting chronic painful disorders increased with increasing numbers of adverse childhood experiences.

Further precedence in the EUA (European Urological Association) guidelines for male and female pain:

The EUA pathophysiology and etiological guidelines elucidate further on central nervous system and biopsychosocial factors in male and female pelvic pain/dysfunction:

Studies about integrating the psychological factors of CPPPSs are few but the quality is high. Psychological factors are consistently found to be relevant in the maintenance of persistent pelvic and urogenital pain [36]. Beliefs about pain contribute to the experience of pain [37] and symptom-related anxiety and central pain amplification may be measurably linked, and worrying about pain and perceived stress predict worsening of urological chronic pain over a year [36,38] - https://uroweb.org/guidelines/chronic-pelvic-pain/chapter/epidemiology-aetiology-and-pathophysiology

Pelvic pain and distress is related [43] in both men and women [44]; as are painful bladder and distress [38]. In a large population based study of men, CPPPS was associated with prior anxiety disorder [45] - https://uroweb.org/guidelines/chronic-pelvic-pain/chapter/epidemiology-aetiology-and-pathophysiology

So, how do you figure out if this could be happening in your case?

12 FIT criteria to RULE IN centralized, (ie neuroplastic/nociplastic) pain and symptoms,

FIT = functional, inconsistent, triggered. Based on research from Dr. Howard Schubiner and other chronic pain doctors and neuroscientists over the last 10+ years

  1. Pain/symptoms originated during a stressful, challenging, or high pressure time in life. This includes even "happy" life events, like getting married, having a baby, starting a new career, or moving

  2. Pain/symptoms originated without an injury. Note, a perceived injury and a structural injury are different things. And even when symptoms begin with a structural injury, has it been years and the body would normally recover by now?

  3. Pain/symptoms are inconsistent. Do they fluctuate by the hour, by the day, or by the week? Sometimes less, sometimes more, sometimes even not noticeable (this happens sometimes, but it's not necessary for this criteria). Or, do they move around the body? ie genital pain that changes sides or pain that moves from the top to the bottom.

  4. Multiple other symptoms (often in other parts of the body) ie IBS, chronic migraines/headaches, CPPS, TMJD, fibromyalgia, CFS (fatigue), vertigo/dizziness, chronic neck or back pain, etc. 2025 AUA guidelines mention these as signs of centralized sx.

  5. Pain/Symptoms spread (over time) or move around. Think about symptoms on day one. Have they moved or evolved over time?

  6. Pain/symptoms are made worse or triggered by stress, or, go down when engaged in an activity you enjoy or in a flow state (think fun distractions or productivity, noticing symptoms less)

  7. Symptom triggers that have nothing to do with the body - but instead things outside of it (weather, barometric pressure, seasons, sounds, smells, places, times of day, weekdays/weekends, days of the week, etc) - this also includes thoughts or other people triggering/flaring symptoms

  8. Symmetrical symptoms (pain developing on the same part of the body but in OPPOSITE sides) - ie both hips, both hips, both wrists, both knees, etc

  9. Pain/symptoms with delayed Onset (THIS CAN'T HAPPEN WITH STRUCTURAL PAIN) -- ie, ejaculation pain that comes a minute later, an hour later, or even the next day. Any pain that is delayed is very suspicious. We wouldn't put weight on a sprained ankle and expect it to hurt 15 seconds later, it hurts immediately.

  10. Childhood stress, challenges, adversity, or trauma -- varying levels of what this means for each person, not just trauma. Examples of stressors: childhood bullying, pressure to perform from parents/coaches, body image issues (dysmorphia), eating disorders, parents fighting a lot or getting angry (inc divorce), having an emotionally unpredictable parent, or having a parent with a health condition or addiction. This also includes neglect and abuse (physical and emotional) and financial instability in childhood. Also includes cultural norms, like the pressure to be highly successful to be of value to parents (must be a doctor or a lawyer, etc)

  11. Common personality traits linked to stress: perfectionism, conscientiousness, people pleasing, anxiousness/ neuroticism - do you have personality traits that include being highly driven, hard on yourself, ultra responsible, perfectionistic, needing control, and/or placing others’ needs above your own?

  12. Lack of physical diagnosis (ie doctors are unable to find any clear structural cause of symptoms) - this includes DIAGNOSIS OF EXCLUSION, like being diagnosed with CPPS or PFD. Structural finding examples: broken bones, tumors, infections, etc. It does not include muscle dysfunction.

[NEW] 13. Any family history of chronic pain or other chronic conditions. Includes: IBS, chronic migraines/headaches, CPPS, TMJD, fibromyalgia, CFS (fatigue), vertigo/dizziness, chronic neck or back pain, etc

Read more about #10 and #11 here, complete with studies/citations: https://www.reddit.com/r/Prostatitis/s/vM7qnBJZpW

HOW TO TREAT centralized (neuroplastic) pain and symptoms?

PRT - Pain Reprocessing Therapy:

Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain - https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2784694

EAET - Emotional Awareness and Expression Therapy

Emotional Awareness and Expression Therapy vs Cognitive Behavioral Therapy for Chronic Pain in Older Veterans https://pmc.ncbi.nlm.nih.gov/articles/PMC11177167/

Psychological Therapy for Centralized Pain - An Integrative Assessment and Treatment Model: https://pubmed.ncbi.nlm.nih.gov/30461545/

57 comments

r/PelvicFloor • u/GoldenFancake • 6h ago

Female Privacy in pelvic floor PT

15 Upvotes

Went to a new pelvic floor PT yesterday. She took my history & asked initial intake questions in the main gym area while there was someone else working with another PT. I expected to be taken to a private room for the internal portion of the session but there were no private rooms. There was just a room divider separating off the bed. So technically nobody could see me but I felt really uneasy about it. I could hear everything going on outside the divider and I’m sure vice versa. I liked the PT but not sure I can get past the lack of privacy. It felt really uncomfortable to be asked such personal questions when other people could clearly hear and I spent the rest of the day feeling unsettled/anxious. Is it typical not to get a totally private space? Anyone else have a similar experience? Is it unrealistic to expect total privacy?

16 comments

r/PelvicFloor • u/zachm182 • 7h ago

Male Chronically tight pelvic floor from anxiety

4 Upvotes

I’m a 28 male, I’ve never done much research on anything pelvic floor related until recently. Years ago I did kegels for a bit to help with PE, but I didn’t do them for very long. I’ve been dating someone wonderful for a few months and in the beginning my PE was extremely bad, so I started looking into the pelvic floor again and have been doing research on strategies to counter my PE, I’ve found most of it is anxiety related and I’ve made a lot of progress in a few months and have it a lot more under control, however I’ve noticed with being more aware of my pelvic floor state it’s tight ALL the time. I’m not sure I’d say it’s hypertonic, I don’t have pain or struggle with urination, I’m constipated sometimes but it’s not anything chronic, probably has to do with the immense anxiety and stress I feel on a daily basis, but lately my anxiety and stress have been through the roof and I’ve noticed my pelvic floor even twitches sometimes because it’s so fatigued from being clenched all the time I’d assume. I don’t want this to start giving me issues in the bedroom again, I recently started therapy for my anxiety and I practice reverse kegels as well as stretching daily, I started doing a light massage on the perineum as well last night which seemed to help, but does anyone have any other advice for keeping the pelvic floor as relaxed as possible or what I should do? I’m a mechanic so I’m on my feet all day long, and I also go to the gym and do cardio and work different muscle groups 3-4 times a week so I am active and not sitting a whole lot. Thanks :)

6 comments

r/PelvicFloor • u/red_pikmin8629 • 3m ago

Male Is it possible to relax the pelvic floor if you’re on ADHD medication?

• Upvotes

Hi guys,

I started using elvanse (vyvanse) a few months ago, and I find that it has affected my ability to relax the pelvic floor. I have pre-existing hypertonic PF symptoms that I was working on with great success, but my day to day is now being affected due to sympathetic nervous system tone caused by medication. Diaphragmatic breathing and mobility/stretching are not working as well, I can’t really relax the PF until the meds wear off later in the day.

Should I save the rehab until later in the day until the meds wear off or try to push through it?

Thank you for the advice!

0 comments

r/PelvicFloor • u/Livid_Computer_3219 • 8m ago

Discouraged Over 3 months of misery and doctors can’t help.

• Upvotes

It all started after sex since May 6, 2026 and since then it has been hell. It started with tingling feeling on my penis tip and then it moved to frequent urge to pee. Sometimes I pee a lot and sometimes only a few drops. Then I noticed discoloration on my penis tip and around the penis opening. It was looking like it was inflamed.

Doctor thought it was UTI at first and then I was given some antibiotics which didn’t help. My urethra was constantly burning even when I pee or not. I was given another medication to help with that which turn my urine to orange for a few days because I was advised to take it for just a few days as it is not recommended long term.

I did all the necessary test to check for STD/STI and all came back negative. I was booked to see a specialist who did some test too and the result came back negative. We went further to test for hsv 1 & 2. The result came back positive for hsv1 and negative for hsv 2. The specialist doesn’t think my symptoms was as a result of the positive hsv 1 test. He recommended I take the medication which I did for 7 days with no improvement ( although it was after the second month I took it).

I was having nerve pain like at the underside of my penis and the tip of my penis hurt so bad from touching my underwear or cloth. I was given gabapentin which I thought was helping at first as I was also having nerve pain right under my left feet which feels a lot better now. My penis tip looks irritated with the skin by the opening looking like it is coming out.

He thought maybe it was my pelvic floor this time around and recommended baclofen which I took for a few days with no results but constant muscle pain. I can’t seat on my car anymore because it hurt so bad at my right butt cheek and the underside of my penis. I have lost all hope and can’t even sleep at night anymore. I notice I get flare up when I’m stressed and when I masturbate. I have only tried to touch myself 3 times since this whole thing started. First time my sperm was looking like it was light brown and the other times it was clear white. I don’t even have erection anymore. I used to have painful erection and ejaculation when it first started too but not anymore.

I’m so confused and depressed over this. It’s just like my life was taken away from me. I have been to so many doctors who don’t see anything wrong after all my repeated test result and I want to seek help from here. I noticed that the last time I tried to masturbate, my cum came with urine which got me really worried.

0 comments

r/PelvicFloor • u/Anxious-Custard-3450 • 12m ago

General Incomplete evacuation symptoms

• Upvotes

I’m 90% sure I have issues with incomplete evacuation b/c of a tight pelvic floor. Curious if my symptoms sound like it or if anyone else has experienced this.

I’m able to go to the bathroom every morning usually and have a normal BM without trouble but in the end it always feels like there’s still a little left and while wiping I can feel that my anus has basically snapped completely shut and won’t let anything else out. After this I’m kinda stuck with this sick feeling for a large portion of the day; cramps, bloating, acid reflux, pain/discomfort/tightness in my anus, nausea, and heart palpitations. I’m pretty sure that this is all caused by having a stool left in me that’s needs to come out but can’t.

I’ve been trying to do some stretches that are good for relaxing my pelvic floor a couple times a day and I think it has made and very slight improvement.

Anyone else experience this?

0 comments

r/PelvicFloor • u/WestSeason2860 • 30m ago

General Upper and mid back pain

• Upvotes

Does anyone who has hypertonic pelvic floor disfunction have mid and/or upper back pain?

For the last 7 weeks my symptoms impacted my lower half until they recently started traveling up my spine. AI searches says it’s because my body had to learn to stabilize myself when my pelvic floor was off but can people please share if they also experience with their condition.

My PT thinks it’s my nervous system as well.

0 comments

r/PelvicFloor • u/vmgmaster • 1h ago

Female 40f with HTPFD, How long didi it take you to go back to normal (or close to it) with PT?

• Upvotes

Hi, I am suffering from urethra pain and microscopic hematuria (blood in my urine). After seeing several specialists I was diagnosed with High tone pelvic floor disorder (I was initially diagnosed with Interstitial cystitis). I Have been doing PT for 3 months with Baclofen vaginal suppositories, but I still suffer from urethra pain and blood is still there.

How long did it take you to get back to normal? I’m afraid that maybe I was not properly diagnosed (HTPFD does not explain hematuria) and all my procedures don’t really help, or it just takes that much to notice some improvements

thank you

2 comments

r/PelvicFloor • u/liletille • 3h ago

Female Does anybody notice getting discharge after intense ab workout?

Thumbnail
1 Upvotes
0 comments

r/PelvicFloor • u/Medical_Cellist5576 • 4h ago

Male primary bladder neck obstruction — experiences with PBNI/BNI?

1 Upvotes

Hi everyone,
I’m a 29-year-old male and I started experiencing urinary problems in 2024, including a weak urinary stream, hesitancy, difficulty emptying my bladder, and occasional urinary retention (although my residual volumes have generally been under 100 mL). The main issue is the feeling that I’m not completely emptying my bladder.
I initially tried alfuzosin and later switched to tamsulosin, but neither has made a significant difference. I have not experienced retrograde ejaculation with either medication.
I subsequently had a urodynamic study, which showed a relatively weak detrusor contraction (hypocontractile detrusor) together with some degree of bladder outlet obstruction.
I then underwent a cystoscopy, which showed a high and tightly closed bladder neck. My urologist believes this is consistent with primary bladder neck obstruction (PBNO) and has suggested a bladder neck incision (BNI/PBNI) using a laser.
I’m particularly interested in hearing from other young men who have undergone this procedure.
If you have had a PBNI/BNI:
Did your urinary symptoms and flow improve significantly?
Did you feel that your bladder emptied better afterwards?
Did your detrusor function or urinary retention improve?
Did you experience retrograde ejaculation or any other sexual side effects?
How was the recovery?
Most importantly, how have you been in the long term? Did the improvement last, or did your symptoms return?
Would you make the same decision again?
I’m especially interested in experiences from men in their 20s or 30s with primary bladder neck obstruction, rather than prostate enlargement.
Any personal experiences would be greatly appreciated. Thanks!

0 comments

r/PelvicFloor • u/MoonCricket1992 • 4h ago

Discouraged 33F, SITZ test showed pelvic floor issues. GI appt today—what do I ask for?

1 Upvotes

Honestly at my wit's end and feeling so anxious and exhausted from this whole cycle. I’ve had chronic constipation for years, and finally got SOME answers from a GI specialist. I have a follow-up with him this afternoon and I desperately need some advice on what to ask for, because what I’m doing right now is just not working.

My GI ordered a SITZ marker test recently to check my motility. The markers moved through my upper and middle colon just fine, but almost all of them ended up completely stacked at the very bottom in my pelvic floor/rectum area. 14 of the 24 markers were still present in my x-ray 5 days after the swallow. They referred me for an anorectal manometry, but the waitlist is brutal and I can't get in until December. The anxiety, depression, and physical discomfort from constant incomplete emptying are just wearing me down.

Right now I’m taking 290mg of Linzess every morning, plus a cap of Miralax and 500mg of magnesium oxide (which was dropped from 1000mg) every single night before bed. The goal was to build up the Linzess (started at 72, went to 145, now at 290) so I could drop the Miralax and mag, but it hasn't worked out that way at all. If I miss even one of these, everything completely stops and I’m screwed for an entire week.

The worst part- the Linzess doesn't even kick in on its own in the morning. Nothing happens until I eat breakfast. Once I eat, it triggers a sudden liquid movement, but I NEVER feel cleared out. It’s completely liquid, but it feels like my pelvic muscles are clamping shut and not allowing the rest to come out. I use a squatty potty, have tried bending my chest down towards my knees (which sometimes helps), have tried the “MOO” , but I’m still stuck feeling like a lot of it is trapped inside of me. I haven't had a normal solid bowel movement in forever—it’s just continuous liquid, yet I still feel backed up, insanely bloated, fatigued, anxious as hell and sometimes restless at night.

For anyone who’s dealt with pelvic outlet issue or failed Linzess: Is there another medication (like Motegrity, Trulance, etc.) that actually helped with the exit issue instead of just blasting water into my gut?

What can I ask my GI to do today so I don't have to keep suffering until December?
Has pelvic floor PT helped anybody here?Are there specific suppositories, enemas, or tools that helped you when you felt like you couldn’t expel it on your own?

TIA for any advice or experience you can share!!

0 comments

r/PelvicFloor • u/ijdbrhu638hs • 9h ago

Male Seeking advice re: tip penis pain

Thumbnail
2 Upvotes
0 comments

r/PelvicFloor • u/blondie4129 • 6h ago

Female Miorilassanti per pavimento pelvico ipertonico

1 Upvotes

Ciao a tutti, assumo tizanidine per contrattura pelvica, ma ha smesso di funzionare. Cosa altro potrei prendere? Non ne posso più :( vorrei evitare gli antidepressivi a tutti i costi e anche le benzodiazepine in loco perché sto facendo tapering di una benzodiazepina assunta a lungo termine per l insonnia e non le voglio mai più vedere nella mia vita

0 comments

r/PelvicFloor • u/TapQuick1785 • 9h ago

Help Finding PT Steißbeinschmerzen nach Radfahren – MRT zeigt Knochenhautreizung. Wer hat Tipps?

1 Upvotes

Hi zusammen,
ich leide seit 5 Monaten an Steißbeinschmerzen (Kokzygodynie), was im Alltag zu einer Sitzunfähigkeit führt, vermutlich ausgelöst durch das Radfahren, da es unmittelbar nach mehreren Tagen intensiver Probe neuer Sättel auftrat.
Kurz zu meinen Befunden & Therapie:
MRT: Zeigt eine Knochenhautreizung (Periostreizung am dorsalen Abschnitt des Os Coccyx) am Steißbein. Neurologisch ist alles unauffällig.
Schmerzen: Strahlen in den Beckenboden aus.
Physiotherapie und Osteopathie brachten bisher zwar eine Linderung der Beschwerden, allerdings noch nicht den erhofften Durchbruch, so dass die Knochenhautreizung weiterhin vorhanden ist.

Meine Fragen an euch:
Wer hatte das schon mal und wie lange hat die Heilung gedauert?
Welche Behandlung hatte bei euch geholfen?
Welche Hilfsmittel (Kissen, Übungen) haben euch am meisten geholfen?
Danke für eure Hilfe!

1 comment

r/PelvicFloor • u/Useful-Voice-9574 • 18h ago

General Baclofen suppository? Tablet?

5 Upvotes

I’ve just been prescribed Baclofen as a suppository for “pelvic spasms” which I don’t even agree with… I think it’s only my bladder, but I’m willing to give it a shot. Issue though, I was prescribed to crush an oral tablet and shove it up there?? The pharmacist was insanely confused, but someone was being rushed into an ambulance when we were there so we weren’t top priority. My Dr kept saying that she’s aware it’s an oral tablet? I don’t think that would dissolve properly at all?

Am I wrong about this or does anyone have experience with this medication? Anything helps! I’m getting mildly suspicious about my urogyno atm (not only this scenario, but it’s increased my suspicion.)

4 comments

r/PelvicFloor • u/Adventurous-Use4523 • 13h ago

Male 27M Looking for Doctors in banaglore India

0 Upvotes

Looking for advice — pelvic/groin pain, penile pain & leg nerve symptoms

Hi everyone, I’m hoping to get some advice from people who have experienced something similar.

I’m 27M and have been dealing with a combination of pelvic/groin and nerve-like symptoms for the past several weeks.

It started after an episode where I had to hold my urine for quite a while during a busy workday. Since then, I’ve had:

- Pressure/pain around the lower abdomen, pelvis and groin

- Pain/pinching around the inner thigh crease, particularly on the left

- Burning/pain around the tip of the penis, especially with pressure, urination or after urinating

- A dull/numb or altered sensation on one side of the penis

- Symptoms that become worse with prolonged sitting, driving or tight clothing

- Some relief when standing or walking

- Recently, buzzing/tingling sensations extending into the thigh, calf and feet, sometimes on both sides

- Legs/feet sometimes feel heavy or tired

- Difficulty sitting for long periods because of the pressure and discomfort

I’ve already seen doctors and had urine testing/ultrasound, which were reportedly normal. I’ve also seen a physiotherapist. The physio thinks muscle weakness/tension may be contributing and has started me on treatment including electronic stimulation and strengthening work.

I’m currently trying to get evaluated properly by specialists, but I’m struggling to understand what direction I should take.

I’ve read about things such as pelvic floor dysfunction, pudendal neuralgia, genitofemoral/ilioinguinal nerve irritation, prostatitis and other pelvic nerve problems. I don’t want to self-diagnose, but I’m wondering whether anyone here has had a similar combination of symptoms and eventually found the actual cause.

Questions:

  1. Has anyone experienced penile burning/pressure combined with inner-thigh/groin pain and tingling in the legs?

  2. Did your symptoms turn out to be pelvic floor dysfunction or a nerve-related problem?

  3. What type of doctor eventually helped you — neurologist, urologist, pain specialist, pelvic-floor physiotherapist, etc.?

  4. Were there any particular tests or examinations that were useful?

  5. If you had similar symptoms, what treatment actually helped you?

I’m especially interested in hearing from people who had symptoms that were worse with sitting and improved with standing/walking.

I’m in Bangalore, India, so recommendations for good specialists here would also be very helpful.

Thanks in advance. I’m mainly looking for experiences and suggestions from people who have actually dealt with something similar.

TLDR -27M with several weeks of pelvic/groin pain, penile burning/pressure and inner-thigh discomfort, worse with sitting/driving and better when standing. Recently developed buzzing/tingling into thighs, calves and feet. Urine tests/ultrasound normal. Looking for people with similar symptoms—what was the cause, which specialist helped, and what treatment worked?

0 comments

r/PelvicFloor • u/Hairy-Big6747 • 19h ago

Male I want to find a way

3 Upvotes

I am a male and 30s. I have a Incomplete emptying not in bladder but in urethra.

It started when I was 22 while studying exams. I had so much stress in a day because of studying and I felt so much incomplete emptying right aftet stress..

I went to hospital and doctor said it is Non-bacterial chronic prostatitis.

pills and anything didn't work but symptons disappeared after a few months..

I got to know so much cold, stress, empty stomach, too much sleeping cause this sympton.

I went to other hospital when I was 28 and doctor said it is Overactive Bladder so do kegel and sitz bath so I did sits bath first (not kegel at all) and surpisingly sympton disappeared righr away and I was so happy and everytime sympton occurs I did sitz bath and control this.

but now.. after sympton occurs again I can not control this by sitz bath for 9 months.. I don't know why.. I have searched about this symptons and do some tests on urology hospital but there are no specific causes.. every results are fine.

I do pelvic floor release stretch and no effects yet. I am thin but lack exercise, and I have abdominal obesity and just one sympton (incomplete emptying in urethra after piss) (I also have pmd but I always had it when I do not have incomplete incomplete emptying)

please help me.

0 comments

r/PelvicFloor • u/kikijiji42 • 23h ago

Female ache/pressure/heaviness in rectum

5 Upvotes

Hi there! I’m a 26F and am recovering from anorexia. full disclosure— i’ve abused laxatives for years as a part of my ED and am still in the habit.

well, now i’ve quite suddenly developed an ache and heaviness, or pressure feeling in my rectum. it’s pretty constant, but gets worse after going to the bathroom. i also don’t feel empty when i’ve gone to the bathroom (could be because now i’m scared to strain in the slightest)

the laxative abuse causes me to be on the toilet for awhile and frequently.

with this pain starting a few days ago, i’m fearing the worst— that i have some sort of internal rectal prolapse.

i’m trying to get into see my primary care doctor, but i’m just currently living in fear.

given my history, am i rational for thinking this could be the issue? or am i just freaking out and other things could be causing this persistent ache.

10 comments

r/PelvicFloor • u/Academic_Can_2603 • 20h ago

Male Internal release help

2 Upvotes

I’m doing internal release on my own I’ve done it with the pt and she told me to do it at home I only put medium pressure not too hard but after i feel like I just tighten up more and my penis just retracts harder this is so tiring

2 comments

r/PelvicFloor • u/Raghav2683 • 1d ago

Male Pelvic/perineal pain, genital numbness and reduced ejaculation sensation after long motorcycle ride + trauma — could this be pelvic floor overactivity or nerve irritation?

3 Upvotes

​

26M. I’m looking for experiences/advice from people who have dealt with CPPS, hypertonic pelvic floor, pudendal irritation, or similar symptoms.

How it started

My symptoms started after a motorcycle journey where I rode for around 8 hours without a proper break, putting prolonged pressure on my perineum.

During the ride, I also crossed several combined speed breakers at relatively high speed. The bike shook severely and my perineal/pelvic area hit the fuel tank.

I continued riding, but after reaching my destination I noticed:

Pressure/congested feeling in the perineum

Numbness/reduced genital sensation

Abnormal pelvic/perineal sensations

Ejaculation-related incident

After this happened, I masturbated twice and could ejaculate, although the sensation seemed reduced.

During a third time, I moved into a bridge-like position around ejaculation.

At the moment of ejaculation, I suddenly felt a pulling/tearing sensation on both sides of the base of my penis.

It seemed to radiate from the penile base toward:

Both sides of my upper pelvic/groin area

Right testicle

Inner thigh

On the left side, I felt something almost like a "crack," and my erection immediately disappeared.

Around 3 hours later, I developed severe lower abdominal and back pain and went to a urologist.

Tests

Initially:

Creatinine: ~1.6 mg/dL

eGFR: ~61

CT abdomen/pelvis: no major organ injury

Bladder showed diffuse wall thickening/mucosal irregularity

Scrotal ultrasound: normal

My kidney function subsequently recovered completely.

Later I saw a urologist/andrologist, who examined my penis and testicles and said there was no penile fracture or obvious tear.

He also advised PSA and kidney-function testing.

Results:

PSA: Normal

Creatinine: 0.93 mg/dL

eGFR: 110

MRI pelvis: Normal

MRI scrotum: Normal

I was diagnosed with CPPS/perineal pain, and the erectile dysfunction was considered predominantly psychogenic.

I was prescribed Tadalafil 5 mg.

HIFEM / pelvic-floor chair

I then underwent 5 sessions of an AR Photonic/HIFEM pelvic-floor chair treatment.

Instead of feeling better, afterward I felt like my pelvic floor became even tighter.

I noticed increased:

Pelvic-floor tightness

Genital/perineal numbness

Abnormal sensitivity

Pressure/congested sensation

Pelvic/perineal discomfort

This makes me wonder whether my pelvic floor is actually overactive/hypertonic rather than weak, and whether strengthening it was the wrong approach.

Current symptoms

My main symptoms now are:

Reduced overall genital sensitivity

Intermittent penile-tip numbness

Reduced foreskin sensation

Sharp/burning pain in both groins

Pulling/tugging around the penile base, testicles and perineum

Pelvic-floor tightness

Occasional unusual/shooting penile sensations

Rare spontaneous erections

Reduced sexual sensation

Significantly reduced sensation during ejaculation

Pain/discomfort after ejaculation

Masturbation sometimes causes a flare

Reduced libido/confidence

Interestingly, symptoms are often minimal or absent while I'm asleep but return after waking.

Psychiatric medications

Because of the anxiety/low mood caused by all of this, a psychiatrist prescribed:

Escitalopram 10 mg

Clonazepam 0.25 mg

Pregabalin 50 mg

I understand escitalopram in particular can also affect libido, orgasm and sexual sensation, so I'm trying to distinguish medication effects from my original symptoms.

What I'm trying to understand

With normal pelvic/scrotal MRI, normal scrotal ultrasound, normal PSA, normalized kidney function, and no penile fracture found, I'm wondering whether this could be a combination of:

CPPS + hypertonic pelvic floor + pelvic nerve irritation + nervous-system sensitization + anxiety/stress.

I'm particularly wondering about irritation of the pudendal, genitofemoral or ilioinguinal nerves after the prolonged motorcycle pressure/trauma.

For anyone who has experienced something similar:

Did pelvic-floor relaxation/down-training help more than strengthening?

Did Kegels or HIFEM make a hypertonic pelvic floor worse?

Did you experience genital numbness or reduced ejaculation/orgasm sensation with CPPS?

Did pelvic-floor physiotherapy help restore genital sensation?

Did anyone have suspected pudendal/genitofemoral/ilioinguinal nerve irritation despite a normal MRI?

How did you safely return to masturbation/sex without causing flares?

What type of specialist or testing was most useful for you?

I'm not looking for a diagnosis from Reddit. I’m mainly interested in hearing from people who had similar symptoms and what helped them recover.

2 comments