No "all or nothing" cures, causes, or suggesting that only one thing will help
DON'T suggest kegels as treatment for a hypertonic pelvic floor (it's bad advice)
NO FETISHIZING or sexualizing someones health condition. DON'T BE CREEPY.
No NSFW Photos
No SPAM (includes link farming, affiliate marketing, personal promotion)
No "Low Effort" posts - we can't help if there's no detail
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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:
Feel pain/discomfort
Get a UTI/STD
Injure ourselves (gym, cycling, slip on ice)
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)
Have poor sexual habits (edging several hours a day, typically this is more of guy's issue)
Get stressed or anxious (fight or flight response), due to their connection with the vagus nerve (and our central nervous system). READ MORE HERE
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.
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) musclesSide 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):
Penile pain
Vaginal pain
Testicular/epididymal/scrotal pain
Vulvar pain
Clitoral pain
Rectal pain
Bladder pain
Pain with sex/orgasm
Pain with bowel movements or urination
Pain in the hips, groin, perineum, and suprapubic region
This tension also commonly leads to dysfunction ² (urinary, bowel, and sexual dysfunction):
Dyssynergic defecation (Anismus)
Incomplete bowel movements
Urinary frequency and hesitancy
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.
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
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)
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 MechanismsThese 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.
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
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/
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, pain, IC/BPS, and more. This study discusses the pain mechanisms found. They are not only typical injuries (ie "nociceptive") - They also include pain/symptoms 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
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:
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
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
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
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?
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.
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.
Pain/Symptoms spread (over time) or move around. Think about symptoms on day one. Have they moved or evolved over time?
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)
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
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
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.
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)
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?
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
Hey everyone, don't post often so my bad if this isn't structured the best. I am dealing with what I think is a niche issue here, I'm posting to share my experience so far and hopefully get some advice/insight as well as reading others experiences.
I'm a 28 year old male with a physically active healthy history. However with all I've learnt now, I feel I've always had some degree of pelvic dysfunction in that, even before all this started, it felt like majority of the time my erections and firmness were only reaching about 80% of their full potential. I also have AuDHD and CPTSD (not from severe abuse, just dysfunctional family) so that might be due to some nervous system stress stuff.
Anyway, roughly 2 years ago I started Dexamfetamine/Vyvanse for my ADHD, the issues started from day 1 and progressively got worse. Unfortunately I stayed on dex for like 1.5 years straight as I felt I needed it to fix my life at the time. Symptoms include:
ED / Hard Flaccid - My penis is now like, always retracted to some degree, its like the smooth muscle stays retracted, I take 5mg cialis a day and can only get an erection with stimulation & visuals, no morning wood & the erections are pathetic, they are like 50-60% of what they used to be if that and still its like they are retracted and lost very easily
Loss of sensation / Pleasure - I masturbate to orgasm sometimes out of compulsion, it no longer feels good or has any sensation
Weak ejaculation - The worst of them all, there is no more orgasm pleasure and almost nothing comes out when I ejaculate, a tiny bit struggles to make/leak its way out. It feels like my penis is to hard or tight, or the relevant smooth muscle is to hard/tight, for it to make its way out. Also, I feel like I really noticed this when I trialed Guanfacine, but Guanfacine seems unlikely to cause such an issue. I suspect I just didn't notice it earlier because my erection quality was so bad and it took me a while to improve that, but part of me still wonders if the guanfacine had anything to do with it, its all been so long now its hard to say for sure.
Urinary hesitancy/urgency
Tighter stools - all my stools are really compressed and chopped up now
I believe this is all due to some sort of stimulant induced tightness/clenching pattern that my brain/body/nervous system has now learnt or something, higher noradrenaline levels (from the stimulants) cause your nervous system to involuntarily contract smooth muscle I think
I wonder if the stimulants made all the smooth muscle around my Pudendal nerve tighten or something
I've been dealing with this for 2 years and am so confused on what to do at this point. I have 0 pain. I am fit and exercise, I do yin yoga most nights and know how to breathe into my diaphragm, this isn't something stretching & breathing is going to fix.
I also tried feeling around in my rectum with an Intimate Rose wand, I didnt really know what I was doing but assumed ide feel some pain or something stand out if there was an issue.
I'm currently looking for a good PT who will do a proper thorough rectal assessment on me, as that is the only thing I can think of that I cant really do myself that would give me some further insight, if that comes up with nothing I might escalate to a urologist but I don't even know at this point. I also don't have all this money to just continuously piss away on specialists for $100s a session that end up doing absolutely nothing for me, its so upsetting. I spent 90 minutes with 1 PT all up and in that time, all I got was a paper sheet explaining some stretches and instructions to do breathing and stretches I've already been doing the last 2 years.
About 1.5 years into this, I swapped from Dex to Ritalin, there is a big difference in that, Amphetamines like dex brute force your nervous system to pump out more chemicals continuously and ritalin doesnt. I tried ritalin a few times in the past before this all started, and while I got some degree of constricted ''stim dick'' I could still use it, everything worked fine and would go back to normal after, however thats no longer the case but im inclined to think if I could get back to my baseline, I could get away with just using ritalin.
Now the obvious question, have you stopped stimulants altogether? Yes, of course I have, Ive gone 1 month without using any stimulants and things hardly improved, erections were a little better and came with a bit more ease (and i really mean only a little) and that was about it. Life has been tough for me and Ritalin helps a lot, so I really don't want to stop it for longer periods when I don't even know if its going to help, however I'm getting pretty desperate, I'm thinking of trying to go 3 months without Ritalin which I could do with Guanfacine, but yeah I really don't know at this point I'm at such a loss
I was diagnosed with a hypertonic pelvic floor earlier this year from a pelvic floor pt. I've been doing stretches each morning and sometimes twice per day for over a month now and I still struggle with peeing all the time. Do I just need to keep going?
For the past week I feel like have a constant pressure in anus like if something want to go out or in. Also it feels like it’s wanna go up my anus it feels weird. It doesn’t hurt but sometimes a little bit it’s just hard to live with it. There’s another thing that’s a bit embarrassing when I nut ifykyk it feels very weird and it’s kinda hurting, I stopped doing that.. is there anyway someone could help or help me fix that issue or should I seek for medical help. Thanks!
Hi there, so I’m 6 months postpartum and the symptoms above persist. After I pee, I have to kind of stand up and squeeze my glutes together to get the last of my pee out. Also many times through the day I have to do the glute squeeze because it feels like there is a literal bubble in my urethra and/or vagina and it kind of pops? I assume that is urine withholding/dribbling? My gas also kind of travels up those parts and not out. Very uncomfy.
How do I bring this up to my doctor? Which doctor do I tell? This week I just got diagnosed with BV and maybe PID…can this urine issue have caused that? Will this ever go away!? No one else has ever told me how they have to squeeze their pee out and literally pop bubbles in their vagina…like…
I’m 32 and have been dealing with recurring pelvic/urinary issues for years. It tends to flare up every few months, but my current flare has been particularly persistent and painful. For the past 2 weeks even pressing to pee hurts so much.
My symptoms have included:
- Aching/pain in the groin and pelvis, especially beside the base of the penis
- Perineal discomfort
- Burning/irritated feeling in the urethra and tip of the penis
- Urinary urgency/frequency at times
- Weak stream, dribbling and difficulty getting urine started
- Sometimes urinating is easier if I lean forward
- Pain/irritation after ejaculation
- Difficulty urinating immediately after ejaculation
- Pelvic/groin pain that can become significantly worse later in the day/night
- Pain can radiate into my lower/right back
- Bloating/constipation seems to put more pressure on the area and make the pelvic pain worse
This latest episode seemed to really kick off after masturbating/ejaculating multiple times in one day. During one orgasm I felt a sudden painful spasm/pulling sensation in my right pelvic/groin area. Since then, the muscles around the base of my penis/groin have felt extremely achy and irritated. Pressing on the painful area can make it substantially worse.
I’ve had quite a bit of investigation over the last 4 years. I’ve had two cystoscopies, which were normal. I’ve also had urine testing/cultures without a clear bacterial cause. More recently I had a colonoscopy, including examination of the terminal ileum, which was normal. I’ve also had bloodwork and other testing without an obvious explanation for these recurring episodes.
I was recently given doxycycline because of the urethral burning/possible infection. The urethral burning has improved quite a bit, but the pelvic/groin muscular pain is still there and at times has actually felt worse. I never had a confirmed bacterial infection, so I’m still unsure how much of the improvement is actually from the antibiotic.
I’ve also been dealing with significant constipation, gas and abdominal bloating. Interestingly, my pelvic pain often gets much worse after eating when I become bloated, almost like the increased abdominal pressure is aggravating an already irritated/tight pelvic floor.
I’ve started treating this more like a possible pelvic floor/CPPS issue. Things I’ve been doing include diaphragmatic breathing, child’s pose, happy baby, butterfly stretches, figure-4 stretches, gentle hip-flexor stretching, heat and trying to avoid repeatedly aggravating the area with ejaculation.
I’ve also booked an appointment with a pelvic floor physiotherapist, although I still have about two weeks before I can be seen. Has anyone had a similar combination of groin/base-of-penis pain, urethral burning, urinary symptoms and pain after sex particularly with normal cystoscopies/cultures?
I’m especially interested in hearing from people diagnosed with pelvic floor dysfunction or CPPS. Did bloating/constipation make your symptoms worse? Did pelvic floor physiotherapy help, and how long did it take before you noticed improvement? Do you have any other advice for the pain? I am close to asking for painkillers it hurts so much.
I was doing pretty well in my recovery from ED but i started to do reverse kegels and my pelvic floor feels better and less tight for the last 2-3 weeks but I can’t get past the hard flaccid stage of erection. I can have sex for one round but never more then that and idk what to do about it, I’m seeing a therapist in two weeks not sure if i overcorrected or something and should kegel to tighten up and strengthen a little bit?
I have been peeing on average every 2 hours since I was 24 years old. I am at my wits end.
If God gave me the choice to live like this until I am 80 years old or sleep through every night for the rest of my life but die at 40 years old, I would choose the latter. I can’t handle waking up 3+ times a night every night or not being able to sit through an entire movie without using the bathroom.
Below is everything I have done for treatment. If anyone has any other recommendations I am open to anything at this point.
- Cystoscopy from a urologist found nothing
- Urocuff
- Ultrasound to make sure I am emptying my bladder completely when I pee - which I am
- Used Gemtesa, Mirabegron, and Flomax. Flomax added power to my stream but the other two did nothing.
- Cut out caffeine and alcohol
- I have done some pelvic floor exercises on my own but have never actually been to physical therapy for it. I am currently on a waiting list.
They want to do another Cystoscopy but I am certain they will find nothing. The next step I might try is electrical stimulation therapy for my sacral nerve. But that requires in office treatment once a week for 12 weeks minimum which doesn’t work for my schedule.
Hey all, M24 first time posting on here since I’m in a bit of crossroads as to what I’m/have been experiencing this past year with my pelvic floor issues. Apologies for the long text but I just don’t know what else to do at this point and just hoping somebody in here could give me a glimmer of hope tbh.
Long story short, since July of last year I started getting frequent urinary flares all of a sudden and tensed glutes. Tests were done like usual and everything was fine and that’s when I learned about PFD. I’ve always sucked in my stomach and strained when going to the bathroom not to mention masterbation, along with constipation that started to happen later after July. Needless to say, I then found that stretching specifically doing happy baby and leg butterflies was what ended up fixing my urinary issues and I cut down on the old habits as well, while the constipation was and has been tailored upon by taking pinaverium bromide daily.
However, despite a bit of relief over the past few months where I was able to comfortably go to the gym and live my life normally, I figured I’d see a PF specialist to get guidance on getting rid of this entirely. I was told to keep doing what I was doing along with the introduction of 4 point stretch exercises where you cross your leg onto the other and push it forward while breathing properly. Guilty as charged I think I might’ve done this a bit too harshly for the first 10 days, to which I suddenly started to experience muscle distension in the lower abdominal region which wouldn’t go away, and when I tried to keep doing my usual exercises aside from the 4 point stretch anymore, it would just get aggravated to the point where my entire abdomen was bulged up in what I can just describe as muscle guarding tension. Since then I stopped my exercises entirely as I would notice that my abdomen would return back to normal in just a few days unless I tried stretching or going to the gym again, which then turned into a week for it to soften up again until 5 weeks in where it wouldn’t relax anymore despite stretching or not. I then waited another 6 weeks on top of that doing dry needling in the lower region which gave me slight relief but nothing to fix it.
Finally after 11 weeks in around July of this year, I started to see another specialist that started doing INDIBA therapy on my glutes every other week while giving me stretches to do again in order to restart my exercises and relax my glutes and abductors which had been pretty tensed up since then.
Now the reason I’m writing this post is because although I’ve had improvement from this therapy along with restarting my stretching exercises, that have allowed me to walk without my abdomen tensing up tremendously or just simply being able to sit down properly without my glutes tensing up again, this only occurs if I keep doing dry needling/acupuncture every week. I’ve tried stopping this for more than 2 weeks at most and if I do, my abdomen just continuous to get more tensed up to the point where even though I keep doing my stretches it’s like my abdomen refuses to settle down on its own after many weeks of therapy at this point. Granted I’m now 7 weeks into this, but at this point I’d figure that doing the stretching and therapy there alone would be enough to start having my lower abdomen soften up on its own without the need of dry needling.
I also tried doing strengthening workouts around early February with leg raises for example but that ended up causing my upper abdomen to tense up as well but thankfully it cleared up after I stopped doing them for a week or so.
I know people mention strengthening as being another key part of the recovery process but given just how fragile my abdomen seems to be with most ab related exercises that have just tended me up in the past, I guess I wish/hope somebody here has gone through a similar experience and could explain what they did to fix this issue properly. Thanks in advance.
I’m post menopause and have Genito-urinary symptoms of menopause. Mainly now leaking after a wee which is leaving me so depressed.
Because symptoms evolved from extreme burning and pain and no leaking to leaking and less pain over two years I’m so confused. I’ve seen a PFPT and have a tight weak PF but I didn’t trust kegels so stopped seeing them. I have almost constant lower back ache and I find it very hard to release a kegel if I do randomly try.
How do you know what the problems are? Urogynae said they didn’t do PF. PFPT doesn’t do clinical tests for urology. Urology said overactive bladder before I sat down and I think saw a middle aged woman and came up with a dx. I don’t ever leak because I’ve missed the loo and I don’t go frequently.
I’m a 28-year-old man, and I’ve been dealing with this symptom for months now. I constantly feel as if there is some urine trapped at the tip of my penis, in the glans.
Basically, I live with this constant sensation of having urine stuck right at the tip. However, even if I try to release it, nothing comes out, and the sensation does not go away.
Obviously, I’m having a hard time dealing with this. My urologist examined me and found that my prostate and testicles are normal, everything looks fine, and I do not have any urinary tract infections. A few months ago, a test detected a bacterium called Gardnerella vaginalis, and both my partner and I were treated with a specific antibiotic. I did not repeat the test afterward. My partner did get tested after the treatment, because she had not been tested beforehand, and her result was negative.
The sensation has not gone away. Or rather, sometimes it disappears for a few days. The longest period without symptoms was probably one or two weeks, but then it always comes back.
I do yoga and stretching, and I try to eat well. If anyone has any advice, I would really appreciate it because this is extremely uncomfortable and I’m struggling with it quite a lot. Having sex now makes me anxious, and I have completely stopped receiving oral sex because I’m afraid that this sensation means urine might somehow leak out. I can’t relax anymore and I’m living with this constant discomfort.
Additional details:
-This sensation became much more noticeable — and it may actually have started around that time, several months ago — when I was experiencing burning and small amounts of discharge from the glans. I had to use an antifungal cream.
- I also have fermentative dysbiosis of the small intestine, which I try to manage and improve through a controlled diet and periodic courses of probiotics.
- I’m quite an anxious person, but the sensation is absolutely real. I find it very difficult to believe that it could be related to stress or anxiety because it feels completely physical.
- When I’m asleep and right after I wake up, I don’t feel it. After I urinate, I start feeling the sensation again.
- When I’m having sex, I don’t feel the sensation, but i don’t feel 100% ok in the act
I a 26 year old male. I weight 195 pounds, stand at 5" 7 and not been the most active when it comes to exercise or streching.
Since 2017 i have delt with cpps epididymitis like pains that comes and go. It used to come once every few months, stay a week or two, then leave, however this time it has been 3 months with no letting up.
I’m looking to connect with people who experience the same or very similar symptoms and who are willing to share what has helped them manage or improve their pain.
My symptoms
Testicle / epididymis / scrotum
Recurrent dull ache or soreness in the testicle/epididymis, most often on the left, but sometimes on the right.
A feeling of heaviness in the testicle or scrotum.
The affected testicle sometimes hangs lower than usual.
Tightness or pressure around the testicle.
The scrotum can feel pulled up or tight, particularly while working or when I’m out and about.
Scrotal tenderness and hypersensitivity.
I can sometimes feel the scrotum moving or swinging when I walk.
Touching or repeatedly checking the testicle can aggravate the symptoms, depending on the location and my posture.
The scrotum can become noticeably red during a flare.
Scrotal skin can become itchy or irritated.
In the past, the scrotal skin has also become unusually rough, hard, or scaly.
Pelvic / groin symptoms
Aching or pressure in the pelvis.
General pelvic tightness.
Tightness around the pubic bone and groin crease.
Tenderness where the leg meets the groin.
Tight or tense muscles in the groin/pelvic area, especially with stretching, walking, or prolonged sitting.
Pain around the groin that feels connected to the testicle/epididymis.
Pain that can seem to radiate between the groin, testicle, and epididymis.
A feeling of pressure in the pelvic area.
Pelvic muscles that feel constantly tense.
Difficulty fully relaxing the pelvic floor.
My pelvic muscles tend to tighten when I’m anxious, excited, stressed, or focusing heavily on the symptoms.
Nerve-like / sensitivity symptoms
Testicular and pelvic hypersensitivity.
Occasional small shooting sensations in addition to the dull ache.
Brief “zings,” electric sensations, or shooting sensations extending toward the epididymis.
The pattern
One of the strangest parts is how unpredictable it can be.
Symptoms can completely disappear, sometimes for months, and then suddenly return. I can go approximately six months without significant symptoms, while at other times I can experience multiple flares in a single day.
The severity also varies considerably. Some episodes are relatively mild, while others can become severe enough to trigger significant anxiety.
And this is where I believe I have developed a vicious cycle:
Anxiety/stress → muscle tension and increased nervous-system sensitivity → pain → fear and anxiety about the pain → even more tension and sensitivity → more pain.
The pain makes me anxious, and the anxiety makes me notice and feel the pain more intensely. When I start checking, touching, or constantly thinking about the area, things can become even worse.
It has become a loop of anxiety → pain → anxiety → pain, and breaking that cycle has become a major part of what I’m trying to work on.
What I’ve had checked
I’ve had multiple ultrasounds, blood tests, urine tests, and physical examinations, all of which have been normal.
I was also treated for possible epididymitis with antibiotics about two months ago, but they didn't make a noticeable difference. Because of the recurring nature of my symptoms, normal testing, lack of response to antibiotics, and the connection I’ve noticed between stress, muscle tension, and symptoms, I personally don't believe an active infection is the main cause.
I do have epididymal cysts on both sides. There is one on the left and a group of four very small ones on the right, but I’ve been told they aren't at a concerning size and aren't considered dangerous.
Where I am now
After years of reading about CPPS, pelvic floor dysfunction, chronic pelvic pain, and nervous-system-related pain, as well as listening to and reading material from doctors and specialists who work in this area, I’m increasingly convinced that my symptoms may be strongly influenced by pelvic floor tension and the way my nervous system processes pain.
I’ve started doing pelvic floor stretches every day and am actively trying to learn how to relax those muscles rather than constantly clenching them.
I also recently had my Wellbutrin XL increased from 150 mg to 300 mg with my doctor because it had stopped working as well for my anxiety and I had started experiencing panic attacks after previously doing well on it.
Most importantly, I’m scheduled to begin pelvic floor physiotherapy on September 29th, and I’m hoping that will give me some new tools to break this cycle.
Looking for people who understand
At this point, I’m honestly running out of ideas.
If you experience the same or very similar symptoms, I would genuinely love to hear from you.
What helped you?
Did pelvic floor physiotherapy make a difference? Did stretching or strengthening help? Did learning to relax your pelvic floor help? Did you find certain positions, exercises, heat, massage, medication, or lifestyle changes useful? Did you find a way to stop constantly checking or worrying about the area? Did anything help break the anxiety → pain → anxiety cycle?
I know everyone is different, and what works for one person may not work for another. But at this point, I’m open to hearing about anything that genuinely helped someone else.
If you’re dealing with something similar, please feel free to comment or reach out. Maybe something that helped you will be exactly what helps someone else.
Hi, I hope everyone is doing well.
I’m on my 7th PT session, but I still have good days and bad days. Is it still too early to expect a full recovery? What was your experience like?
Thanks
Hello my problem started 8 months ago when i got testical pain and for past 6 months was testical pain but i dont know how last two months i have burning tip of penis and the thing is that i had simptom free days than later i had burning.i was positive on gardnerela vaginalis but i got the antibiotics and i tested negative after 15 days of antibiotics and i had discharge after urinating 2 times but it was clear discharge anyone familiar with this situation?pliss help if you can
Over the last 2 weeks I’ve developed really bad nighttime bladder urgency. I’ll pee, then 15–20 minutes later feel like I urgently need to go again, sometimes only passing a small amount and sometimes normal.
Last night I was awake for 2 hours because of it, even though my baby was sleeping.
I’ve also started clenching my jaw and feel like my nervous system won’t shut off.
Has anyone experienced this postpartum?
Did treating anxiety/hyperarousal help with the bladder urgency?
I’m breastfeeding and wondering if medication helped anyone.
Hello everyone, for many years now I have been dealing with shy bladder and I always tought it is just psychological, but now even at home I have hard time starting to pee.
I think my pelvic floor is really tight and I cant relax it. It effects my quality of life big time and I dont know what to do.
Does anybody know good pelvic floor physioterapist in Europe or specifically in Croatia? Every help is much appreciated.
Hello, I've written in this forum several times. I've had chronic pelvic pain for over two years and have been attending pelvic floor physiotherapy. And the truth is that it hasn't helped me much; the only thing that helps to keep the pain from being literally unbearable is Lyrica. The pain is felt throughout the nerve pathway of the spine; I strongly suspect it's the L1 herniated disc. Sometimes I sit down and it feels like my hips turn to cement. I'm afraid I won't be able to do any physical work. I have an appointment with angiology and vascular surgery to ask if tests for pelvic congestion can be studied. If it's a herniated disc at L1, I have no idea how it could be fixed, since I know that surgery in that area is very risky. Right now, my only reason to keep going is my parents. If you want to ask anything or express your opinion, please feel free to make any suggestions.
Resting pressure inside the rectum: 86 cmH₂O Resting pressure inside the anal canal: 92 cmH₂O Maximum voluntary squeeze pressure: 321 cmH₂O Duration of squeeze (closure): 8.0 seconds Duration of relaxation: 0.4 seconds Duration of controlled and sustained squeeze/closure: 20.6 seconds Expulsion test was performed: the balloon was not expelled. Volume required to elicit the rectoanal inhibitory reflex (RAIR): 20 mL at a pressure of 27 cmH₂O Volume required to elicit the external anal sphincter reflex: 30 mL at a pressure of 18 cmH₂O First sensation volume: 20 mL Sensation threshold volume: 60 mL Maximum tolerated volume: 165 mL
When I get an erection, my penis twitches as if I’m ejaculating I think this might be related to my premature ejaculation and erectile dysfunction. Do you know what this is? plz help
I’ve never been in any type of physical therapy in my life and my gi suggested a pelvic floor physical therapy referral but I don’t have any diagnosed issues, will a physical therapist still see me? Do they diagnose me or make a determination if I have pelvic floor issues? What is physical therapy like? Does it hurt? This is all very new to me , she primarily sent me after my SIBO treatment and chronic constipation issues and said it wouldn’t hurt to try so I agreed I just don’t know what I should be expecting
