Ivan was self referred to us (after reading the website) due to right sided testicular pain and pelvic pain upon sitting. He is a 34-year-old male with a supportive wife and a medical history of prostatitis and hemorrhoids. He is a technology manager, which requires him to sit daily. His other symptoms of urinary urgency/frequency began 1 year ago. At that same time, he and his wife were having intercourse very frequently to conceive and he experienced pelvic pain the entire day after intercourse. Ivan’s urologist referred him to a physiatrist (a doctor of rehabilitation) where he was incorrectly diagnosed as having a “groin strain”. Hip massage and trigger point needling were not helpful. A pelvic ultrasound revealed varicoceles. Ivan was seen by another urologist and given a 30-day dose of antibiotics. His symptoms improved a little but later persisted.
Initial intake with us revealed normal urination frequency of every 2 to 4 hours, normal BMI (body mass index), healthy diet and normal bowel habits of 2 daily. Because he is in a rush at work, he bears down to evacuate his bowels faster. He rated his stress level as moderate due to his work and inability to conceive with his wife. Ivan’s pain level was 3 out of 10 and worsened with prolonged sitting and intercourse. His pain improved with exercise, abstinence and after a bowel movement.
Ivan’s orthopedic evaluation revealed an uneven pelvis (called a pelvic obliquity), decreased flexibility lower quarter muscles, impaired sensation along his hip/thigh region, mild impaired hip range of motion, and mild visceral mobility restrictions.
His pelvic evaluation revealed left-sided superficial pelvic floor muscle pain/tightness, peroneal body tightness/swelling and moderate to severe deep pelvic floor muscle pain. Palpation of his prostate caused penile tip pain (a reproduction of another symptom). Ivan had very good strength in his pelvic floor muscles therefore his main issue was pain, shortening or tightness, and perineum swelling. His sEMG biofeedback testing confirmed hypertonicity at 8.07 uV, whereas normal is considered below 4 uV. Special nerve tests revealed tension along both pudendal nerves.
We referred Ivan to a top urologist, Dr. David Kaufman, in NYC who also specializes in pelvic floor muscle pain/pelvic pain. He confirmed the pelvic floor muscle dysfunction but also thought another course of antibiotics was indicated to further treat the ongoing prostatitis. The frequent intercourse seems to have been a cause or at least a perpetuating factor of the chronic prostatitis issue.
Physical therapy treatment for Ivan has consisted of manual therapies to realign his pelvic gridle and resolve the lower quarter muscle imbalances. Specific manual techniques to reduce swelling and resolve his pelvic floor muscle dysfunction have proven to be beneficial already. Neural tension releases have helped ease compression off of the pudendal nerves. After 4 sessions to date (August 31, 2010), Ivan is now able to sit at work! The intensity of his testicular pain is now 1-2 out of 10 and there are times of the day where his pain abates completely. Specific manual visceral techniques to his colon and prostate have lessened his penile pain and his sensation of bladder urgency/frequency improved. A bowel retraining and education program was implemented. Ivan no longer bears down for bowel movements and has improved his dietary fiber intake. Ivan is taking daily baths at home to relax the pelvic floor muscles and is performing prescriptive therapeutic exercises and stretching exercises at home. He has been asked to abstain from intimacy for another week or two until his symptoms resolve further.
We are off to a great start! Stay tuned for a progress update soon…..