Health Organization for Pudendal Education

I am new here. I began seeing a PF therapist 5 years ago after chronic prostatitis. I am a 55 yo male. The therapy always seemed to get me out of my symptoms of frequent uriniation urgency etc.

This year took a turn for a nightmare for me personally. My typically gentle and slow going therapist got more aggressive. She must have found an intense trigger point at the internal sphincter and it was like an electric shock went through my whole body when she touched it. My therapist felt it and said it was a trigger point in the muscle.

I have been in pain and discomfort ever since and that was 6 weeks ago. I started having difficult bowel movements with thin stools. sensation that stool is there but no movement. had to get squatty potty. Irritation with bm. and a burning sensation and rectal pain.

I never had these symptoms until six weeks ago, like I am sitting on a golf ball. Where do I go from here? A colorectal surgeon to rule out cancer etc? I can't seem to find a comfortable position. I sleep on my back and the pressure on my sacrum makes the dull ache in my rectum worse.

MY PT says the sacral ligaments are inflamed and the PN is irritated. I have piriformis syndrome and she thinks I should get the hip x rayed in case the labral is torn?
If anyone can ease my anxiety over this I would be grateful. I hate the idea of going to a Colorectal doctor but it seems that rectal discomfort requires that I go?

I have never had an MRI of the low back and coccyx so perhaps a Physical Medicine doctor would be a better place to start to do an MRI first? I'm really anxious and confused. I take clonazepam and advil and that seems to help. But I find it very stressful to go to work with this constant worry. thanks for reading if you made it this far.

I think it's reasonable to have other possibilities ruled out with an MRI and you could see the colorectal surgeon to make sure there isn't something obvious that got missed, but I would not go into that appointment with huge expectations just based on the experiences I have read from other people who saw colorectal surgeons. Ruling out a labral tear makes sense too. I think it's smart to approach it from all angles so you don't miss something.

What about your SI joints -- is there any dysfunction there? Pelvic instability? I have had piriformis syndrome off and on related to SI joint dysfunction and a few injections of prolotherapy at the SI joint area helped. I also used a TENS unit 2 hours a day to calm down the piriformis muscle and that was really helpful. You could also try some alternating hot/cold sitz baths to ease the tension in the pelvic floor muscles and rectal area.

Violet

thanks for the feedback. Yes, I have hip instability and SI joint inflammation. I have 2 different PT's one for PFD and the other to just work on all the tender muscles and ligaments of my lower back. MY QL was really bad a few months ago before all this started. I had an MRI of lumbar spine 5 years ago that showed deterioration of discs especially at L5 S1. I then found out I had Lyme Disease to I went off on a different type of treatment and my PT took weeks to get my lumbar and lower back to calm down.

I guess I am wanting to run to a colorectal surgeon because I have never had rectal pain before. This burning pain has concentrated after my PF therapist hit that spot on the internal sphincter that almost sent me off the table. I guess I have to be careful because I started going to the gym and was lifting weights. I have celiac disease and osteopenia so I have to keep my bones from getting worse.

I have read that people with PN/PNE have searing pain when sitting, mine feels like a dull ache and then burning. But I can check out the list of doctors on here as I live close to NYC. There is also some physiatrists and physical medicine osteopaths near me. Good advice to do an MRI first and then go to colorectal. Columbia Pres Hospital has a colorectal department with pelvic floor specialist. It says they do sacral nerve stimulation as well, so I thought that was progressive for colorectal doctors.

Hi Gfguy,

A good colorectal doctor is Dr. Nipa Dilip Gandhi. She is in midtown west (I forget what hospital she is affiliated with). She can do a basic exam to check for internal fissures/hemorrhoids. She can also tell you if the spot you are referring to is a trigger point or whatever it may be. She is also a very nice doctor.

Another good doctor in NYC is Dr. Eric Goldstein (he is actually a gastroenterologist), but he does rectal manometry testing which can be used to look for issues with your sphincter muscles and other neurological problems in your rectum. It is not a comfortable test by any means, but it doesn't last long and it's worth while doing it to narrow down your quest for answers. He is also very nice as well.

Hope this is helpful.

~ Buttercup

Thanks buttercup, for the referral.

I was going to see a local physiatrist, but I am wondering if I should see a PN/PNE specialist. The ones listed for NY are radiologists it seems, so not sure if you go to them for the MRI
or if you bring them the MRI results to them.

thanks again.

Hi,

I think if you are wanting to go to a radiologist, you could bring your prior MRI with you and then they may order a new one if they aren't satisfied with your original MRI. It depends on what type of radiologist they are. From my experience, interventional radiologists see patients, but basic radiologists just read films and don't meet with patients.

For example, someone like Dr. Potter (PN expert) --- I think she just reads MRIs and doesn't meet with patients. So you would then get an MRI done at HSS and ask that Dr. Potter be the radiologist to exam the images. But, I think you need a referring doctor for an MRI to be ordered at HSS in the first place.

~ Buttercup

I had this same issue although not caused by a PT. Getting checked for anal fissures or 'roids is a good idea as fissures especially can cause both sharp pain and dull aching and cause the sphincter to spasm causing intensive pain, foreign object sensations and thin stools. Your PT could have been pushing on a fissure...that would be intensely painful. It could be a "rebound" issue. Sometimes if you try to massage out or stretch a very tight area, it can rebound even tighter....an example being spasms after bowel movements, forcing BM through a tight space causing it to rebound even tighter. What you describe sounds pelvic floor dsyfunction but it may not be PNE.

The hip could def be causing issues. I had rectal pain, terrible SI pain, pelvic instability, back pain, and more that resolved after hip surgery even though the dr and PT swore up and down that they were unrelated. If your hip is unstable and you have instability elsewhere in your pelvis particularly (or have a weak core), your body will recruit other muscles and soft tissue to do what the hip should do but cannot. You can't see a labral tear on xrays. You'll need a MRI with arthrogram (constrast injection) or a 3t MRI (most places only have a 1.5t machine). Groin pain, back and knee pain, SIJD can all be signs of hip issues; your hip may not even hurt, it can be everything else around it. You may be essentially overusing your rectal muscles because your other core muscles are too weak or hypertonic.

Another issues is a tight back. If your back is tight and esp if you have marked lordosis (arch in your lower back), that can cause rectal issues. My PT always had to remind me that if I was having rectal pain, I needed to my exercises to "turn off" (NOT stretch) my back. If your lower back is arched, then you are basically pulling your tailbone upwards and all those muscles and tissues are going with it. You can feel this if you put your hand on your tailbone and arch your back and then round. Making sure your back is "off" and your pelvis is in neutral will help recreate space for your rectal muscles to be and relax. Postural Restoration PT is so great for this...helped me a huge amount after so much had failed. A good exercise you can find online is the "90-90"...good for shutting off the back, repositioning pelvis into neutral, getting hammies on so they pull back your hips into correct position and more but you have to do the breathing...that's what gets the back to shut off. Another thing you can try is putting something like a small rolled up towel or a wallet under your left knee when you sit. That can help tailbone and sacrum pain in a lot of people. Of course, it's best to see a Postural Restoration PT so he or she can do an eval. I can't recommend this type of PT enough. I had severe rectal pain and spasm issues for a long time, and I rarely ever have those issues anymore.

If I could go back to when this started for me, I would not scare myself reading about PN. I made things a lot tighter down there because of the severe anxiety and fear. I would also stop straining or pushing trying to have BMs. Stop trying to get the rest out. Remind yourself that your brain is lying to you amd straining will be far more harm long term.

Good luck.