Health Organization for Pudendal Education

I've found quite a lot of trigger points myself now. They're all around the 12 o clock position near the sphincter. I think it's going to take a long time to release them all. I've been doing the internal massages myself and things are improving slowly. The bowel movements are getting better, things are opening up there now. I think I'll continue the massages myself, my physio doesn't use much pressure which is why I missed these trigger points.
Also in the Amy Stein book she said not to massage that area, how wrong she was!

I'm seeing the urologist tomorrow, I'll only use Botox as a last resort.

I have hope now. I always knew there were trigger points that I was missing.

I know what caused the tightness in the sphincter area.

This whole problem started when I was trying to become more flexible. I was trying to touch my toes. I was reading a book by this Russian guy who said you should clench your buttocks (like you are try to hold a coin between them) and then release. This fools your nervous system and when you release you will stretch further. It does work.

But me being the impatient idiot that I am, I thought I'd speed things up by using a weight in my hands to stretch further. This must have over stretched my sphincter and surround muscles.

A couple of days later I had this burning feeling around my anus and perineum. It was constant. I was working in Ireland at the time, I flew back home after 2 weeks, I masturbated and went to sleep in my nice comfy bed. I woke up the next day and the pain was gone. I was so happy. Then disaster struck, I went back to work on Monday, had a very stressful day and spent 13 hours there, most of which was spent sitting. Since that day I've never been the same. I've had tightness and pressure in my rectum, a lot of which was relieved by massaging the external sphincter muscles. But now I think I've found the culprit are for the remaining tightness.
I always knew it was internal because whenever my bowels were full I could sit with next to no pain. Because something was being stretched inside.

It probably is the pudendal nerve being trapped because I get the penile numbness and tingling when I sit for long periods.
Once the tightness goes, I will be cured. It may take a month or two but I'm now hopeful.

Wow this sounds great - I hope it all comes out as you plan. Good luck and keep us posted.

I'm 95% certain I have levator ani syndrome. More specifically the puborectalis is spasming. It all makes sense now.

I have obstructed bowel movements. The stool just doesn't pass through the area of the puborectalis, on the rare occasion it does pass I get pain but also a feeling the tension is released momentarily.

When I sit on the toilet too long it burns. When you sit on the toilet your puborectalis is stretched open. But because mine is so tight it cannot open, this is likely due to the trigger points. Again although it burns, i feel the tension/pressure is released momentarily.

The tension is felt between the 11 o clock and 1 o clock positions. This is the puborectalis.

When my bowels are full I can sit with no pain, this must be stretching the levator ani.

If I pull my lower butt cheeks apart I feel a release of tension.
If I do any activity which puts pressure in that area, like sitting or even a pushup I get pain. If I sit with my cheeks open I get a lot less pain due to the levator ani being stretched.

What do you guys think about my symptoms? Do you think I'm right?

My previous physiotherapist even told me my puborectalis was tight.
I've switched physios now. The new one is so much better, she's more vigorous with the internal massage and is full of knowledge.

I hope I respond better with the new physio.

I do hope the new physio can release the tension and stop the spasms. Having 3 rounds of levator ani I know how painful it can be, you are doing a great job researching and getting the help you need. Thanks for the update and maybe 2012 will be the road to better days ahead. I finally started working 6.5 hour days and hope to get up a bit more so the paychecks are higher and I am at least appearing to be more on the full time path than going part time. Four more years and then I can retire.
Janet

Yes I hope 2012 will be the year I get my life back on track. 2011 was the worst year in my life. It truly was my Annus Horribillis, no pun intended

One symptom I have that is not explained by levator ani syndrome is penile numbness/tingling when sitting down. But again this symptom disappears when my bowels are full. So again a muscle being stretched resolves the problem.

I think I've made the wrong diagnosis again.

My brilliant new physio examined me thoroughly today. It appears the root cause of my problem is a tear in my internal sphincter, a fissure. She's found a lot of scar tissue in the internal sphincter, which hurts when touched. It reproduces the initial burning pain I had when I first had the problem.

This in turn has caused the sphincter to spasm. This tight sphincter is probably pinching a nerve which is causing the tingling pain in my sphincter and also penis.

Other things which support my theory. I have lost the ability to pass wind silently, this points to a tight internal sphincter.

When my bowels are full I can pass wind silently and sit down without pain because my internal sphincter is being stretched.

Whenever I have a bowel movement the stool will not pass through the area where tear is. And if it does it causes a burning pain as opposed to tingling pain, and it will also release the tightness feeling momentarily.

I also had lots of trigger points in the external sphincter, when I massaged this area it gave me a lot of relief and got rid of 80% of the tightness I feel.

The pain I get is in the sphincter, I think in levator ani syndrome, it's higher up.

Whenever I do get pain I always found massaging the sphincter helped.

My doctor will be referring me to a colorectal surgeon who I hope will help me get rid of this problem.

It's so important to have a good physio who is detailed, has good medical knowledge and listens to you.

Hi Reckless. I hope you are well. I haven't posted for a while, but you may remember that I have very similar symptoms to you.

Like you, I have desperately sought answers. Over the last 15 years I have sought advice from GP's, dietitians, specialists, even hypnotherapists. I think now I have a fair understanding of what is going on. This doesn't mean I am confident of finding any answers!

I have always thought your symptoms sounded like Levator Ani. From what I understand this is consistent with a tight pelvic floor/pelvic floor dysfunction. Do you feel pain 'up' inside, somewhere you cannot really touch... as if you are sitting on a tennis ball?

This is what I have been diagnosed with. However, I am not convince that the cause of my problem isn't PNE and the symptoms follow. I have been told that I am holding my pelvic floor up subconsciously. but I think there may be a physical cause.

Can I ask about your bowel motions? Sorry to be graphic, but are they solid or messy? Mine are a complete mess, but even when very wet take me ages to pass. I am spending up to 3 hours on the toilet at the moment trying to get empty. Now I have urinary problems as well!

tummydepressed wrote: I have been told that I am holding my pelvic floor up subconsciously. but I think there may be a physical cause.

Perhaps at some point there was a cause, perhaps an actual infection that antibiotics cleared out and even though the infection was gone you still "guarded" yourself by involuntarily tensing up your pelvic floor muscle out of habit.

I have levator ani issues which is causing my prostatitis and symptoms. I got this from compulsively flexing my pelvic floor as some sort of guarding mechanism... I was a nervous and anxious kid so that may of been the cause but who know, I had an awful diet as a teen so perhaps some sort of infection triggered all this. In any case the very fact that you can drop your pelvic floor muscle on command shows that there's nothing physically making it flex up, only your subconscious and your compulsion to flex it. Just a habit that can be broken and reversed is all. Just kind of always has to be on your mind until you get the proper physical therapy to loosen all the tight tissue and muscles in the pelvic floor. I've been doing this for about a month now and have noticed a difference... definitely a reduction of pain but I keep in mind this is something I have been doing for 5 years and rehabilitating my tense and sore muscles will be a long process. Anyway good luck all and drop those pelvic floors!

This is definitely a fissure not levator ani syndrome.

Can fissures somehow affect the pudendal nerve?

I'm confident that as soon as the spasming internal sphincter and fissure go away then I will be better.

The pudendal nerve innervates the external sphincter so hopefully you will not have any PN involvement. I'm glad you found a PT who was able to help you figure this out. Please let us know how this resolves for you.

Take care,

Violet M