10 Weeks Suffering with Pelvic Pain
February 10, 2015 1:19 AM   Subscribe

You are not my doctor, but if anyone could possibly shed any light on what I've been dealing with for the past 2+ months it would be greatly appreciated. I'm a 38-year-old male and my symptoms appear to be urological in nature, but I'm not certain as to the root cause. I've visited three urologists, a chiropractor and a physiotherapist, but to no avail.

A timeline of events:

• Began feeling discomfort, tightness and tenderness in perineum in early December, along with moderate burning after urination.
• Visited a urologist for a urine test which indicated an elevated white blood cell count. Was given antibiotics for a possible UTI. 5 days on antibiotics didn't solve the issue.
• Took a long-haul flight two weeks later. Following the extended period sitting, the symptoms became much worse, progressing to pain after urination and now after ejaculation.
• Had another urine test and bacterial culture done in late December, which turned up no sign of infection or STD. Had a digital rectal exam for prostatitis and was told that my prostate felt normal.
• Visited a chiropractor in early January who suggested possible non-bacterial prostatitis/pelvic floor tension. Was given stretches and exercises which only exacerbated the pain.
• Saw a physiotherapist in late January who thought it was sacroiliac joint dysfunction. Was given more stretches and exercises to do, which again amplified the symptoms.
• The pain is better when lying down or in a hot bath and exacerbated when sitting.
• The symptoms wax and wane. Sometimes there is burning after urination, sometimes there isn't. Some days are better than others but the tightness when sitting (akin to sitting on a golf ball) has remained.
• Symptoms that I still have: tenderness in the front of perineum when sitting, occasional burning after urination, a dull ache in both testicles and a red rash on the tip of the penis after urination/ejaculation, lower back pain and very tight gluteal muscles.

Given that urine tests/cultures have shown there to be no problem, I'm really at a loss as to what could be causing this. I am under a lot of stress and anxiety at the moment (that began before these symptoms started and has only worsened as a result of them) and suspect that may be a contributing factor.
posted by Tenacious.Me.Tokyo to Health & Fitness (6 answers total)
I've had chronic prostate trouble, and a lot of this sounds familiar. The burning when you pee and some of the other symptoms, and the fact that it feels better when you take a hot bath, makes it sound more like a urological thing than a joint problem.

With non-bacterial prostatitis, I've had episodes where I felt just awful and nothing showed on lab tests, and other times when I felt middling and the results came back with an elevated WBC count. I remember a doctor telling me that it's a bitch to treat. I am not sure this is what you have, but I've had a whole lot of the symptoms you describe and after years of pain and tests doctors pretty much gave up and called it a weird prostate thing. If you are not peeing constantly, or struggling to pee, consider yourself lucky! For me that was always the worst symptom. Prostate stuff can make your taint and balls hurt, and do all kinds of freaky things.

Stuff that can't hurt to try: avoid caffeine and spicy foods, if you're not already. Take a hot sitz bath. The sitz helps, don't ask me how. Drink some cranberry juice, and lots of water. Ask your doctor about Flomax. It shrinks the prostate, and has helped me feel better. Also, if you're wearing boxers, try briefs. They'll keep you snug, and may lessen the ball pain.

Again, I don't know for sure you've got the same condition I had, but it sure sounds familiar. Good luck!
posted by Ursula Hitler at 2:14 AM on February 10, 2015 [1 favorite]

It sounds kind of similar to Interstitial Cystitis, which is an elusive beast and, in my experience, definitely triggerable by stress among other things.

This page I found says: "It is claimed that many more men have interstitial cystitis than is appreciated and are often misdiagnosed as having other conditions such as prostatitis."
posted by greenish at 5:08 AM on February 10, 2015

Yes, it sounds like Interstitial Cystitis to me also. It may be a good idea to keep a diary and record what you were eating, drinking, and doing before the symptoms get worse. There may be some trigger you're missing.
posted by Lingasol at 5:14 AM on February 10, 2015

Did you ever have any imaging done, like a sonogram or CT scan? I had a similar experience--not pelvic--and a panoramic x-ray found a grape-sized cyst that otherwise wouldn't have been otherwise apparent. It might be worth asking your urologist about it as an option, since it seems your other diagnoses haven't yielded you much relief. A sonogram would be much less expensive and simple than other kinds of scans, but I'm not sure if your doctor would consider that a useful exercise considering they know more about the prevalence of specific maladies in the region than I do. But still, it's one of those things that non-physicians seem to think of up front--scan me, bro.
posted by late afternoon dreaming hotel at 9:04 AM on February 10, 2015

Chronic prostatitis is a difficult problem to treat and there are not usually any abnormalities on urine testing. Definitely go back to the doctor to tell them how long this has been going on.

This isn't the sort of thing where if they didn't get it right the first time you saw them, there's no point in seeing the doctor again - the duration of symptoms and the fact that the initial treatment didn't work will give them more information to narrow down the differential diagnosis.

This does not sound like a problem that a chiropractor or physiotherapist would be useful for. Muscular problems do not cause pain with urination or rash - sounds more likely to be signs of inflammation. Also, not sure what the situation was at the physiotherapist but the location of the pain and the other symptoms make it sound very unlikely to be related to your SI joint.

You might be interested to note these previously questions from others in similar boats.... you might see some things that look familiar.
posted by treehorn+bunny at 9:14 AM on February 10, 2015

There are a huge range of symptoms that can be caused by tight pelvic floor muscles, including pain on urination, perineal pain and pain in the testicles. Prolonged sitting well make the tension worse, stress and anxiety will make it worse, and worryng about your symptoms will probably make it worse.

If you want to know more, check out The Trigger Point Therapy Workbook, A Headache in the Pelvis, or Teach Us to Sit Still. Or Google "pelvic floor trigger points". There are lots of people in internet land who know a lot about this from first hand experience.

If you want the standard medical view, then look up "chronic pelvic pain syndrome".

But by far, if the doctor says nothing is wrong, the best thing is not to worry. Not that he's right - there IS something wrong, but it's muscular and stress related, so a doctor will be of no use to you. If you wanted to throw money at it, you could track down a physical therapist who does intrapelvic massage.

Be wary of exercises that involve muscular contraction, such as kegels, as they may exacerbate the tension.

PM me if you're interested in knowing more. I don't have answers, but I have some personal experience and lots of theories.
posted by UncleCaveMan at 12:38 PM on February 13, 2015

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