T Nation

Perineum Nerve Pain


#1

Hi

I'm a 39 yr old guy with a 3-4 year background in crossfit, a little cf football and more recently playing around with Coach Rut Fitness Conduit wods at crossfit kc.

In the last year my training has been inconsistent and came back on to the Fitness Conduit 3 day week program comprising at present low rep heavy work then metcon.

About a month ago I got pain in my left testicle, lower abdomen and what felt like kidney area, had it checked - took antibiotics and got an ultra sound, was told no testicular problems but got a urological referral which is due for late Dec, as I think I've had three non STI testicular infections in last 10 years which I was told was rare for males - I say 'think' because after treatment with antibiotics the problem went away. The pain started a couple of days after doing a sprint/kip pull up/heavy dumb bell swing workout.

Within two weeks of the initial problems I started getting pain on the left side of my penis and numbness in my right testicle along with the pain in lower abdomen. I was checked again with ultra sound and advised no testicular problems (blood supply fine) and that the problem may be neural emanating from my spine. Shortly prior to this starting I had done some heavy clean and jerks, hang power cleans, front squats and dead lifts. I was given another more powerful antibiotic to rule out infection.

Last weekend I was doing some bar muscle ups and squats and included in my warm up some chi gong style spinal twists (turning as far left and right as possible). On Tue I started getting pain from the back of my testicles across the perineum into my anus. The pain moves back and forth and sometimes across the whole area. My anus often feels cold or full. At present it feel like a have a object pushing from my anus through into the back of my scrotum.

I've been to see a private dr as my dr told me that there long waiting lists for public mri/neurology assessment. I've had a lower spine area MRI and am awaiting results. In the last three days I've had for the first time in my life what I would describe as panic attacks. Which I'm concerned with also affect my work. Luckily I have a very supportive wife.

Any thoughts, advice welcome.

I think the cause is that I've come back from time off too hard, with too much weight and compromised form.


#2

Read those lines you wrote and think about it. It seems that your pain is being caused by excessive exercise like you said. However, it doesn't seem like you have taken time off to let your pelvic floor relax.

Read my comments in this thread and do some searches on T-Nation with words like pernieum, pelvic, groin pain, etc.

http://tnation.T-Nation.com/free_online_forum/sports_body_training_performance_bodybuilding_injuries/compressed_perineum

Your symptoms have been experienced by a lot of people on here (including myself, I dealt with this for years before figuring out it was muscular, mobility, and exercise related).

Best of luck to you. For now, the best thing you can do is take a break from crossfit (for a month or so), learn, and reassess its usefullness/impact on your pelvic health.

If you have any questions, let us know.


#3

Most grateful for yr advice BIA, will rest for a month, only walk for exercise and let you know if it helped.

Forgot to mention that I was addicted to mountain biking from my teens to late twenties, clocking up hundreds of miles a week on and off-road mostly on a nasty hard small sharp seat.

The other exercises I'd been doing recently included weighted dips and weighted pull ups.
Will be really hard to give those up.

Thanks again.


#4

Don't mention it. Let me know any additional questions you have. Lots of people are great on the Injury forum and will surely chime in.

In regards to biking riding that much, it's always a mistake. Even with the best bike seats, you will be putting pressure on that area. It simply wasn't designed for that kind of abuse.

My recommendation would be to give up bike riding (if you're still doing it) for the time being. Also, even weighted dips and pullups will put stress on the pelvic area. You really need this time to fully relax. Short walks and some light mobility work a few times a week will serve you well and point you in the right direction. Also, do you best to relax during this time and stay off internet forums (ironic I know). This will only increase your stress during this period as there are lots of people experiencing these issues. Nobody seems to discuss in any of these forums how exercise is related to this issue. I was like you and did a lot of cleans, back squats, front squats, deads, farmers walks, etc. Think about it. All these exercises are stressing the hell out of your pelvis. Your body will respond by tightening this area (just like if you did a ton of shoulder work for example).


#5

I've ordered Amy Stein's book on Pelvic Pain to check out her take.


#6

Points taken! Never thought about the stress on the pelvis, we take that area for granted.
Going to miss training, but anything to alleviate the pain.

One further thought - the specific perineum pain began after making love with my wife, I'm guessing this was the final straw in terms of tightness. Thinking sex is on a moratorium for a month too, though pain i m in at present its the last thing I'm thinking about.

I'll keep eye on here but avoid other forums - already scared myself on sites related to p nerve surgery.


#7

The pain from perineum nerve/muslce(?) after urinating was so intense that i was doubled over on the floor just now, shaking for about 5 minutes. Has anyone else experienced this?

Have to wait until Monday for discussion with my Dr.


#8

Yeah, having the pain you're talking about (especially the side of the penis pain) makes sex the last thing on your mind. Don't worry though, you will get better with time. Regarding surgery (especially for pudendal nerve issues)... DONT. I have not seen enough evidence to warrant these types of surgeries. Some of them are insane. I've read ones that take 3-5 years recovery time to see if they were successful... no don't do this. Don't even read about this. Rest, mobility, and proper exercise selection is all that is needed once the doctors confirm if there are any other strange issues occurring.

If the symptoms don't improve during this time, I would be surprised. But that would definitely NOT warrant surgery (or any type of surgical exploration).

Have a good weekend!


#9

Yes, this is because these muscles are involved during urination (as well as other "activities").

http://www.google.com/imgres?imgurl=http://radiographics.rsna.org/content/23/4/951/F2.large.jpg&imgrefurl=http://radiographics.rsna.org/content/23/4/951/F2.expansion&usg=__oCiA1uT5uIKQDtg0ojLv7vZUp1c=&h=1063&w=1280&sz=326&hl=en&start=0&sig2=xTFqBWLTJFo_XNowNYQ9WA&zoom=1&tbnid=91IpvRZf7yAmkM:&tbnh=120&tbnw=144&ei=RV3oTLVIi5ucB6GjrPcM&prev=/images%3Fq%3Dperineum%26um%3D1%26hl%3Den%26client%3Dfirefox-a%26sa%3DN%26rls%3Dorg.mozilla:en-US:official%26biw%3D1440%26bih%3D694%26tbs%3Disch:1&um=1&itbs=1&iact=rc&dur=346&oei=RV3oTLVIi5ucB6GjrPcM&esq=1&page=1&ndsp=34&ved=1t:429,r:14,s:0&tx=54&ty=37

BTW, the pain on the side of the penis is most likely caused by excessive tension on the ischicavernosus and bulbos muscles.


#10

BIA yr responses are profoundly reassuring, can't say how grateful I am for yr thoughts.
Feels like the penis pain is mostly on the vein on the left, guess that could be affected by the ischicavernosus and bulbos muscles - I'll ask my doc.

Going to try to sleep.


#11

No problem at all :slightly_smiling: Here are a couple other things:

  1. Female pelvic health is different the male pelvic health. From what I've gathered, their treatments deal mostly with relaxing the pelvic floor mentally. While ours tightens up for that reason, a lot of it is due to the way the body handles outside stress (sitting too much, too much exercise, straining during a heavy lift). Treatments are a little similar, but guys need far more mobility work as our "stuff" is surrounded by muscles.

  2. Regular GPs don't know much about pelvic related problems. If you mention the ishicavernosus muscle, don't be surprised if they don't know where it is. I would bring that picture as a print out and point there (I've had to do that). Whenever you deal with doctors, always show them EXACTLY where the pain is both on you as well as on chart. After that, most likely they will check your prostate (definitely important) and do a urine test to check for an infection. If everyone turns out good, the next stop would be a urologist to look for anything abnormal (if doctor recommends it). Don't buy into the idea that this is non-bacterial prostatis until we've tried all the mobility and relaxation work.

  3. This whole thing is reversible. As long as you get checked out for other abnormalities, it's pretty straightforward with what this is. If you were inactive, that's one thing, but since you're doing crossfit, it kinda points us in the direction that this is a pelvic musculature problem.


#12

chockers,

Were you riding a hardtail mtn bike? Or a FS? I hate hardtails!


#13

Hard tail - still have same bike - Kona Lava Dome, same frame, bars, rims, just chainset/crank which have been replaced numerous times. Also I had a small frame (16 inch) with a really high seat post which anodysed into the frame.

Now this part will sound really stupid which it was - my son is now almost 12, he's a gymnast, small and light but I used to ride around with him on my back when he was 3-6 years old on this bike with the narly seat.

In last couple of years I havent been doing much riding, but did get a 2nd hand Sinclair a-bike (smallest bike in the world) for my 39th birthday - I rode it for about 25 minutes before it got a flat tyre, that was two weeks ago. It has the worlds hardest narstiest seat. Plan to sell it on as its practically unrideable.

www.abikecentral.com/aboutabike.html - not advertising, just giving you an idea.

Hardly slept last night due to pain despite taking paracetamol and diclofenac.
In so much pain just under and into the back of my testicles and left lower abdomen that I'm heading to my local accident and emergency again.

BIA I've printed out the image you kindly posted and yr advice, will discuss when I get there.

Wish me luck! :slightly_smiling:


#14

Steel frame/seat post is now over 20 years old.


#15

Man riding a hard tail is like getting kicked in the taint! lol Id sell it too. Rear shock technology is so good now! I was thinking of getting a road bike, but this thread has got me thinking..

This is just my personal experience with crossfit. I get tons of injuries from doing it.


#16

Well with hindsight (no pun intended) I would avoid riding entirely unless it was a recumbent and those are more likely to get you run over.

My trip to Accident and Emergency was to no avail - I'm not at deaths door, so was told to go see my doc again tommorrow. Hospital doc said could be pudenal nerve or prostatis, but felt symptoms didnt fit this the second.
Got myself codeine/paracetamol and gel diclofenac. Can't even walk normally now, as result of pain which is wrecking my lower back. Time to relax methinks. BIA I showed the doc the image, he wasnt interested, will discuss the private dr who will respond to mri.


#17

BIA I've been thinking about the tightness issue you've elabourated in detail:

I travel throughout the day as part of my job by car and often have to hold tight onto a full bladder as I drink fluids regularly = Tightening up. Once a week I travel for 2 hours taking my son to a practice and most weeks have to hang on for dear life for the last ten minutes before I can relieve myself.

I used to do chi gong exercises too where you tighten up the perineum while squatting.

All in all - recipe for disaster.

Most pain at present feels like its in the spermatic cord area - so far the pain meds have had no effect.

I've emailed an Active Release Therapist for assistance.


#18

Hey Chockers,

First, your doctors response is typical (the "not interested" part). If it isn't something that doctors treat regularly, I've found they rarely want to consider other potential problems that cause an issue. Urologists are by far the worst in this area and will usually just say either you have prostatis (lots of times without getting a sample to determine if you have an infection) or if you have pain in the penis, they will say you could be developing peyronnies disease. But this is just from what I've noticed after seeing many of them.

Second, yeah holding your bladder for hours and doing chi gong type exercises were you compress the pernium is probably some of the worst thing you can do. Combine that with heavy squatting and bike riding and your pelvis is going to be completely locked up (like you're saying).

Third, spermatic cord area is a common place for pain. Any tightness in your iliopsoas and iliacus will cause tension in your pelvic muscles. Remember, the spermatic cord has muscles around them as well and if these muscles are tight, you will get pain. The best way to go about loosening all these muscles is to find good stretches from the Active Release Thearpist (good move by the way, they are effective in helping this) along with correcting the reasons this tension occurred (no holding bladder, no chi gong or kegel exercises, limited to no heavy exercises that compress this area), and lots of mobility work.


#19

The urologist who saw me briefly in A and E a month ago was puzzled by the penis pain and the what i described as nerve pain at the underneath my testicles - as they dont appear to focus on muslces/tendons or nerves.

Also public GP's and hospitals have limited budgets, large demand and limited supply - so healthcare is rationed.

Still amazed that such intense burning, cold, numbness can be result of tightness - qualitatively different than any other muscular tightness I've ever had.

I'm thinking mindfulness meditation is going to be helpful too.

Already started on mobility work: hams/adductors/psoas


#20

Think of how many nerves are present in this area compared to other areas.

It's a great area to have when it works, hell when it doesn't tho.