T Nation

Pudendal Nerve Problem?


#1

Anyone ever have a pudendal nerve problem? I think that I may be going through this right now, if there is any good advice please pass it along.

This is pretty scary!


#2

Why do you think you are having this problem?

beef


#3

Thanks for posting:

I have pain / numbness in my right (choad) along with quick sharp pains to my testicles and penis.

I know that this problem is considered very rare, and its symptoms can be the same as a dis-functional pelvic floor.

What makes me think that I could have developed it (besides the symptoms lining up) is I squat relatively heavily and very low, and have been for about 14 years.

I believe that this being the case other weightlifters may be experiencing the same thing or have had it officially diagnosed and worked on.

I hope to get some good advice and encouragement from them and possibly some of the experts, as this has me pretty much in the dumps.

I am married, and this is really effecting my relationship in a negative way physically.


#4

I have never heard of this issue as a result of heavy/deep squats or lifting, but that does not mean it does not occur. Rather than speculate on this diagnosis, I would see a physician, preferably a Urologist. At least you should have an exam to rule out hernia. Possibly an ultrasound or CT scan is warranted.

beef


#5

Thanks for the advice, If my pain does not go away in the next 3 or 4 days I will schedule an appointment with a urologist.

I know that I may be a bit paranoid, but given where the pain in radiating I want to fix this a soon as possible.

Quick question: Have you or anyone ever squatted or dead lifted and strained / tore a muscle in the perineum (chaod). If so what was the pain like and how long did it last.


#6

This post was flagged by the community and is temporarily hidden.


#7

Thanks for the advice man, however I did see a doctor about 3 months ago when I was having testicular pain.

He said that it was probably epeditimytis and prescribed some antibiotics, when this really did not help he had me do an MRI to check for kidney stones, which came back negative.

The pain went away on its own, but has now resurfaced albeit in slightly different areas.

I hope that it is nothing serious, however my next step is to schedule an appointment with a urologist if things do not improve quickly.

As of right now I feel pretty good, I have slight numbness on the right side of my (choad)(area between your testicles and your anus).

What would really help me right now is if any one can tell me if they have ever had any problems similar to mine. I hope that I just strained a muscle in my pelvic floor and it will heal with time.

Also if it were nerve inflammation / damage would Advil pretty much take the pain away or would I be in a lot worst pain.

Thanks for any help / advice.


#8

Okay, I think I can be a big help with this.

I had the same type of issue. It was caused by heavy squats and deadlifts along with poor mobility. I suffered with this for 5 years. I went through all the tests and they thought it was pudenal nerve entrapment, but it wasn’t (I don’t even think PNE exists to be honest).

I don’t believe Advil will do much of anything as the inflammation would have went away after awhile.

Here’s what I suggest:

  1. Drop all exercise that puts strain on your pelvic floor. This includes heavy squats, heavy deadlifts, cleans, etc etc. I used to love these exercises until I learned what they can do to your pelvic muscles.
  2. Go to someone who specializes in manual therapy. What I’m talking about is stretching for legs and pelvis (like Active Release therapy), not internal pelvic floor therapy or bio feedback. This does absolutely nothing for guys. I have gone down that route and it doesn’t do anything. My therapist who I go to every once in a while for a check up is one of the leading male therapists in the country for pelvic floor dysfunction agrees with this. There is a huge difference between what works for girls and guys.
  3. More manual therapy. This is by far the most important part. Most problems guys describe down there (testicle cord pain, testicle rising up, pain in perineum area, spasms, pulling of pelvic muscles, tightness around genitals, etc) are caused by excessive tension. You need to loosen and lengthen the muscles and get them to fire correctly again. I would recommend an Active Release therapist critique your walking, squating (bodyweight), and lunge form (also bodyweight). This will show where you are tight.
  4. Relax. The pelvis reacts to stress by tightening. Just relax and you’ll feel better. If it was anything more serious, you would have more serious symptoms.
  5. Look at everything you do. There are lots of sports that cause this problem. Lots of weight lifting exercises too. You will have to access each one to see if it could cause you problems.
  6. Repeat the above. This is a very scary personal issue you’re dealing with. It was absolutely devasting to me because no doctors knew about it. I was diagnosed with so many different things and had so many tests I nearly went broke. But you’ll get through this. Just relax, get mobility back, stop the exercises that cause the tension, and repeat.

This lack of understanding is so common, I was invited by my therapist to speak about my experience at the next pelvic floor convention in Chicago this August. The internet has so many of these stories it’s insane.

Good luck buddy. Shoot me a message anytime with questions :slight_smile:


#9

And just to confirm, the area you are describing (Choad as you said) is right between the testicles and the anus, right? This area includes the pelvic muscles and also muscles that surround the penis. This is where I would get my spasms and tightness feeling.

Is this correct?

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=22&sig2=RcsDoFxAgvyv7-oU5vkl5w&tbnid=91IpvRZf7yAmkM:&tbnh=129&tbnw=154&ei=6nhHTP2rC8LknAeo1u2IBA&prev=/images%3Fq%3Dpernium%2Bmuscles%26um%3D1%26hl%3Den%26client%3Dfirefox-a%26rls%3Dorg.mozilla:en-US:official%26biw%3D1280%26bih%3D563%26tbs%3Disch:10%2C228&um=1&itbs=1&iact=hc&vpx=123&vpy=251&dur=188&hovh=205&hovw=246&tx=146&ty=206&page=2&ndsp=22&ved=1t:429,r:0,s:22&biw=1280&bih=563


#10

He man, I really appreciate your post. At the very least it gives me hope. This has been very disturbing to me to say the least. Since you have experience with this I would like to ask a few more questions.

  1. Did your pain get worst when you sat down. I ask because this is what they say is the number one symptom of PN pr PNE. Mine does not seem to; however, I have avoided sitting down for long periods.

  2. I hope you are correct when you say that PN / PNE does not exist, but what makes you think so?

  3. Did you have any sexual disfunction?

  4. I may need the contact information of your therapist.

You are right on with your “choad” def.

I cannot thank you enough.


#11

No problem at all, bamit. I totally understand what you’re going through. I’ll provide as much help as possible until you’re better.

See answers below:

  1. Did your pain get worst when you sat down. I ask because this is what they say is the number one symptom of PN pr PNE. Mine does not seem to; however, I have avoided sitting down for long periods.

Actually, my pain did NOT get worse when I sat down. This is when I realized that the PNE diagnose wasn’t correct. I really don’t believe PNE exists unless people actually compress the nerve (such as a small bike seat for many hours). Even then, I think it’s just pelvic muscle tightness.

  1. I hope you are correct when you say that PN / PNE does not exist, but what makes you think so?

I really should say I think it is extremely rare and most cases of PNE are actually pelvic floor tightness. From what I’ve learned, it’s hard to entrap a nerve like this and muscular tightness causes the same type of symptoms. There are some scary things people do to try to cure their “supposed PNE” like flying out to Germany for experimental pelvic floor decompression therapy. The estimated time these people are supposed to feel better is 5 YEARS (and that’s if it works). From what people described on these forums, it seems like it didn’t do much if anything (some got worse). And when people think their PNE is actually athletic hernias and have that surgery, a lot end up worse. My reasoning for all this is that the underlying issue is tightness and both surgeries make it worse.

  1. Did you have any sexual disfunction?

Sadly, yes. I was able to get an erection just fine, but the muscles were so tight that one side of my genitals was being pulled to the side. Doctors diagnosed me with an early stage of peyronnies disease, even though I didn’t have a scar cyst. After this diagnose failed to be true, I was directed to a pelvic floor doctor (after 2 years) who treated me the same as a female client (ie internal therapy, meditation, biofeedback, muscle relaxants). None of these were effective and the original symptoms got worse (as a result of me not moving around or actively lengthening the muscles). Once I gave up on all this an worked on getting mobility work and tension off pelvis (A.R.T, mobility work, ditching exercises that caused it to tighten up) all my original symptoms went away.

  1. I may need the contact information of your therapist.

Absolutely. I will shoot you a private IM with this information. If anyone else would like it, I can shoot them an IM as well.


#12

Once again thanks for your reply. I have a few more questions.

  1. Does your therapist think that PNE / PN is virtually none existent as well?

  2. How did your pain develop, in other words was it all at once are a progressive thing?

  3. Are your pretty much 100% now?

  4. Supposing my pain gets worse, do you recommend that I seek manual therapy first before spending an ass load of money on doctors? I ask because I am a teacher and my wife is a office manager. We have a baby on the way and or insurance sucks ($3,800) dollar deductible, so money is tight, I would rather spend it where it will make a difference.

  5. Do most people with PNE (if it exist) have extreme pain all of the time? Did you? Or did the pain come and go?

  6. Did you ever have pain in your penis?(If you want to respond to this via PM please do)

To all of T-Nation, if anyone has had any type of pelvic floor strain with similar symptoms did it heal up with time with all symptoms subsiding?

I really appreciate your help man. if you would prefer to have the bulk of or communication take place via PM I understand. I just feel that there has to be other lifters with this problem, especially in the power-lifting community. I beg them to chime in with any info. / advice they may have.

Also, I would love to get Eric Cressey or Mike Robertson’s opinion on this, but I cannot locate the old authors’ locker room thread, where is that thing?

Thanks,
bamit


#13

[quote]bamit wrote:
Once again thanks for your reply. I have a few more questions.

  1. Does your therapist think that PNE / PN is virtually none existent as well?

  2. How did your pain develop, in other words was it all at once are a progressive thing?

  3. Are your pretty much 100% now?

  4. Supposing my pain gets worse, do you recommend that I seek manual therapy first before spending an ass load of money on doctors? I ask because I am a teacher and my wife is a office manager. We have a baby on the way and or insurance sucks ($3,800) dollar deductible, so money is tight, I would rather spend it where it will make a difference.

  5. Do most people with PNE (if it exist) have extreme pain all of the time? Did you? Or did the pain come and go?

  6. Did you ever have pain in your penis?(If you want to respond to this via PM please do)

To all of T-Nation, if anyone has had any type of pelvic floor strain with similar symptoms did it heal up with time with all symptoms subsiding?

I really appreciate your help man. if you would prefer to have the bulk of or communication take place via PM I understand. I just feel that there has to be other lifters with this problem, especially in the power-lifting community. I beg them to chime in with any info. / advice they may have.

Also, I would love to get Eric Cressey or Mike Robertson’s opinion on this, but I cannot locate the old authors’ locker room thread, where is that thing?

Thanks,
bamit
[/quote]

Responses below:

  1. Does your therapist think that PNE / PN is virtually none existent as well?

I’m not sure if he thinks it’s virtually non existent, but this is more my opinion on the matter. I’ve dealt with this for a long time and talked to many people. This is the conclusion I came to.

  1. How did your pain develop, in other words was it all at once are a progressive thing?

Pain started as tightness feeling in genitials. Progressed to tightness in pelvic floor (especially after deadlifts or squats) and then eventually to very intense spasms. This was definitely a progressive thing.

  1. Are your pretty much 100% now?

I would say I’m 90% now. I have to keep up with mobility work. I got messed up from another therapy in trying to treat this (not one I mentioned, it was involving injections). This set me back the most and what I’m trying to fix now.

  1. Supposing my pain gets worse, do you recommend that I seek manual therapy first before spending an ass load of money on doctors? I ask because I am a teacher and my wife is a office manager. We have a baby on the way and or insurance sucks ($3,800) dollar deductible, so money is tight, I would rather spend it where it will make a difference.

If I were you, I would contact the therapist and ask his opinion. He could point you in the right direction based on where you are at now (with your problems). Manual therapy is also quick (only took 6 visits, was about $500 total). This isn’t as expensive to treat as you think cause most of the stuff revolves around mobility, proper body mechanics, and proper exercise (all free and stuff you do alone).

  1. Do most people with PNE (if it exist) have extreme pain all of the time? Did you? Or did the pain come and go?

Yeah, it’s pretty extreme all the time (For PNE suffers). Apparently, the only thing that makes it better is sitting on the toilet or in bed. My pain would be at a steady state (from the residual tension) and then get worse when I would exercise (tension would increase). Now, the tension is pretty much gone because I addressed the underlying issues.

  1. Did you ever have pain in your penis?(If you want to respond to this via PM please do)

Yep, I definitely did. This was my pain symptom at first. It was terrible. It was just on one side. This is why doctors thought it was peyronnies disease starting up. But really, it was just the pelvic floor and surrounding muscles on that side being tight. Once it loosens up (mainly ART to adductors helped), the pain went away. Is it a pulling type pain?


#14

[quote]bamit wrote:
I really appreciate your help man. if you would prefer to have the bulk of or communication take place via PM I understand. I just feel that there has to be other lifters with this problem, especially in the power-lifting community. I beg them to chime in with any info. / advice they may have.

Also, I would love to get Eric Cressey or Mike Robertson’s opinion on this, but I cannot locate the old authors’ locker room thread, where is that thing?

Thanks,
bamit
[/quote]

I definitely think it effects a lot in the powerlifting community (but also alot of other people as well). If you think about it, all powerlifting movements cause you to tighten the pelvis very hard. If you train very hard several times a week, you’re training your body to tighten up in this area, which can cause these problems.

I don’t remember hearing the authors address this particular issue, but I heard some of them think sports hernia surgery is BS.


#15

The penile pain that I have had has been a quick sharp pain that definitely radiates from the (chaod) it is only on the right side as of now.

All of my pain is pretty much gone as of right now, except for a little tightness / tingleing via my right choad.

I have not taken any anti-inflammatories (advil or aleve) today except for fish oil.

I sat down for about 15 minutes on my couch to kind of test the waters, and everything seemed fine, I had slight pit of tingling in the (chaod) but that was it.

I drove yesterday for about 15 to 20 minutes and all seemed well, except for one or two sharp pains in the choad and penis.

Do you know if those that have PN /PNE can sit at all, or is the pain just unbearable?

Given all of the info. so far what is your opinion?

Sorry to be a pest, but I know that you know a great deal about this and also how it can affect ones outlook on life.

I have stopped all exercise as of now, my last work out was Monday(upper body push)I just do not want to tighten up at all.

Thanks again,


#16

Do this, stop all exercise for a month and just work on some slight mobility work (only a few times a week). If your problem gets better, then you know it’s related to muscle tightness.


#17

That is what I have decided to do.

It sucks because I have been lifting weights for about 15 years, only taking planned breaks, but all in all it is a small price to pay if it helps.

I will say that stretching does seem to help.

I have a friend who is a CHEK III practitioner coming over today to kind of check me out.

I will post how it goes.

Thanks again,


#18

My friend who is a CHEK III checked me out today an his opinion is as follows:

  1. I have one of the tightest and largest periformis muscles that he has ever felt, which is saying something because he has felt a lot.

  2. One of the hamstring muscles ,which originate way up in the (choad) is extremely tight, in fact when he touched it, it did refer some pain into my perenium.

  3. He believes that if it is PN that it is not the actual nerve that is damaged, but rather inflammation around the nerve do to tight muscles, which he says is very curable.

  4. Even if it was a worst case scenario, which would be PNE, he believes that any nerve that is entrapped, can be un-entrapped.

All in all he is very optimistic about it all, he said on a scale of 1 - 10, his level of overall concern about my condition was a 2.

As of right now I am going to schedule an appointment with a urologist just to rule out any problems with the prostate. And I am going to schedule some sessions with a NMT for some manual work.

Not to mention a lot of stretching at home, my friend ordered me to stretch my periformis every 2 hours that I am awake.

Also, all lower body work is put on hold for at least the next month.

Let me know how all this sounds, and if anyone has any suggestions please pass them on.

Thanks,


#19

Sounds good. Make sure not to sneak in any exercises that will stress that area too badly for the next month or so.

Good luck!


#20

I will continue to post here with updates and questions because I feel that there has to be other weightlifters suffering from this.

If any body reading is a therapist, specialist, or just someone else who has gone through this I hope and beg that you contribute with some advice / encouragement.

Thanks to all that have helped.

God Bless,

bamit