Addressing Pelvic Pain and Urinary Issues in a Fit and Active Male

34-year-old Christian* attended Sydney Pelvic Clinic seven weeks after undergoing emergency laparoscopic surgery for a twisted bowel. He was experiencing a range of urinary problems – including a frequent need to urinate and stop-start urinary stream – as well as discomfort and pain in the perineum and testicles.

Fit and very active, Christian had stopped all exercise the week before his visit due to experiencing numbness in his perineum and testicles after cycling. Tests for UTIs and STIs all came back negative, and an ultrasound of his bladder and prostate were normal.

Christian’s symptoms included needing to urinate every hour, a stop-start urinary stream, post-micturition dribbling, discomfort in the perineum, and aching in the perineum and testicles after ejaculation.

Christian hoped to reduce his urinary frequency to a normal level of 2-4 hours within six weeks, be free of post-ejaculation pain within three months, and resume all his normal physical activities – including cycling, running, motorbike riding, pilates and yoga – within three months.

Reducing pelvic floor activity to a healthy level

Following an examination that included a full pelvic floor muscle assessment, Christian was diagnosed with acute pelvic pain with voiding dysfunction, driven by pelvic floor muscle overactivity.

Christian’s pelvic floor muscles had reacted to the ‘trauma’ of his recent surgery in order to protect him. Recovery relied on facilitating the pelvic floor muscles to let go and reduce their activity to a healthy level.

A holistic approach to improving pelvic health

Christian’s treatment in the clinic focused on muscle release of the pelvic floor, using mindfulness and deep breathing techniques to enable the muscles to let go, as well as myofascial release to the hip flexors.

A home management plan allowed Christian to practice releasing his pelvic floor muscles and the muscles around his bladder, using mindful breathing along with visualisation exercises. He also embarked on a stretching regime targeting different muscles, as well as using a Therawand to release tension in his pelvic floor.

The final element of Christian’s integrated treatment approach focused on mental wellbeing. This involved daily meditation, spending time in nature, and socialising with friends.

During the course of his treatment, Christian aimed to ease back into exercise and physical activity as his condition improved.

What were the outcomes of Christian’s treatment?

After four sessions, Christian reported an 80-90% improvement in his condition. His urinary frequency had reduced to 3-hourly rather than 1-hourly, with a normal stream. He noted no awareness of his perineum and no pain after ejaculation. He was up to three yoga sessions and two pilates sessions per week, but was not yet back to running or cycling.
After his eighth session, Christian was pleased to report he had experienced no issues for the past two weeks. Although a stressful period had resulted in his urinary frequency symptoms flaring up again, this had settled quickly and he felt confident in the fact that any
stress-related symptoms would not last, as well as knowing how to manage his symptoms

By this stage, Christian was now back to all his normal sport and activities, including cycling, running, motorbike riding, pilates and yoga. His sexual function was also back to normal, with no perineal pain.

*In the interest of patient confidentiality, names have been changed

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