For the past year, 39-year old David* had been suffering from ongoing perineal and
rectal pain, as well as anal fissures. After unsuccessful treatment from two urologists,
David hoped Sydney Pelvic Clinic could help alleviate his pain so he could get back to
a normal life.

David’s pelvic pain caused significant burning and tingling in the perineal and rectal area.
While the use of NSAIDs prescribed by a urologist reduced the pain somewhat, it failed to
alleviate it completely. He’d also tried a course of antibiotics which failed to get rid of the
pain.

In addition to his pelvic pain, David suffered from regular anal fissures and was also
experiencing pain after ejaculation, sometimes for a full day after sex.

David’s goal was to be free of his pelvic pain and reduce the occurrence of anal fissures.

Pelvic floor tension found to be the cause

A physical examination revealed that the cause of both the pelvic pain and the anal fissures was tension in the pelvic floor muscles, resulting in decreased circulation in this region.

There was also found to be irritation of the pudendal nerve.

A multi-disciplinary approach to alleviate pelvic pain

By educating David on the cause of his condition with relation to the pelvic floor muscles and pudendal nerve anatomy, the physio ensured he felt in control and open to the
recommended next steps in his treatment.

In the initial two sessions, treatment included:

  • Breathing and relaxation techniques
  • Assessment of grip and release patterns
  • Pelvic floor muscle down-training
  • Mindful pelvic floor drops and pelvic stretches
  • An educational seminar – Pelvic Pain and Your Brain – to help David better
    understand his condition

After this, further management techniques were introduced to provide an integrated
treatment approach. These included:

  • Continued pelvic floor muscle down-training and biofeedback; mindful breathing;
    pelvic floor drops and stretches
  • Massage to down-regulate the nervous system and ease thoracic spine stiffness
  • Gluteal strengthening to help offload the pelvic floor muscles
  • Use of Therawand to assist with internal release work

What were the outcomes of David’s treatment?

After two sessions, David reported a 50% improvement in his pelvic pain, while the pain he experienced after sex now only lasted 1-2 hours rather than a whole day. While he still experienced occasional anal fissuring, there was much less perineal/rectal/testicular pain.

Following a total of nine sessions over a two-month period, David was thrilled to achieve a full resolution of all his symptoms, with no more pelvic pain and no fissures. He hadn’t even needed to use his Therawand at home.

A physical examination found his pelvic floor muscles were relaxed and there was no
tenderness. Thanks to the support and education from his physio, David said he felt
confident that he would know how to manage his pelvic pain should he have a recurrence.

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

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