Pelvic Floor Physical Therapy- Timberline OP

[Ghost]

timberline on Mon Jan 05, 2015 4:51 pm

OK so here goes. I have to pass on my experiences with pelvic floor physical therapy. Pelvic floor PT and trigger point therapy is basically a series of stretches and holds that loosens up the muscles and connective tissue in your pelvic floor and perineum. These are the muscles/tissues that are directly continuous with the fascia and erection chambers of your penis. Thankfully this is becoming a much better understood field and awareness is starting to spread...for anyone here that has chronic rectal, pelvic, or genital pain, you NEED to spend time understanding this aspect of of human physiology. Interestingly, the most likely root cause of pelvic floor dysfunction is either 1) psychological stress and worry (OCD anyone?) and/or 2) postural problems and muscular imbalances. Perhaps we should start an entire thread on this topic, but for anyone interested, please start by reading "Headache in the Pelvis" by David Wise. There are other good books and thought leaders out there too (e.g. Amy Stein in NYC). I think a combination of physical therapy and active relaxation techniques can go a long way.

for me personally, I've finally started to see some benefits to sexual function two years after initially learning about pelvic floor dysfunction and reading the Wise book. One of my problematic symptoms has been "cold glans" or "glans insufficiency" - basically the corpus spongiosum (bottom chamber of penis and the head) does not fill or stay full during an erection, and the stability and sensation is greatly reduced. It's kind of like having a little kid boner at times... While I believe that neurohormonal (e.g. SSRI complications) can contribute to this problem, I'm starting to believe that dysfunctional muscles and connective tissue (i.e. fascia) in the pelvic floor are a bigger contributing cause. The best explanation is that contracted and 'tight' tissues in the pelvic floor and perineum are keeping the spongiosum from fully expanding, and/or are compressing the arteries that feed the spoongiosum. So while you might believe that your only problem is a centralized arousal problem, it could in fact be that chronically contracted tissues are compressing the base of your penis.

the people most likely to suffer from chronic pelvic pain and related sexual dysfunction are "clenchers" - the type of people that clench their rectum and pelvic muscles in response to every stressor or worry. Type A's, OCD people, over-achievers, hyper-analytical people...all vulnerable to this problem. I say this not as someone who is just observing or judging OCD people or Type A's...but as a perpetrator myself. I have a strong intuition that many people on this forum suffer from this problem and have never been educated on it. I’m lucky to have been directed to some good practitioners in the last few years and I’ve learned a lot myself…

[Ghost]

Post r on Mon Jan 05, 2015 6:54 pm

Some thoughts,

I think that many of us have problems with PD, lack of control, and soft glans (if what timberline is saying is true) due to learned behaviors meant to cope with SSRI side effects. Delayed orgasm is an incredibly common side effect, and clenching/kegeling can induce and quicken orgasm. This becomes a subconcious behavior after a point, and after SSRI treatment is discontinued it results in adverse sexual effects.

[Ghost]

Sonny on Mon Jan 05, 2015 11:47 pm

Thanks, that's actually very helpful.

[Ghost]

Post timberline on Tue Jan 06, 2015 10:13 am

'r' brings up a great point and I should have mentioned this. when delayed ejaculation (or near impossibility of orgasm) develops following SSRI use, we develop new methods to reach climax. Invariably this involves clenching or contracting the ischiocavernous muscles (IC's or PC muscles - which are involved in keeling) or any number of other muscles in the lower abdomen and pelvic floor. Also, a lot of times we'll tense the pelvic floor muscles in an effort to "push" blood into the penis when we are having ED issues. Eventually these muscles get constricted and fatigued, and they no longer relax or activate the way they need to for normal function. This is what leads to compression of nerves and blood vessels leading into your genitals (testicles and rod), as well as eventual muscle weakness. This is also what lead to chronic, mid-grade soreness and aching in the rectum, genitals, or pelvis that never seems to completely go away.

As 'r' mentioned, one of the correct things to do is a "reverse kegel" or simply a subtle pushing movement, similar to when you relax your pelvic floor muscles in order to pee or have a bowel movement. It's no coincidence that some people with PSSD report some better sensation and blood flow after going to the bathroom. The thing you DO NOT want to do is a traditional kegel, in which you are contracting the IC muscles - similar to when you try to stop yourself from peeing. This will only cause more tension and contraction in the pelvic floor.

The other big component to restoring normal pelvic floor function is relaxation, typically with the mind leading the body. Deep breathing, expanding the diaphragm and lower abdomen, and various relaxation techniques can be very helpful. I was once given the analogy of an animal that tucks it's tail under stress. When an animal is scared or "freezes" during the fight/flight response, its tail drops. This is actually a contraction in it's pelvic floor / rectum. With people it's the same thing (so less of an analogy than just a parallel with other mammals). When you get scared to death, you contract your pelvic floor and "tuck tail". This happens to everyone. However, some of us unfortunate worriers and OCD-type people are almost always contracting our pelvic floor in response to imaginary threats, catastrophic thinking, irrational fears, un-solvable metaphysical dilemmas, etc.

Now think about this for a minute. As someone with OCD or chronic anxiety, you are already clenching your pelvic floor too often - you might have low grade pain or constipation that you don't even associate with this phenomenon. Then you start taking SSRI's and you develop anorgasmia or delayed ejaculation, or erectile dysfunction. Now you are clenching every time you have sex or masturbate in order to keep an erection or get off. You do this for months or years and create a vicious cycle of more contraction and even less sensation and blood flow. Even when you get off SSRIs (regardless of the persistence of the neurohormonal imbalances), you still have reduced sensation and blood flow. Which of course worries you to no end, contributing to an ongoing cycle of clenching and dysfunction.

Now...I am NOT suggesting that the ongoing sexual problems with many of us are purely related to pelvic floor dysfunction. I experienced first-hand the loss of arousal that occurred from SSRIs, and I am more inclined than not to believe that changes to the central nervous still contribute to my current state. There is plenty of evidence of other types of chemical use leading to persistent sexual dysfunction and arousal disorders, too (post-finasteride syndrome for example).
However, I have a growing conviction that pelvic floor dysfunction is a major contributing cause to my own and many others' ongoing sexual issues. It could possibly be an even bigger issue than serotonin / dopamine pathways.

The real dilemma we have is that we are in a vicious cycle. We are full of anxiety, likely have diminished arousal pathways, and have dysfunctional physical tissues in the pelvic floor. Our lack of sensation and arousal leads to more clenching during sex or masturbation and our bodies get worse. Our bodies get worse and we worry even more. Repeat cycle.

How do we break the cycle? I don't have the magic answer, but the following seems reasonable:

Each time you engage in sex or masturbation, do everything you can to MAXIMIZE arousal and blood flow so that you do not have to rely on muscle contraction and unnatural physical or mental exertion (ever watch twenty porn windows at once?) in order to get off. Get in touch with what or who turns you on the most. Take PDE5-Inhibitors - Viagra, Cialis, Levitra (you might find one works better than the others), or take L-Arginine (pretty tried and true way to increase NO and blood flow). Take things that you know could be helpful from a neurohormonal perspective - the 5HT1a theory is solid, so try the agonizing agents and see if they help (buspar, CBD, horny goat weed, someday Flibanserin perhaps). And/or try a dopaminergic (cabergoline, prami, etc.). And/or a drug (e.g. clomid) or supplement (e.g. topical pregnenolone) to increase testosterone.

For a lot us, this might mean reducing our frequency of sexual activity for a while. Instead of trying to get off every day (sometimes just to see if you can), maybe ejaculate once every four or five days...or once a week. Whatever is right for you at THIS moment in time.

I hope it is helpful to some. I have suffered a lot and I want to help other people.

[Ghost]

SingleCell on Tue Jan 06, 2015 3:03 pm

timberline wrote:do everything you can to MAXIMIZE arousal and blood flow so that you do not have to rely on muscle contraction and unnatural physical or mental exertion (ever watch twenty porn windows at once?)

No, but I know what I am doing later... hahaha

[Ghost]

Ghost Tue Jan 06, 2015

I now notice that I have kegeled during masturbation for years. I never thought of it before, and just did it. Since PSSD, I've done it a lot more to try and help soft-glans because it pushes blood there. This reverse kegel could be very helpful, and something that I would have never found otherwise.

[Ghost]

Post north4 Jan 6, 2015

maybe this can help ? http://en.wikipedia.org/wiki/Transcutan ... timulation

[Ghost]

Ghost Jan 6th, 2015
This site gives a really good run-down of how to do a reverse-kegal.

http://www.risingmaster.com/reverse-kegels/

**Sadly...this is where the cache cuts out!**

[Sonny]

That's the part that matters. Thank you for that.

[Moloch]

Sonny on Wed Jan 07, 2015 10:51 pm

apachuri wrote:
Thanks for the advice Ghost!

Sonny, just a suggestion, but perhaps you could create a section for people to vent about their feelings concerning PSSD, the doctors, pharmacy companies, etc. I feel like it will help our conversations in these other sections to be more productive.

The activism section is full of that already. So people can post it there.