Can anyone give me advice on how to get through very modest exercises without having painful flares?
I have a history of very tight muscles in the pelvic region. Recently, I have tried very modest exercises mostly targeted towards Strengthening my core. Most recently I simply tried to simply contract my transverse abdominus on and off for 2 minutes 3 times a day. Even a pigeon stretch for my piriformis results in a flare
The flare itself consists of constant burning in the anal area along with the formation of very painful blisters also in the anal area. Sitting becomes impossible. I have a history of issues with the anal branch of the pudendal nerve and suspect it is involved. Thanks for any help you might be able to provide
Update-just got back from PT and we identified the root cause but do not know how to reverse it. If I contract my pelvic floor muscles they take 5-10 seconds to very slowly relax-and not completely. Does anyone else have any experience in solving this problem pelvic muscles which will not relax?
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try trigger point injections! and yoga to stretch?? don’t sit for long periods of time. walk every hour if you have a desk job and when sitting, rest foot on knee to open hips
Thanks but the pelvic floor is relaxed until I try exercising. Then there are too many muscles to treat . Plus I’m not sure there are many internal muscles which can be treated via Trigger point injections.
I am very interested in the "painful blisters" part of your post. For me, two years ago (around this time) after using Monistat and then a prescription vaginal gel for a yeast infection from an antibiotic, I broke out in vaginal blisters and what resulted in what felt like a chemical burn. The burning feeling and pain, lasted for months, though the blistering just a little bit. This apparently led to PFD (I am very tight everywhere) where I felt as if I was sitting on a rock. Over time, my symptoms have located to the anal/rectal area specifically. There is pain much of the time and even the slightest of stretching, yoga or exercise flares it terribly. The best way I manage it right now is to work very hard at no constipation, alternate sitting and standing as much as I can, sit on ice packs, and rest. (I did complete months of PFD PT and it really didn't help much at all). Now then, what I am really interested in is the blistering. What caused that for you? I had the same thing though it has never happened again, I just wonder if there is a connection.
For the record, I am seeing a multi-disciplinary team (colorectal, PFD, PT for PFD, etc.) in June at Massachusetts General Hospital and hope a team approach will bring more answers and results.
That is an amazing story and an amazing set of symptoms surprisingly like mine! Your initial trigger is unusual - I wonder if the antibiotics triggered your symptoms indirectly by changing your microbiome, and the the balance of neurotransmitters in your gut which will affect your muscle tone. I now believe my case started in the 1980’s from antibiotic use and followed the path I mentioned above. If you are interested I could explain in greater detail-but let me ask you a couple questions to see if our cases are similar (I think they are and this is the first time I have said that).
1. Did you notice feeling more anxious after the symptoms started? I don’t mean just feeling more nervous because you have pain; I mean a raised basal level of anxiety.
2. Do you have hyperlordosis in your lumbar region?
3. Have you ever done core strengthening exercises and what effect did they have?
4. Has a physical therapist ever assessed your overall neural tension? Is it unusually high?
I am not sure what exactly the blisters represent and what causes them. They just seem to be representative of a higher level of irritation. Mine last typically 2 to 3 days. It is obviously frustrating because I am trying to re-educate my pelvic floor But the process itself irritates it and sets me back a week by the time everything calms down. That’s why I was asking for help in ways to calm down my pelvic floor. Wonder in biofeedback would help.
If you don’t mind would you describe the entire team that will see you at Massachusetts general hospital? I am down in Washington DC and the level of care from the doctors is just abysmal. Just getting a Botox injection is an adventure and I ended up traveling up to Pennsylvania for someone I trusted more but still not completely.
Let me try to answer the questions and yes, I would love to speak more regarding the microbiome as I was on a ton of antibiotics in the 80’s due to several strep infections and yeast infections. Now then, here we go:
1. I am not certain to be honest. I have anxiety in general and it increases astronomically for issues like this. I can tell you I was very upset for months and nervous. Whether it was because of the problems or just my anxieties I can tell you it was through the roof.
2. I am not sure what hyperlordosis of the lumbar region is; though I suspect it is a pelvic tilt. I can tell you my tailbone hurts alot, including to the touch. I will check with my chiropractor to determine if I have hyperlordosis.
3. I have done core training exercises and it always felt as if not matter how hard I worked at it I could not strengthen my core. Now, I can do scarcely a thing without a flare.
4. I have completed 4+ months of PFD PT and many times it made the condition worse or no relief at all. She did do biofeedback of the rectal area and my tension was through the roof. Even without testing I can assure you my neural tension is abnormally high. How is that tested or assessed?
5. I have had no blisters since the very first time.
6. I know one test that the new PFD team at MGH will conduct is anal manommetry. They explained that it is an instrument with a bulb on the end. Once it is inserted they inflate it a bit and you expel it. The machine reads the level of tension of the anal/rectal muscles.
The appointment is June 24 and I will keep you posted on all the experience. If you go to the MGH PFD website there appears to be quite an impressive multidisciplinary team. I remain hopeful.
I look forward to your response. I am also happy to text or have a phone call.
Yes-maybe a phone call would be best-we seem to have some similarities in our cases.
Isn’t it frustrating when new PT patients come in and are healed within five sessions while you keep going in pain?
Hyperlordosis just means your spine curves more than it should towards your belly button (in the lumbar region). This can increase strain on the discs and cause pain and increased muscle tone in the lower extremities. If you need a pillow under your stomach when you sleep on your stomach (due to low back pain), that means you have it.
Overall, I think my problems started decades ago with
1. Antibiotic use for years (so bad)
2. Bad changes in microbiome
3. Increased anxiety from altered microbiome
4. Increased muscle tightness from constant anxiety
5. Hyperlordosis from increased muscle tightness (spine pulled forward by tight psoas muscle)
6. Irritated lumbar spine
7. Increased muscle tightness in lower extremities in muscles innervated by lower lumbar spine
8. Pains anywhere in lower extremities from pinched nerves. The pain pattern will be influenced by your activities. If you bicycle-the nerves located where your buttocks hit the bike seat and support the entire body weight will get hit hard because they are already irritated. (This is how things started for me)
Anyway-we can talk about all of this by phone. Mich.emil@gmail.com is my email. After you email we can exchange numbers.
I don’t know about blisters, but have had the same problem with exercising. Tightening the core also tightens the pelvic floor, hence increasing pain. Had some better success with yoga (although you have to be careful of what you do). I find walking to be the best exercise for me, and the only one that doesn’t increase my pain. Not in the best overall shape, but a lot better than when I started using the treadmill. I ended up buying one so I would use it regularly. Best of luck.
Ok, so I had urogenital PT and the best tool I used was a dilator. Ask about that so your PT can advise for your particular needs. I also have the best chiropractor who listens to me and knows nothing can be too aggressive around the spine and pelvic area. You just have to educate them. He taps only! No popping with the table, rolling on spine, etc. This is a journey on how to manage. Wish there was a real fix and it could be gone. Not my experience, but it is so much better.
I find swimming the crawl and backstroke to be the best form of exercise. Walking causes me increased pain but swimming doesn't, and it's important to get some kind of exercise for circulation. Sometimes I do walk but never more than 30 minutes. I'll have a slight increase in pain in the evening when I do this but am then back to the status quo in the morning. I unconsciously tighten my pelvic region all of the time, so am also working on trying to relax even when I feel pain. For me this involves deep breathing.
Thanks but the pelvic floor is relaxed until I try exercising. Then there are too many muscles to treat . Plus I’m not sure there are many internal muscles which can be treated via Trigger point injections.
I experience more pain after exercising (no blistering though). I now do pelvic floor relaxation exercises that I found videos for on youtube. There are a lot so you may have to watch a few to find one that suits you. It usually involves breathing techniques to release tight muscles and 'drop' your pelvic floor down. I can't really explain it that well but maybe this combined with a trigger point massage either from a PT of self-induced pelvic floor massage may help you.
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Could it have been the Botox??
non relaxing pelvic floor levator ani or piriformis dysfunction? sacroiliac joint?
Chronic pelvic pain 
Possible PN?
Vaginal suppositories 
