Chronic pelvic pain is a boundary "disease" affecting urology, colorectal, gynecology, physical medicine, neurology and other specialties. When sitting aggravates or causes the pelvic pain (perineum, genitals, coccyx, rectum, and pubic hair) we suspect pudendal neuralgia, often called pudendal nerve entrapment. Pudendal neuralgia is considered in all men and women with pelvic/urogenital pain with or without bladder symptoms or sexual dysfunction. A simple definition is perineal pain aggravated by sitting, reduced by standing, not present when recumbent and generally relieved when seated on a toilet seat.
The striking common feature in pudendal neuralgia patients is that flections activities of the hip (sitting, climbing, squatting, cycling, and exercising) induces or aggravates urogenital pain, chronic pelvic pain, or prostatitis-like pain. Many male patients played American Football, lifted weights and wrestled as teenagers and young adults. Often, the females were active in high school athletics, gymnastics, dance line, or cheerleading.
Our primary hypothesis is that hypertrophy of the muscles of the pelvic floor during the years of youthful athleticism causes elongation and posterior remodeling of the ischial spine. A posterior and medical shift of the ischial spine leads to juxtaposition of the sacrotuberous and sacrospinous ligaments that are normally quite separated at their insertions into the ischium. This change results in the "lobster claw" of two ligaments that can compress the pudendal nerve.
The goal is to stop irritating the nerve. Decreasing the neurotransmitters to the spinal cord lets your pain decrease. The other secondary problems will gradually improve.
This novel but remarkably effective treatment of self-care was based on the observations by the French (Robert and colleagues) that sitting on a toilet seat relieved pain and by our continuing observations of exercise-induced pain. Therefore, treatment is to sit with the weight of the body supported on the ischial tuberosities with the perineum suspended to relieve the pressure of the ischioanal fat against the nerve. Cessation of flexion activities is extremely important.
An office testing procedure, i.e., sitting on two parallel paperback books with the perineum suspended was added to our evaluation treatment of a large cohort of over 600 patients. Reduction of pain, in only a few minutes, can be dramatically effective in over 50% of the patients. Over a period of time this technique can cure pain, bladder irritability, and sexual dysfunction.WHAT TO DO:
DO NOT SIT!
• Go to our website and download and complete the pain, voiding and sexual function scores. These provide important reference information or benchmarks for future comparisons. • Continue your medications. Wear loose clothing that keeps pressure off of your bottom. Stop ALL exercises except on a flat surface or pushups.
DO NOT SIT!
• If sitting is necessary, make a "perineal suspension pad". The concept is to sit on a pad that supports your body weight by the "sit bones" or ischial tuberosities to "suspend" the perineum, thus relieving pressure from the pudendal nerve. • Use the sitting pad at work, in your car, at church, at home, and in restaurants. (An alternative is to tuck a small book under one "sit bone" to lift your perineum slightly. One businessman used a leather folder with two tablets. He left it on his chair prior to sitting and tucked it under one sit bone. The second folder contained information for his meeting). • Stand to use your computer, read the paper, or does office work.
DO NOT SIT!• Buy a simple fold-down metal wall shelf to support your computer keyboard. • Lie down as much as possible to watch TV, read, etc. • At work, lie down on your lunch hour or breaks. • Use an extension handle to pick up clothes and objects from the floor. DO NOT DO THESE ACTIVITIES!!!
1) Squatting 2) Lifting 3) Yoga 4) Cycling 5) Bowling 6) Skiing 7) Piriformis stretches 8) Ab crunches 9) Sit-ups 10) Gym workouts 11) Leg presses 12) Jogging 13) Stair master 14) Pilate 15) Spinning 16) Ellipse 17) Step aerobics 18) Exercise cycle 19) Avoid climbing stairs. Use an elevator or escalator whenever possible.Results of self-care treatment
We have demonstrated statistically significant improvements in pain and bladder symptoms. As noted in "Abstracts" and "Importance of Questionnaires" on our website.
From the Prostatitis Foundation website – 2003:
From past patients:
I feel that I have more penile sensitivity and ejaculate without pain.
Life is good. This treatment has changed my life.