Perineal Pain. Whatt??
I had a very unusual walk in patient a few weeks ago. He came in complaining of perineal pain for about 4 years now. He has seen many Drs and he was diagnosed with Chronic Prostatitis. His symptoms did improve after taking some medication for his diagnosis but it wasn't completely gone.
Normally, the pain would last for less than four days but his symptoms were not improving and it was affecting him. He saw a urologist three months ago and he was given some medication for his diagnosis but his condition did not improve and hence, the Dr referred him for physiotherapy. His perineal pain occurs after coitus and the pain would last for days; smoking and consuming alcohol would worsen it.
There were no red flags, his reflexes, muscle power and ROM were all within "normal" range. However, he found it difficult to urinate; just the initial phase. I did a diagnostic ultrasound scan on his bladder and he had poor control. He couldn't lift or contract his pelvic floor. So, I gave him some kegel exercises to do.
The only training I had that was related to the perineum was Women's Health. And with what I could remember, I applied IFT adjacent to his perineum. Two near the femoral triangle and the other two on his adductors (near the pubis) for 20mins and the current was as tolerated.
I was reading up on chronic prostatitis and I stumbled upon an article about how PT can help. The article recommended to perform myofascial release around tender points. I was very eager to try but my patient did not turn up for his appointment!!! How disappointing!!! So, I thought he won't return but I was wrong, he came for a second treatment but I was not around that day. My colleague saw him on my behalf and he told my colleague that he felt relief for around 4 days but the pain re-occurred when he ran on the treadmill.
My colleague phoned me and I told him to perform some myofascial release around his tender points. I haven't heard from this patient for a week now so I hope we are on the right track. I will keep you guys posted if my patient re-visits.