Men who have entrapped pudendal nerves (pudendal nerve entrapment) commonly complain about urinary problems such as urgency or frequency. It is reported that men often experience erectile dysfunction despite using traditional erectile dysfunction treatment. In other cases, they also describe it as having a feeling of a lump in their pelvis or groin area, even though there are none.

In light of the different symptoms they experience, how can we determine if the pudendal nerve is entrapped?

Let’s find out now.

Pudendal Nerve Entrapment

Pudendal neuralgia (also known as Alcock’s syndrome or Pudendal Canal Syndrome) is caused when the pudendal nerve is entrapped, compressed, or irritated, resulting in pain in the local region. The characterization is pain, swelling, and numbness in the pelvis or genital area. This happens when there is damage in the major nerve in the lower body or irritation, making it difficult to use the bathroom, have sex, or sit down. Experts believe this condition is rare, but it’s not clear how many people have it.

Symptoms of Pudendal Neuralgia

The primary symptom of pudendal neuralgia is pelvic pain. When there is a compression in the pudendal nerve’s path by other structures, it irritates. Anywhere along the course of the nerve can produce pain, tingling, or other sensations, including the tip of the penis. The reason behind the name pudendal neuralgia is “pudendal nerve pain”.

Also burning, stabbing, or shooting pain may occur, coupled with numbness or tingling sensations when you have pudendal nerve entrapment. Symptoms can be worse by activities involving bending at the hips, such as sitting and squatting.

Talk to your physician if you notice any new symptoms related to erectile dysfunction, urinary illness, or bowel problems. These symptoms may be caused by a medical condition that needs to be addressed by your doctor. When a medical reason cannot be identified, there is a very good chance the nerve is being pressed by muscles or other tissues in the pelvic floor. Physiotherapy for pelvic floor disorders can be extremely helpful in these situations.

Causes of Pudendal Nerve Entrapment

Several factors cause damage to the pudendal nerve. An injury or surgery can cause it and sometimes, exercising too much, such as riding a bike, can contribute to it.

Other causes may include:

• Pressure on the pudendal nerve caused by nearby muscles or tissue
• Spending a lot of time sitting, cycling, horseback riding, or constipating (usually for many years) can sustain repeated minor pelvic injuries.
• Pelvic surgery
• A broken pelvis
• Cancer or non-cancerous growth compressing the nerve

Some causes, however, cannot always be determined.

How to prevent pudendal neuralgia?

Considering lifestyle changes can prevent pudendal neuralgia. These include:

• Managing your bowels and bladder: Don’t strain when emptying your bowels or passing urine, as this stretches the nerve. Physiotherapy can help you establish good bladder and bowel habits that are suitable for you.
• Sitting modification: Avoid pressure on the perineum (the area inside your ‘sit bones’), as this prevents pressure on the nerves. Sitting less can also reduce blood pressure.
• Avoid nerve-irritating physical activities: riding a pushbike and horseback riding are two of the biggest. Other activities to avoid are trampoline jumping, bench pressing, and too many ‘core muscle’ exercises. With osteopathy and physiotherapy, you can identify movements unique to you that may need to be minimized.

Physiotherapy can help relieve Pudendal Neuralgia

Physiotherapists can help you relax and stretch your pelvic floor muscles, which may be over-contracted so that the nerve is less irritated. They can also help you to manage the painful trigger points in your pelvic floor muscles as well as recommend using TENS, if necessary, to relieve your pain. Using this device for self-management is effective – but you may need the assistance of a physiotherapist to place your electrodes properly.

Furthermore, you could benefit from specific external exercises and stretches that will focus on correcting your posture and avoiding activities that may aggravate your pain. Physiotherapists will also encourage you to do general cardio exercises to maintain both mental and physical fitness and strength.

Physical therapy can also help you maintain control over your bladder and bowels if you have pudendal neuralgia. They can help you develop a bowel and bladder management routine.

Physical therapy is one of the best treatments for your pelvic floor problems. If you have the same symptoms for pudendal neuralgia, PELVIS.NYC can help assess your needs. We provide 15-minute teleconsultation for FREE because we care for your health.

Related Blog: Pudendal Neuralgia: PT Is Your Treatment

What is Hard Flaccid Syndrome?

Hard Flaccid is a newly coined term that describes a symptom of pelvic floor dysfunction/CPPS. But before we dive deep into how to get rid of your hard flaccid syndrome, let us understand first what could be the cause and risk factors.

Similarly, patients describe their symptoms to be a nuisance throughout the day and in the bedroom. Men will often describe that their penis doesn’t hang as low as it did in a flaccid state and seems somewhat retracted. Men will describe that their penis can feel cold, takes more physical stimulation to get aroused, feels rubbery during an erect state, the penis doesn’t get as much blood flow/maintain an erection, and a weak stream of urine.

What are the psychological effects of hard flaccid in men?

As for why this happens? We don’t understand the full mechanism behind it. In fact, the majority of medical professionals will deny that this diagnosis even exists and will say “it’s all in your head” and probably prescribe you some sort of PDE5 inhibitor (Viagra/Cialis) to get rid of your “anxiety”. The dangerous part of using the word anxiety is that you may have developed or worsened your anxiety due to this issue as it would any male going through this, but anxiety isn’t causing this issue.

Prior to feeling these symptoms, we men never had to think about our penis. In fact, we only used it for the 2 P’s; Pee and Pleasure. So the fact that now you are constantly thinking of “how much urine is coming out”, “will I be able to maintain and keep a rigid erection” induces anxiety and further takes the SEX out of SEXY. All you are left with is a Y (see what I did there?). This constant feedback loop causes anxiety and further increases sympathetic tone which is the antithesis of getting an erection.

So this blog post is for those that have been searching for some answer, for those who are looking for options, doable options to get rid of a hard flaccid syndrome. This is written for you!

It is equally important to know that these symptoms are real and they are very much treatable. Furthermore, in Pelvis NYC, we do have a working hypothesis that hypertonic/weak pelvic floor muscles may be causing the issue. The majority of men seen with this condition have very tight lower abdominals, their perineum is weak and cannot sustain a contraction longer than 10 seconds.

Who can help in getting rid of hard flaccid syndrome?

First thing is, always get yourself to a primary care physician or urologist to get medically cleared for anything serious. High blood pressure, diabetes, obesity, as well as High cholesterol are one of the few conditions that will start as erectile dysfunction.

Second, get yourself to a pelvic floor physical therapist who can help evaluate and treat you. Remember not all medical professionals are equal, just because you saw one should not mean that you have exhausted your options.

Third, start to take matters into your own hands. Do your best to control the variables in your life that are easily controllable.  Start by evaluating your diet, sleep, stress, and movement. The second you start to see improvements in some areas you will notice improvements within others as well.

What are the pelvic floor exercises I can do now to get me on the path of getting rid of hard flaccid?

1)    Ease the tension around the lower abdominals. Try these:

a.     Cobra stretch ( 2 minutes min with exhalation at the top to let your belly go)

b.     Couch stretch ( 2 minutes- inhale and exhale into the stretch)

c.     Foam/Lacrosse ball – Find a tender area and gently breathe through it This is a nice soft tissue release.

2)    Decrease tension around perineum

a.     Deep Squat stretch – This will help stretch your adductors and your perineum (2 min). If you have a bathtub you can use the buoyancy to help decrease the strain on your knees

b.     Happy Baby – 2 mins

At Pelvis NYC we want you to know that we understand what you are going through. We truly care about your well-being. Now that you know these symptoms are real and that it is treatable….BREATHE!

The next step is to follow some of the recommendations here, see what works for you, and let us know how we can help. Contact us now!

Pelvic floor dysfunction affects more women than men, but MEN ARE AFFECTED TOO. Since most physiotherapists are focused on treating women, a lot of men are silently suffering, left untreated, misdiagnosed, and experiencing depression and anxiety. That is why a need with a Male Physiotherapist is essential.

In this interview between Simon Edward Smith of The Medical Journo on Youtube entitled Interview With Male Pelvic Specialist Dr. Adam Gvili, they have discussed below topics:

00:15​ Can you explain a bit about what you do?

Dr. Adam Gvili: I’m a physiotherapist as you know, in the States, right I’m here in New York City & my specialty is the male pelvic floor. I hope to treat females one day, but I’d like to focus solely on males for now.  I also treat orthopedically and treat a lot of athletes and I really enjoy treating in full spectrum. And the only population I don’t treat is pediatrics. Coz I think there are much better people out there that can focus on pediatrics than men.

So I treat a lot of females for orthopedic issues but I won’t treat them for the pelvic floor. Obviously, I’ll treat men for any issue. 

Simon Edward Smith: “Right and this is based out of New York, you’ve got a clinic there?

Adam: Yeah right in Manhattan.

Simon: How long have you had that for?

Adam: About two years now.

01:40​ Dr. Gvili’s experience with pelvic floor dysfunction 

Adam: I don’t know how much you know about me. I myself went through pelvic floor dysfunction a couple of years back. Maybe ten years ago, at that time there was nobody out there to treat it. Really, in terms of men treating men. Right there were females treating it, but having a conversation like ‘hey you know when you pee at the urinal and you get this weird feeling, oh wait you don’t pee at the urinal right?’. And you can probably relate to this topic.

It’s like a weird dead end that I couldn’t complete a plan of care. But luckily I did meet a woman who is really familiar with male anatomy. I can give her a lot of kudos and I did learn from her. One of the reasons I started on my own, was because I was like there are no males treating males and guys don’t like to talk about their penis that much and that is the truth.

Simon: Yeah so what are your experiences in pelvic pain?

Adam: So luckily I only had some pain like an occasional shooting pain. Sometimes into the rectum maybe two seconds and it goes away. It was just a hypertonic pelvic floor. So as a patient, I had some issues like weird erectile dysfunction, premature ejaculation. Muscles are so tight that it is constantly contracting around my prostate. And it’s almost a borderline persistent general arousal disorder.

And I remember the third physical therapy session got better. It pushes the right buttons so I think that was what it was.

03:18​ Dr. Gvili’s treatment of his pelvic pain 

Simon: What would you do in a physiotherapy session to recover so quickly?

Adam: So we didn’t do much movement base stuff which is kinda I think what is needed to speed up the process but what I did appreciate was this certain individual did a lot of internal and that’s part of my practice as well. I do a lot of internal. I’m gonna kick that taboo on the side. Guys treating guys.

I think even orthopedic clients need that therapy with touch to get that therapeutic effect right. I need to tone down your system. If that is the case, most of my guys have had a hypertonic pelvic floor. I treat mostly an average of 20 to 40, we had the outliers but I used it to tone down the system first before trying to get you engaged or to believe that this is gonna work. Because by the time you’ve gotten to me, you’ve seen so many practitioners that have run you down some rabbit hole. Googling and thinking that you have a terminal disease so I have to calm you down a bit and the way to do that is by internal.

04:31​ The taboo over male-treating-male treatment 

Simon: You said that there was a taboo with men treating men. Do you find that in the US then?

Adam: Totally! And it’s funny! Because when you speak to practitioners in the UK and Australia who are light years ahead of the US. We’re practitioners and we’re here to get people better and that’s our goal. And that has nothing to do with gender. But for some reason when you speak to people coming out of school or people that might be interested in specialties. They hear what you do and ‘oh I can never do that’ those were the usual answers that follow and you do get that a lot.

05:15​ The influence of A Headache In The Pelvis

Simon: You’ve heard of a headache in the pelvis? Well, that’s all internal. Not all of it actually no that’s wrong but some of it is internal isn’t it. And that was crazy in the US. I was quite surprised that it is such a big book within the physiotherapy world. I’m surprised it’s not just common being accepted into the practice.

Adam: It’s such a big one in the physiotherapy practice.

Simon: It’s such a big-known book that I’m surprised that there is a bit of an issue around men treating men.

Adam:  So it’s interesting I do give Dr. Wise a huge kudos because they kind of got this whole movement started. If you really think about it, especially for males. I’ve had a wand and I used it. I’m not the biggest fan of it. But I mean internals out there for some reasons it’s still a taboo right.

Like when I took my first men’s pelvic floor course. I remember it was a two or three-day course either way we spent a good two hours or an hour and a half talking about what you do in a situation where a guy gets an erection. So it was more geared towards women feeling comfortable treating men as opposed to just how do we diagnose and treat men. Even within the female kind of sector, there was a taboo here like oh what do we do right.

06:59​ What name would you give to this condition?

Simon: What name would you give to this coz there’s a lot of debate of groups over what terminology people should use. But you know coming from actually from the field what would you call it?

Adam: Yeah it’s tricky because have you heard of sciatica?

Simon: Yeah that’s the nerve down the thigh.

Adam: Yeah it’s actually at the back of the leg.

Adam: Sciatica or it can be in your spine it could be coming along that pathway. Like pelvic pain, we have an umbrella term, we kinda branch out from there. So I don’t necessarily know if I would rename it because it depends on someone’s symptoms and it depends on it being a multi-fast issue we don’t know what’s going on. I think the biggest disservice we have done so far is diagnosing people with stuff we’re not sure they have.

Simon: Right, such as an inflamed prostate.

Adam: What the h*** does it even mean?

Adam: No seriously I’m a little more animated than your average physical therapist. But what the h*** does that even mean. I have a leading urologist in New York City referring me to clients. Thankfully, I’m very thankful for that. But how can I feel an inflamed prostate? You can’t feel if it’s baggy but can I tell if it’s really inflamed. I’ve touched many prostates. I don’t know if that’s necessarily true. Can I be honest? It could be wrong.  Maybe I’m feeling but I’m telling you what I think. or I mean I have this theory that specifically in the US but I don’t know it is in the UK but we over medicalize here. We definitely over medicalize. We diagnose, the reason why we have to diagnose is so we get paid by the insurance 

I never walk out of a doctor’s office saying we’re not really sure what it is just do this, and this. And we’re always looking for an answer for some reason. How do we know it’s necessarily the pelvic floor and it’s a hip issue? How do we know it’s not a low back issue? So many things can cause the said symptoms. That I think we do some disservice, let’s say it’s for sure like this when we don’t have enough research. Majority of those diagnoses that you’ve heard 

09:42​ The problem with giving it a name 

Simon: Yeah! Cole Monahan mentions that giving a diagnosis can be a bit definitive and not really help the situation. Like you said that there are so many different symptoms coming from different places and it’s hard to classify them.

Adam: Totally! And then I’ve had people who have had a one-night stand and said it happens after that. I never had sex before and they tell me they have these symptoms. So when that happened the first time. That person came to me and said I’m actually a virgin. I’ve never had oral sex either. But I have these symptoms. That was like someone shot me in the head. Because I was like we thought to believe that this could potentially be something that changed your urethral or bladder flora.

Whoa, so I’m always at the question mark and I think that it’s the exciting part about treating the pelvic floor that constantly comes up.

10:44​ Issues around internal treatment and trigger points 

Simon:  So I really want to ask what this internal treatment is? Do you say you’re not a massive fan of the wand? Is that because there are few different types? Is that the easy one, the magic wand?

Adam: It’s kind of like an S-shape. Like a small S shape. I’m not the biggest fan because… to go and search for trigger points, I don’t know how helpful that is. Also unless you’re sort of a Marvel DC Comic character when you have a long arm, or you actually can make it to put it in your butt. You might have a problem kind of relaxing certain muscles because you’re utilizing them in order to contract them to a certain position right.

Well that being said I’ll never tell someone not to do something. In most cases, I won’t say no to do something. So if that makes you feel better, do it.

Simon: So you’re using your finger then?

Adam: Yeah we use gloves.

Simon: You’re using your finger like a wand basically?

Adam: So am I looking for a trigger point or not? I have people that seem that don’t have that much tension in their pelvic floor but they go through all the gamma symptoms and everyone who does, has a high torn pelvic floor. So I’m not necessarily looking for trigger points. But something that says that I’m in the right area right. Especially the first session which is evaluation. I go around and try different things and I’ll tell my clients to text me the next two or three days and then I have a log two-three days and another two-three days until they come in. and we’ll see if that did work and we’ll stick with that a little bit and then when we are at the point where we’re stagnating then maybe we’ll switch to something else.

12:47​ Individual treatment for clients 

Simon: So what are these? Are you telling them to stretch? Or do they do the massage and set the internal massage themselves? What is it? Or just a combination of different methods?

Adam: Yeah, I don’t have cookie-cutter treatment. If it takes someone with a really high tone pelvic floor that kinda sits all day, and doesn’t move much. They would do really well, just kind of going out for a walk starting slow, deep squats. My favorite is deep squatting in your bathtub. I don’t know in the UK if you have traditional bathtubs, not sure if you do. Curve the edges on the side. 

 So you can deep squat with your back with supported heels down that curved the edges will further push you to the hip flexion. So what you’ll get is the opening of that perineum and adductor fascia. That’s my favorite kind of talk of almost everyone on their first visit just to see if we get a change because that is what we are looking for right. An active change.

Simon: It’s funny you say that. Because that is the position that I would do. The wand, that’s the exact position that is really helpful. That deep squat just pulls everything open. You can feel like releasing… come open… so I can certainly associate with that.

Based on the above conversations, we can feel how passionate Dr. Adam Gvili is in treating male pelvic floor disorders and how he works with them closely to improve their symptoms and normalize their pelvic floor.

Do you want to know more about a male physiotherapist and how Dr. Gvili treats his patients? Want to learn more tips and advice from an expert who experienced pelvic floor disorder himself? Watch out for our next blog.

Related Blogs: Physical Therapy for Men: FAQs Answered and Guide to Physical Therapy: What You Need to Know

I was in deep sadness, because of an unhealthy pelvic floor. Past tense because it was all in the past. Have you been searching for ways how to regain your pelvic health?

If YOU or you know ANYONE who has been suffering from pelvic floor dysfunction over the years. Please let them read this. Please share this with them.

Because they need to know what I’ve been through. And how my story can HELP them regain their pelvic health back for GOOD.

Here it is…

My pelvic pain issues made me a pelvic floor physiotherapist.

When I was going through my symptoms of a pelvic floor disorder, I remember feeling very bad for myself. I have experienced all the embarrassing signs of pelvic floor dysfunction.

• Weak pelvic floor
• Urinary incontinence
• Fecal incontinence
• Painful urination or defecation
• Erectile dysfunction
• Pain in the bladder or groin area

I tried to rationalize why someone like me who is a good person, would get such a terrible disease. And I also tried to play out every scenario in my head and think of what I could have done over so that I would not feel the pain and discomfort I was feeling. Weird things like my masculinity kept being called into question, I would second guess myself on routine tasks and I would feel less confident around familiar people. I remember crossing the street and thinking to myself “I bet you, he doesn’t have pelvic pain”. This all drove me mad!

Physicians I consulted with thought I was crazy. Every test they examined me for came back NEGATIVE!

Examinations include:

• Digital rectal exam
• Urinalysis
• Blood tests
• Radiology tests
• Cystoscopy

They all concluded that it must be psychological, and I started to believe them. The issue with men’s pelvic pain is that it’s not tangible; no one can prove that you are feeling pain, neither can you. At some point in your journey, you start to ask yourself is my anxiety causing this? What came first, my anxiety or the pain? Did I even have anxiety prior to this? The truth is, it’s a double-edged sword if you are constantly trying to make sense of something in your head and you are feeling symptoms of that which you cannot make sense of, that is anxiety by mere definition. 

It wasn’t until I finally met a pelvic physical therapist focused on men’s pelvic health, who could finally validate my symptoms. And help me get out of pain and discomfort that I started to see the light at the end of the tunnel.

It took me 6.5 long years to finally get someone to listen to me and let me know that my symptoms are real and actually very much treatable.

I remember breaking down and crying at how happy I was.

This was now the beginning of a great journey and all my efforts up until this point have not been wasted. So many men have been through hell and back and have lost hope.

There are so many reasons as to why you haven’t gotten relief yet. In many cases I see clients that haven’t been pointed in the right direction for care. Sometimes it’s a urologist, gastroenterologist, colorectal specialist or even a PCP that didn’t know how to screen for pelvic pain. Other times it’s another pelvic floor therapist that didn’t know how to properly treat the cause of the symptoms. Whatever it is, know that it takes time to get help for a diagnosis with little to no research. Only now are we starting to see leading practitioners research this issue.

So don’t lose hope, remind yourself that you are doing everything in your power to get better and there is absolutely nothing you can do beyond that. Control the factors in your life that you can control.  Getting rid of pelvic pain is multifactorial, look at the whole picture.

• Check your sleep cycle;
• Water intake
• Stress level
• Activity level
• Check your diet and vices

My only MISSION is to pay it forward.

Be that SOMEONE who listens. That SOMEONE who pays attention to your pain. And we are making it possible by creating a judgment-free community of MEN that support MEN, aiming to be free from pain and live their best life.

Feel free to join our EXCLUSIVE GROUP here CHRONIC PROSTATITIS, PELVIC PAIN & ALL THINGS MEN.

If you need someone to talk to, I am here to listen. I am here to tell you that it will GET BETTER.

I am also providing 15-minutes teleconsultation for FREE.

You can also hear my full story on how I overcome PELVIC FLOOR DISORDER here.

WEAK PELVIC FLOOR is synonymous with a TIGHT PELVIC FLOOR. These words are common terms in the world of pelvic health but are usually misunderstood. To give everyone clarity, a weakened pelvic floor is a state of the pelvic floor muscles where your pelvic organs lack the support it needs to function normally. That may stop you from being able to control urine, feces, or gas. 

Symptoms of a WEAK/TIGHT PELVIC FLOOR MUSCLES

• Leaking urine or flow of urine when coughing or sneezing
• Passing wind/gas when bending or lifting
• Reduced sensation in the sexual organ
• Unable to control bowel movements or passing the stool
• Pain in the tailbone (coccyx pain)
• Sudden urge to pee (urinary urgency)
• Unable to poop (constipation)
• Painful sex (dyspareunia)

WHAT ARE THE COMMON CAUSES OF WEAK PELVIC FLOOR IN MEN?

Men’s pelvic floor can be weakened by:

• Obesity (as defined by the World Health Organization, obesity is the abnormal or excessive fat accumulation that presents a risk to health.)
• Type-A Personality ( People with Type A personalities are often high-achieving “workaholics” )
• Chronic constipation (Constipation that lasts for several months)
• Post-Op Prostate Recovery (People who underwent prostatectomy which is a surgery that removes part or all of the prostate gland)
• Straining to urinate or defecate (An intense exertion to pass the urine or stool)
• Minimal Ejaculation (Ejaculating little to no semen)

WHAT ARE THE COMPLICATIONS OF WEAK PELVIC FLOOR?

Have you tried riding a roller coaster and felt like your internal organs are shuffled? And it felt like there is a strong gravitational force pulling you down there? It may be a little exaggerated, but one of the major complications of a weak pelvic floor is PROLAPSE. Prolapse is the bulging or dropping of your rectum or bladder. It is more common in females but may occur in men as well.

Symptoms of PROLAPSE:

• Pressure in the pelvic region
• A feeling that something is falling out
• Protrusion of the rectum or anus
• Trapped stool or difficult bowel movements
• Urine leakage and difficulty in urinating
• Lower back pain

HOW TO REDUCE SYMPTOMS OF PELVIC FLOOR WEAKNESS?

If your pelvic floor muscles are weak, there are lifestyle changes and pelvic floor muscle training that can reduce the symptoms of pelvic floor weakness. It may include the following:

• Pelvic Floor Physical Therapy –  Pelvic floor exercise (especially integrated with a strong core) can help with the symptoms of a weak or tightened pelvic floor. Your pelvic floor therapist can help strengthen the muscles of your pelvic floor and core. 
• High-fiber diet
• Water intake
• Weight loss
• Exercise/Movement
• Yoga

WHERE TO GET HELP?

Having a weakened pelvic floor is not a medical emergency, but it is EMBARRASSING and UNCOMFORTABLE. Pelvis NYC is on a mission to help men get proper treatment and proper care. If any of the above signs and symptoms are bothering you, please consult your specialist. Or you can book a 15-minute teleconsultation totally FREE OF CHARGE. We are here to listen. We are here to help.

Other Related Blog:

PELVIC PAIN IN MEN: KNOW HOW CAN PELVIC FLOOR THERAPY SET YOU FREE