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Date of last update: 8/13/2017.

Forum Name: Urology Topics

Question: Night time frequency with urethral/pelvic floor pain

 blues2use - Thu Dec 17, 2009 11:09 am

I have been diagnosed with interstitial cystitis and chronic pelvic floor pain and have been on every avaialble drug treatment as well as DMSO cocktails, hydrodistention, bladder wall scraping, . Last night, I slept one hour, then up to urinate; then 30 minutes; then up to urinate; then every 15-20 minutes thereafter to urinate throughout the night. Amount of urine varies from 2 to 4 ounces with tolerable urethral/rectal pain. I can usually urinate in 1-2 minutes and return to bed and get back to sleep only to be awakened 15-20 minutes later. Occasionally, I have severe, nearly intolerable painful spasms that can last up to 30 minutes before I can relax enough to urinate. I have noticed that my buttocks are always clenched when I awake. I can tell when a major spasm is coming by the amount of clenching.

At 6:30 this morning, I had a very painful spasm that lasted about 10 minutes. The pain feels like it is being bounced back and forth from my urethra to my rectum. Additionally, in between this pain, I have a nearly unbearable sharp pain between my testicles and rectum that lasts 3-5 seconds and, literally, takes my breath. At some point, I can relax enough to start urination. These major spasms are always based on the amount of urine to be voided. The most painful spasms usually result in a 10-16 ounce amount of urine even if I had previously urinated 2-4 ounces 15-20 minutes previously.

My urologists have been of no help and have generally told me that I have some sort of nerve damage and that I will need to seek treatment from a neurologist.

Any suggestions for treatment are most appreciated.
 Dr.M.Aroon kamath - Sat Dec 26, 2009 8:14 am

User avatar Hi,
"Pelvic floor dysfunction" is known to be associated with
- vulvar vestibulitis syndrome,
- essential vulvodynia and
- dyspareunia (in females),&
- interstitial cystitis.

There are a number of aggravating factors which are believed to play a role.Some of which are...
- sacro-iliac joint dysfunction,
- lumbo-pelvic dysfunction(many cases known to be associated with low back pain)
- Recent evidence indicates presence of "Myofascial trigger points" in the pelvic floor, stimulation of which results in reproduction of the symptoms of Pelvic floor dysfunction.

These trigger points can be located on pelvic examination and can be used in the management (by 'deactivating' the trigger points).

Some of your symptoms point to what is known as "Pudendal Neuralgia ".
Very severe,shifting pain in the genitals or the anal-rectal area and the immense discomfort is usually worse when sitting and during sexual intercourse, is charecteristic of this condition.Most patients with this condition also have Pelvic floor dysfunction.

It is possible that your doctor mentioned about referral to a neurologist based on this suspicion.

Transcutaneous electrical nerve stimulation (TENS),Biofeedback,Interferential therapy,cold laser therapy and ultrasound therapy are some of the modalities available for management of Pelvic floor dysfunction.

If neurological testing unearths a diagnosis of Pudendal Neuralgia, then the management will perhaps be
- management of pelvic floor dysfunction as outlined above,
- Pudendal nerve block,
- Pudendal nerve blocks using using a long-acting analgesic and a steroid
- Botox, & if all else fails, then
- pudendal nerve decompression surgery.
Best wishes!

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