Compressed Perineum

Bigger Stronger Leaner Injuries and Rehab
1

I’m pretty sure I have a compressed perineum. I don’t ride a bike but I have been lifting for 20 years. Lately I can’t do squats or deads with even the lightest weight without coming home and being in pain for 3 days. I also can’t do any seated exercises like the shoulder press machines without exacerbating the area. It’s a dull ache.

It also feels like my balls go cold as well as the end of my johnson and erections are not as strong. I’ve been subbing leg extensions and leg curls but really wish I could squat. Anyone know what to do about this? Thanks for any insights!!

3

Does the pain go away after awhile, or is there always a dull ache, even when you do not work legs or shoulders for a significant amount of time (i.e. 7 - 10 days)?

Does the pain get worse when you sit down?

I suggest that you stop doing all activity that aggravates the area, also go and see a urologist.

I am having somewhat similar problems. You can read about it on the thread titled Pedendul Nerve Problem.

God Bless,

bamit

4

Thanks so much for the advice bammit! I’ll go see the urologist. In the meantime what are the stretches that you’ve been doing to get relief? I believe tight pelvic muscles are the likely culprit because when I stretch that area the pain abates for at least 15 minutes. If you could go into detail on those stretches that you do I’d be very grateful.

The pain does get worse when I sit for long periods but not when I’m on the toilet. It actually did go away when I had a 1 month layoff from working out. It came back much worse than ever when I started working out again a few weeks ago. Interestingly it seems to abate when I do lunges or stretches where I’m opening up the pelvic area so it may be pelvic tightness. I’ve never been very flexible and never done more than a few minutes of stretching a day.

Another possible factor; I’ve been doing kegal exercises for 15 minutes a day for the past year and a half. The past 6 months is when I’ve been getting the pain.

5

[quote]calamari88 wrote:
Thanks so much for the advice bammit! I’ll go see the urologist. In the meantime what are the stretches that you’ve been doing to get relief? I believe tight pelvic muscles are the likely culprit because when I stretch that area the pain abates for at least 15 minutes. If you could go into detail on those stretches that you do I’d be very grateful.

The pain does get worse when I sit for long periods but not when I’m on the toilet. It actually did go away when I had a 1 month layoff from working out. It came back much worse than ever when I started working out again a few weeks ago. Interestingly it seems to abate when I do lunges or stretches where I’m opening up the pelvic area so it may be pelvic tightness. I’ve never been very flexible and never done more than a few minutes of stretching a day.

Another possible factor; I’ve been doing kegal exercises for 15 minutes a day for the past year and a half. The past 6 months is when I’ve been getting the pain.[/quote]

It is good to hear that the pain goes away when you have an extended layoff, I hope that is the case with me, as I am having similar issues.

the stretches I do are as follows:

  1. Standing calf stretch (30 secodns each leg)

  2. levator scapula stretch (30 secosnd each side)

  3. Waiter’s bow hamstring stretch (30 seconds)

  4. kneeling quad stretch (30 seconds)

  5. 90/90 stretch for the periformis (this is the most important one for me, as my piriformis is extremely tight)

I see that you are new to this sight so I really recommend you look up Ian King’s article "A Lazy Man’s Guide to Stretching)

Also, the authors Eric Cressey and Mike Robertson have some great articles on fixing pelvic problems and mobility.

How log did it take your symptoms to diminish during your last break?

Also, are there any other symptoms that you may have left out?

I pray for the best for you man, I know that this is not fun at all. However, I feel that there must be a lot of experienced lifters with these problems, and I hope that they chime in with their experiences, especially ones that have overcome it.

God Bless,
bamit

6

[quote]calamari88 wrote:
Interestingly it seems to abate when I do lunges or stretches where I’m opening up the pelvic area so it may be pelvic tightness. I’ve never been very flexible and never done more than a few minutes of stretching a day.

Another possible factor; I’ve been doing kegal exercises for 15 minutes a day for the past year and a half. The past 6 months is when I’ve been getting the pain.[/quote]

Your issue is most likely caused by pelvic tightness. I’ve heard 1/4 guys have this. From these threads popping up on T-Nation (and other sites), I think this is true.

Immobility and a year and a half of kegal exercises has tightened your pelvic floor. Drop the kegals, weight bearing exercises, and work on mobility. Do this for at least a month.

For mobility work, work on loosening up the hips, groin, lower back, hamstrings, and adductors. Consider going to a specialist (soft tissue or chiropractic) to look at posture/form while you walk, squat, and lunge. They can address any issues you might have (tightness, weakness, etc). You will need to get serious about this if you want to fix it.

7

And I second getting checked out by a doc (as BBB suggested). If you have any prostate issues, this is another story. Always be safe than sorry.

But understand if they give you a clear bill of health, it’s most likely caused by a tight, weak pelvic floor (and surrounding muscles).

8

[quote]bamit wrote:

[quote]calamari88 wrote:
Thanks so much for the advice bammit! I’ll go see the urologist. In the meantime what are the stretches that you’ve been doing to get relief? I believe tight pelvic muscles are the likely culprit because when I stretch that area the pain abates for at least 15 minutes. If you could go into detail on those stretches that you do I’d be very grateful.

The pain does get worse when I sit for long periods but not when I’m on the toilet. It actually did go away when I had a 1 month layoff from working out. It came back much worse than ever when I started working out again a few weeks ago. Interestingly it seems to abate when I do lunges or stretches where I’m opening up the pelvic area so it may be pelvic tightness. I’ve never been very flexible and never done more than a few minutes of stretching a day.

Another possible factor; I’ve been doing kegal exercises for 15 minutes a day for the past year and a half. The past 6 months is when I’ve been getting the pain.[/quote]

It is good to hear that the pain goes away when you have an extended layoff, I hope that is the case with me, as I am having similar issues.

the stretches I do are as follows:

  1. Standing calf stretch (30 secodns each leg)

  2. levator scapula stretch (30 secosnd each side)

  3. Waiter’s bow hamstring stretch (30 seconds)

  4. kneeling quad stretch (30 seconds)

  5. 90/90 stretch for the periformis (this is the most important one for me, as my piriformis is extremely tight)

I see that you are new to this sight so I really recommend you look up Ian King’s article "A Lazy Man’s Guide to Stretching)

Also, the authors Eric Cressey and Mike Robertson have some great articles on fixing pelvic problems and mobility.

How log did it take your symptoms to diminish during your last break?

Also, are there any other symptoms that you may have left out?

I pray for the best for you man, I know that this is not fun at all. However, I feel that there must be a lot of experienced lifters with these problems, and I hope that they chime in with their experiences, especially ones that have overcome it.

God Bless,
bamit[/quote]

Thanks so much bamit and I wish you a fast return to good health! I’ll read those articles and do the stretches you recommend. As for any other symptoms; 6 weeks ago I developed a cyste overnight next to my right testicle. At first I thought it was a hernia. A hernia doctor and ultrasound ruled that out, however the ultrasound revealed a very mild vericocele. The urologist said it was mild enough that it need not be operated on. He said that squats could make it worse though and said to stick to leg extensions and leg curls. The urologist recommended I take a month off from the gym which I did.

3 weeks ago after the layoff the first day I decided that I would do squats but with 35% my usual poundage and go for high reps. So basically I was trying to circumvent the doctors orders as he was fat and out of shape and I wasn’t sure he was right about squats. However that night I started to feel the tightness in the testicles and perineum area as well as the coldness I mentioned.

Today the cyste is almost gone. What I’m dealing with are 3 issues which could all be related to each other, (cyste, vericocele and tight perineum). I went to a chiropractor today and after he adjusted me the pain went away, but only for about 30 minutes. He said it could be a nerve impingement but is sending me to a GP to rule out other possibilities.

9

[quote]BackInAction wrote:
And I second getting checked out by a doc (as BBB suggested). If you have any prostate issues, this is another story. Always be safe than sorry.

But understand if they give you a clear bill of health, it’s most likely caused by a tight, weak pelvic floor (and surrounding muscles).[/quote]

Thanks, I’m headed to the GP next and see my response above about the chiropractor. My theory is that you’re right about the tight pelvic floor. My quads are the most developed bodypart on me at 25" circumference so it could be tightness.

10

[quote]bushidobadboy wrote:
Aside from the fact that you don’t state where the pain is - duh, we need INFORMATION to help you - I suggest you go and get a digital rectal exam ASAP, because it’s possible that you have prostate issus or even prostate cancer.

The dull ache would suggest some underlying pathology, not an acute injury modality.

And don’t you dare put it off just because your worried about having someone insert their finger into your anus. This is potentially life-ending shit so get it squared away yesterday, OK?

BBB

[/quote]

Thanks bushidobadboy, I’ll get that prostate checked out to be on the safe side. I’m not squeamish about anything needed for good health. The symptoms flare up the most after squats so it’s probably a sports injury. Do you guys think a sports medicine doctor is in order? I don’t know much about what they do.

11

[quote]calamari88 wrote:

[quote]bushidobadboy wrote:
Aside from the fact that you don’t state where the pain is - duh, we need INFORMATION to help you - I suggest you go and get a digital rectal exam ASAP, because it’s possible that you have prostate issus or even prostate cancer.

The dull ache would suggest some underlying pathology, not an acute injury modality.

And don’t you dare put it off just because your worried about having someone insert their finger into your anus. This is potentially life-ending shit so get it squared away yesterday, OK?

BBB

[/quote]

Thanks bushidobadboy, I’ll get that prostate checked out to be on the safe side. I’m not squeamish about anything needed for good health. The symptoms flare up the most after squats so it’s probably a sports injury. Do you guys think a sports medicine doctor is in order? I don’t know much about what they do.
[/quote]

Honestly, most won’t know how to help you with this injury unless they are a doctor specializing in pelvic disorders. After taking a trip to the GP, I would recommend doing mobility work and resting for a month (no weightlifting). If it clears up by then, you know your on the right path. If not, you can consult further doctors.

12

Bushidobadboy called it. I went to the GP and had the digital exam. He said I have an inflamed prostate and put me on cipro antibiotics. In 3 weeks I go back for a comparision and psa test. I have a family history of prostate enlargement so we’ll see. I regret taking those T-booster supps for all those years now. Not that they ever had a lasting effect on muscle growth.

Doc said exercise did not cause this but to lay off for a few weeks because my body needs rest let the medicine work and squats will surely irritate the prostate. Thanks for all the info. I’ll let you guys know if there’s further developments and I wish you good health!

13

Did he check the prostate fluid for infection? How would cipro help if he doesn’t know if there is an infection…

14

[quote]BackInAction wrote:
Did he check the prostate fluid for infection? How would cipro help if he doesn’t know if there is an infection…[/quote]

He didn’t actually. That’s a good question. I’ll ask about that.

15

[quote]calamari88 wrote:

[quote]BackInAction wrote:
Did he check the prostate fluid for infection? How would cipro help if he doesn’t know if there is an infection…[/quote]

He didn’t actually. That’s a good question. I’ll ask about that.[/quote]

Typical shitty Urologists… they throw antibiotics at everything without even doing proper investigation…

You see why I don’t think very highly of them?

16

Well, I went on the 10 days of cipro because my GP had said I had an inflamed prostate. During the course I didn’t go to the gym and the pain almost went away. So I thought the antibiotics worked but needed to go back to the gym to find out. Sure enough the pain came right back so the antibiotics didn’t do anything. So far I’ve been to 5 doctors and prescribed 3 types of medicine without anyone ACTUALLY TELLING ME WHAT’S WRONG!

So now the GP told me to go to a urologist. Since the first one sucked I’m going to another one to see what he thinks. The appointment is in a week.

In the meantime I discovered an amazingly helpful thing to do. I’ve been using a flexible heating pad going all the way from my perineum to over my johnson and it takes 90% of the pain away in 5 minutes. The effects even last for a long time after using it and it feels therapeutic. I try to keep it on as much as possible because it seems to be getting the blood flowing and taking away the coldness in the penis and testicles. Sounds simple but it seems to be helping!!

17

[quote]calamari88 wrote:
Well, I went on the 10 days of cipro because my GP had said I had an inflamed prostate. During the course I didn’t go to the gym and the pain almost went away. So I thought the antibiotics worked but needed to go back to the gym to find out. Sure enough the pain came right back so the antibiotics didn’t do anything. So far I’ve been to 5 doctors and prescribed 3 types of medicine without anyone ACTUALLY TELLING ME WHAT’S WRONG!

So now the GP told me to go to a urologist. Since the first one sucked I’m going to another one to see what he thinks. The appointment is in a week.

In the meantime I discovered an amazingly helpful thing to do. I’ve been using a flexible heating pad going all the way from my perineum to over my johnson and it takes 90% of the pain away in 5 minutes. The effects even last for a long time after using it and it feels therapeutic. I try to keep it on as much as possible because it seems to be getting the blood flowing and taking away the coldness in the penis and testicles. Sounds simple but it seems to be helping!![/quote]

Now you know why I have little respect for doctors.

The reason why you got better was not because the cipro, but because you stopped training and stressing the pelvic floor. Returning to training resulted in the pelvic floor becoming tense again. The reason why the heating bad helps is because it relaxes this area.

If you decide to go to any more doctors, I would make them TELL YOU WHY YOU ARE TAKING THAT MEDICATION. If they can’t give a good answer, don’t follow their advice. Doctors aren’t holy men, they are simply “bodily technicians” that are guessing what is wrong with you based on the limited time (often minutes) they spend with you.

If I were you, I would follow my original advice which would be to lay off exercise for awhile and work on mobility. Once your pelvic floor muscles loosen up a bit, you can slowly start adding exercises back in. If the doctors haven’t discovered anything, most likely this is the result of a tight pelvic floor. Think about it: Why would training make it worse and the heating pad make it better? If it was an infection or inflammation, that wouldn’t be the case (heat would make it worse).

19

[quote]BackInAction wrote:

Now you know why I have little respect for doctors.

The reason why you got better was not because the cipro, but because you stopped training and stressing the pelvic floor. Returning to training resulted in the pelvic floor becoming tense again. The reason why the heating bad helps is because it relaxes this area.

If you decide to go to any more doctors, I would make them TELL YOU WHY YOU ARE TAKING THAT MEDICATION. If they can’t give a good answer, don’t follow their advice. Doctors aren’t holy men, they are simply “bodily technicians” that are guessing what is wrong with you based on the limited time (often minutes) they spend with you.

If I were you, I would follow my original advice which would be to lay off exercise for awhile and work on mobility. Once your pelvic floor muscles loosen up a bit, you can slowly start adding exercises back in. If the doctors haven’t discovered anything, most likely this is the result of a tight pelvic floor. Think about it: Why would training make it worse and the heating pad make it better? If it was an infection or inflammation, that wouldn’t be the case (heat would make it worse).
[/quote]

My respect for doctors is almost nonexistent too, believe me!

Can you recommend a good mobility book, dvd or program to follow?

You’re absolutely right about the inflammation or infection. There was none and my GP has now admitted to that.

Here’s an update: I went to urologist a couple days ago and he ruled out prostate issues. He said he’s not qualified to diagnose me so I’m being sent to a sports medicine doctor. Then possibly to a nerve pain management doctor and a physical therapist. The urologist speculated it’s either a pudendal nerve issue, sports hernia or muscle issue.

I agree with BackInAction and BushidoBadboy that this sounds like a muscular problem. When I work out, my muscles are warm and I’m actually in no pain! It’s very deceiving because it’s not until a couple hours after I get home and I’m relaxing does the cramping sensation and cold gentalia set in. Then I’m sitting there reaching for the heating pad, trying to figure out what I did in the gym to exacerbate the pain. I’m not an expert but if this was a nerve impingement wouldn’t I be in pain WHILE training? On the other hand a warm muscle is less apt to be in pain.

I have little or no pain when I’m walking, standing, working out, lying down or doing stretches. The only time I really get the worst pain is when I’m sitting, (except on the toilet). I picked up a prostate seat with a heating element and a magnet in it. It’s been a big help. PM me if anyone wants the name. So sitting and inactivity = tension and coldness.

I haven’t been able to bring myself to stop training altogether. I keep trying to work around it by cutting out a lot of exercises. Right now I’m not working hamstrings, quads, glutes, abs or lower back, (however I’m stretching them for an hour a day). I’m training chest, upper back, arms and calves and trying to stay away from anything where I have to brace my weight with my legs. For example I’m doing dips as opposed to overhead tricep extensions. I may very likely have to take a lifting layoff but I just wanted to see if this would work. So far my pain is half what it was last month when still worked legs but it’s not going away yet.

That brings me to a theory on how I find myself with this problem in the first place - workout plans that created muscular imbalances. Let me know if this makes sense; My leg program consisted of a lot of squat variations, however I never varied the stance. It was always a wide stance and my adductors, hamstrings and glutes would be very sore the next day. Consequently they are greatly overdeveloped while my abductors and quads are undeveloped and have no sweep. My abs are overstretched with an anterior pelvic tilt. My lower back and hips are overdeveloped and tight. Could all this muscle imbalance be the cause? And if it is the cause could I strengthen certain muscle groups to pull my structure into proper alignment and possibly relieve the pressure causing the pain? For instance if I stopped working lower back and just stretched it a lot, while at the same time working my abs hard.

Paul Chek is less than an hour drive from me. I don’t know much about his methods yet, but I’ve heard a lot of people mentioning him on these boards. Do you think I should give his office a call?

20

Definitely agree that this is a muscular issue. Inactivity (immobility I would say) and poor body mechanics are a recipe for this issue. As far as good mobility programs, a few of the authors on this site have good ones. It doesn’t have to be fancy and I’m sure you can find some free ones online.

I’ve heard steve maxwell has a good one, along with Eric Cressey. Just by improving your body weight squat form to perfection (sitting back), you’ll get a lot of benefit.

I know it’s hard to drop lifting right now, but you have to remove it right now until you’re pelvic floor relaxes. Then you can start slowly adding in exercises and will benefit by seeing WHICH ONES aggravate your muscles.

Give Paul Chek a call and describe all your symptoms. Tell see if he can help. Don’t be embarrassed about this at all. A awful lot of people have this problem but are too embarrassed to seek help.