Prostatitis, Pudendal Nerve Entrapment, Both?

I read the TR forum regarding Pudendal Nerve Entrapment and found it to be very helpful. To only a small degree was prostatitis discussed. I would appreciate any input from my cycling colleagues regarding my specific circumstances. I am a 60+ cyclist with over twenty years of competitive experience (road & mountain). One day during a ride I noticed a nauseous feeling and pelvic numbness which over a matter of weeks turned into penile, perineal, and tailbone discomfort. I experimented with different saddles (ISM, BiSaddle, Selle SMP), but no relief. So, I decided to see a urologist. The urologist did an ultrasound and found what he described as “calcification” inside the prostate which is producing localized inflammation. He stated that this condition is something that can be managed but not eliminated. He did not believe that I had nerve entrapment, stating that this is “a rather rare occurrence” (?). He put me on FloMax. It didn’t do anything, but make me lethargic and mildly depressed. So he took me off of it and advised Avodart. I haven’t followed through with this because of potential side effects. I have instead opted to work with a chiropractor, PT, do pelvic floor exercises, and make dietary changes to see what happens. I have been off the bike for six months and haven’t seen any significant improvement yet. I have noticed through online research that prostatitis and pudendal nerve entrapment have similar symptoms and, consequently, get misdiagnosed. While appearing to be similar in symptoms, there are different causes and different treatments for each. Interestingly, I don’t have ANY of the typical BPH symptoms. And, floor exercises and chiropractic are slow to produce any relief. Also, walking seems to nearly eliminate the pain. Hence, I have become a reluctant hiker. :slight_smile: I would be curious to know if anyone has a similar experience with prostatitis and has experienced any progress and/or encouraging outcomes? I also wonder if prostatitis and PNE can coexist?

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Regarding prostatitis, it can be mechanical, or infectious in etiology. If it was mechanical, one would think if related to the bicycle you would be better after 6 months off the bicycle. If it is infectious urologists treat with a course of antibiotics. Have you had a trial with antibiotics? The other issue to consider would be a Lumbar pathology. Central disc herniations in the lower lumbar spine can compress the cauda equina, with referred pain to the genital region. You would need to see a spine specialist, and obtain an MRI of the Lumbar Spine. I hope this advice is helpful, it does not substitute for seeing a MD.

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As you say PNE is actually pretty rare, I also did A LOT of reading into similar symptoms 2 years ago. It sounds like you have a confirmed diagnosis which is a huge help, many many people struggle with symptoms in this area and never get a true diagnosis, myself included.

What I will say is progress with injuries in this is region is painfully slow (pun very much intended) but with careful management can be bearable.

I’m over 2 years into my experience and I’m not totally symptom free yet, no longer have pain but I know things is still aren’t right down there.

Good luck.

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Thanks for the input. @Clifford urologist said that antibiotics are to be prescribed with severe burning, nausea symptoms. I didn’t have any those, so antibiotics were not prescribed. Chiropractor didn’t think that lumbar issues were the cause. The NEXT STEP: acupuncture. I read several medical journal articles that indicated pain can be relieved significantly through this method of treatment. We shall see . . .

Clifford, It sounds like pelvic floor issues. If you ruled out all the other potential prostate problems like prostatitis and BPH ninety five percent of the time it’s pelvic floor. I’ve been dealing with this condition on and off for the last twenty years. Antibiotics rarely work because most of the time it’s not an infection. I’ve found pelvic floor therapy to eliminate ninety percent of my symptoms. Once your pelvic floor muscles become over tightened
all hell breaks loose. A trained PFT can quickly diagnose you in a matter of minutes to see if that’s what the problem is. It’s not the most pleasant thing but it isn’t terrible at all. I’ve found great symptom relief from going to PT and has allowed me to get back on the bike again and return to my favorite trails. Hope this helps-

Best Regards, Mark

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Mark, Thanks for sharing. This is helpful and encouraging. Pelvic floor exercises do seem to alleviate discomfort almost immediately. But relief is short in duration. That said, when the urologist showed me the photo imaging of my prostate gland, he was of the opinion that calcification (stone buildup) within the prostate was the culprit. My chiropractor believes that pelvic floor stretches can provide temporary relief, but believes that treatment needs to be multi-faceted in scope over an extended period of time. Visiting the acupuncturist is the next step. I realize that some folks swear by acupuncture; others swear at it. :smiley:

Hello Mark,
Thank you for the information. I was responding to another person on the thread, but do have my own issues with the prostate.
I think most men do, once they reach a certain age.

Hey how did the acupuncture work for you?

Unrelated to Prostatitis but I have done acupuncture for sciatic pain before and it did diddly squat. I’m in the camp that swears at it.

I’m almost certain Mark is talking about treatment which is more than just stretching based on his words. In my case it was several sessions of hands on pelvic floor muscle manipulation, it doesn’t take a genius to work out what that entails :grin:

TBH, by the time you get to that stage you will accept more or less anything. If I’m honest I had heard about ART (Active release Therapy) treatment and if my therapist had not gone the internal route I would have asked for it. At least that way I had an absolute diagnosis of overtight muscles.