Book Review : Ending Male Pelvic Pain by Isa Herrera

4 years ago I got hit by a severe bout of pelvic pain, lower back ache, painful urination, the works!!! After a year of various doctors and treatments, I finally figured out that I had Prostatitis. And it's come back since. It seems to be triggered by cold weather and stress (and usually happens between November and March).

Anyways, this book was the only one that I could find online that seemed to address the issues, so I purchased it and fortunately it has turned out to be a bit of a life saver. Here are the best bits (or at least the parts that worked for me).

Mindset:

Exercise alone will not set you on the road to pain-free life. You must also address your mindset and perform mental hygiene on a daily basis!

I have observed that the men I treat who are suffering from chronic pelvic pain and other pelvic conditions tend to be depressed. They feel hopeless because their journey has been a difficult and trying one. Many need help with stress reductions. Many need a renewal of their spirit and soul.

The stress, anxiety and emotional upheaval that accompany pelvic issues can rob you of your day-to-day joys and life experiences. In times of painful flare-ups, it might be necessary to do the mind-body exercises more often and throughout the day.

Finding Your Trigger Points is the First Step To Healing:

Trigger points are a section of muscle tissue stuck in a contracted state. Trigger points are knot-like spots - the most well-known examples are those we sometimes get in our necks and trapezius muscle that create a burning sensation or stabbing pain. Trigger points in the pelvic floor are quite similar to these.

They can be activated by stress, pelvic and hip misalignment, chronic pelvic floor muscles holding, prolonged sitting or pressure on the pelvic muscles. Also prostate infections/inflammations.

Trigger points can be latent or active.

The latent trigger points don't actively refer pain but cause pain when touched. Active trigger points can refer pain to another muscle or body part without being touches.

It is a bad habit to push urine out. Let it flow!

Genital herpes can also cause "pain down there".

Medical Conditions Affecting The Pelvic Floor Muscles:

Chronic Prostatitis/Chronic Pelvic Pain Syndrome

Accounting for 90% to 95% of prostatitis diagnoses, used to be known as chronic nonbacterial prostatitis. Chronic prostatitis/chronic pelvic pain syndrome (CPPS) is the most common but least understood for of the disease. It has an unknown etiology and no effective treatment. It is found in men of any age; symptoms can vary and come and go. The pain associated with CPPS includes voiding symptoms and/or pain located in the groin, genitalia, perineum, testes or penis, or bladder area. Rectal pain, reduced libido, stress, anxiety and pain with or after sex are the main symptoms. Many times the pelvic floor muscles are deeply affected and need to be treated as part of a successful treatment program. Usually with this type of prostatitis doctors cannot find anything wrong with the man. The focus of this book is hot to treat CPPS in makes using physiotherapy techniques that incorporate different types of self-healing tools such as exercises, rectal massage/trigger point releases, behavioural modifications and bladder retraining. These self-healing tools are covered throughout the chapters in this book.

Interstitial Cystitis (IC)

IC is a medical condition that produces pain in the bladder and urethra. I recommend my IC patients keep a food diary, as there are many bladder irritants that can lead to painful flare-ups and contribute to excruciating pain if consumed. There will be a list of foods later in this write up.

Adhesions/Scar Pain

Post-surgical scar adhesions occur in men after most pelvic and abdominal surgeries. Adhesions cause tissues to grow together that would not normally be connected. It can become painful.

How to Perform a Self-Examination of Your Male Parts:

Make sure to perform your exam in a well-lit place. You will need a mirror and lubricant. Find a comfortable position. The recommended position is sitting with legs apart, or standing with one leg up high. Look for skin discolorations, warts, redness, sensitivity and painful areas.

Check your prostate:

Remember to examine your prostate on a MONTHLY basis and determine if there have been any changes in the size shape or sensitivity of the prostate gland. Also check the prostate itself to see if there's any pain in it. To check your prostate insert your finer into the rectum to a medium level and point upwards toward your abdominal area. You will find the prostate on the anterior wall of the Pelvic Floor Muscles (PFM's) The anterior PFS's are under the pubic bone. Sweep across the prostate to examine it. The prostate should be the size of a walnut and have no pain upon touching.

PSA TESTING:

Men aged 50-59 should have their PSA level checked :

PSA > 3ng/mL : men should talk to their doctor about having a biopsy.

PSA = 1 -3 ng/mL : men should repeat the test every 2-4 years.

PSA < 1ng/mL : men should repeat PSA test at age 60.

At aged 50 mine was 0.65 ng/mL.

If the biopsy says it's needed, a radical prostatectomy is the surgical removal of the prostate gland and the surrounding nymph nodes.

KEGELS AND REVERSE KEGELS:

Patients are recommended to do a daily reverse Kegel (release) program first and then embark on a Kegel strengthening (contract/release) program for their PFM's. The Kegel program should be initiated only after one masters the muscle relaxation and release Kegels.

They should be used on a daily basis, and especially during flair-ups when they could be used EVERY HOUR until the pain subsides.

When you inhale properly , your diaphragm actually lowers to make room for the air, so it is natural to also lower and relax the PFM's. When you exhale, your diaphragm rises to push the air out, and you can then raise or contract your PFM's.

For example, inhale for five seconds, and then exhale for five seconds.

The most important thing is to increase your awareness and focus and to practice reverse Kegels on a daily basis (or an hourly basis if needed).

The only way to tell if you have complete relaxation is to test your PFM by inserting a finger into your rectum.

What will you feel with your finger during your reverse Kegel self-grade test?

You should feel the tension or grip around your finger releasing, and the finger should slip gently outward. You can also use a mirror to better visualise the reverse Kegel. When using a mirror, you should see the anal muscles come toward the mirror. You should also see the perineal body, or area between the testes and the rectum, drop down toward the mirror. If you see this area lifting up, you are doing the reverse Kegel series incorrectly. Also look at your anus with the mirror. The anus should open as if you are passing gas, but not push out, which is a sign of straining.

OK NOW GO TO PAGES 68-73 FOR SOME EXCELLENT REVERSE KEGEL EXERCISES.

Traditional Kegel Contract/Release Series:

This series is great for men who have mastered the reverse Kegel series. If you are suffering from pelvic pain and start this series before you are ready, you risk a flare-up and exacerbation of your pain by creating more tension and pain.

Start by performing an internal rectal examination of your PFM's. During this self-exam you need to find out how many seconds you can hold a PFM contraction and conversely how many seconds it takes you to release your PFM's completely.

Firstly perform a contract Kegel. For correct Kegel execution look for the following motions: your testicles should move slightly upward, your anus should "wink," and the perineal body, the area between your testicles and anus, should move up and in.

After looking at your Kegel contraction, look at your reverse Kegel as described previously.

Once you are performing the Kegel and reverse Kegel correctly, place a well-lubricated finger into your rectum and contract your PFM around your finger. Count to see how many seconds you can hold the contraction. I can do it for 4 seconds.

Start releasing your muscles and see how many seconds it takes you to release your PFM completely. Mine is 8 seconds. From these two numbers, determine your contract/release ratio. So mine is 1:2.

Now that you have determined your ratio, start your strengthening program conservatively by performing ten repetitions of contract/release three times daily, incorporating your ratio as your guide.

Using a Pilates Ball:

Men who suffer from PFM conditions usually have comparable body types and similar muscular weaknesses. It is the nature of this condition for the body to often draw inward, creating postural issues like forward head, rounded shoulders, slouching into the lower back, and general weakness in the hips. A physio ball can help you. A man of 5'10" should get a ball that is 65cm in size.

OK NOW GO TO PAGES 84-98 FOR SOME EXCELLENT PILATES BALL EXERCISES.

If you are performing your contract/release Kegels, then choose three out of the ten exercises in which to perform your contract/release Kegels with your personal ratio.

Make sure you do not contract/release on every exercise, as you will do over 100 Kegels which is too much for one session! For the other seven exercises, keep your abdominals contracted at 30% effort (bring your belly button to your spine, about 30% of the way) and your PFM's relaxed and released. Focus on the transverse abdominal muscle when pulling in your stomach muscles. See later on for how to activate your transverse abdominal muscle.

Yoga Series for Pelvic Pain and PFM's conditions:

My patients tell me that when they have painful flare-ups, this yoga series is a lifesaver. But why not do them more regularly?

I recommend the exercises be done in order. Once you have mastered them, you need only perform the poses that give you the most pain relief. Some of them require a physio ball.

Try to perform the stretches only to the point where you feel a mild stretch.

Avoid holding your breath (valsalva) because this will strain and excessively stress your PFM's. I recommend that you practice Tension Release Breathing (TRB). To understand TRB in your minds eye, send your in-breath or inhalation to the part of your muscles where you feel the most tension or pain. Imagine that you are collecting the tension in your muscles with your in-breath. With your out-breath, exhale all the tension out of the muscles.

Breathe in through a count of four and exhale for a count of eight whenever possible. Try to inhale through your nose (and release your PFM's) and exhale through pursed lips.

All stretches should be held for 10 to 60 seconds depending on your tolerance and pain.

Perform the series up to three times a week.

OK NOW GO TO PAGES 84-98 FOR SOME EXCELLENT YOGA EXERCISES.

Stretching at the Workplace:

Most men with pelvic pain have postural issues as a contributing factor because certain muscles have become inflexible and weak, leading to poor sitting, standing, and walking posture. Sometimes poor posture comes about as a protective mechanism, as men draw inward into their bodies in response to pain and feelings of hopelessness.

The mind will follow the body if you correct the way you carry yourself. With correct posture you will feel better, think better, and become more confident and reassured about yourself and experience less overall body pain.

Day after day of bad posture at work contributes to excess strain and stress on the lower back, the PFM's, hip muscles, and gluteal muscles.

There are four areas of focus for a proper work set-up : the monitor, the chair, the mouse and the lighting.

1. A good rule of thumb is that the top of your monitor should be aligned with your forehead and your eyes level to the screen.

2. It is essential that you purchase a lumbar roll if your chair does not provide lumbar support. A lumbar roll will help maintain a neutral spine.

3. Make sure to keep your feet flat on the floor. Avoid crossing your legs under the chair!

4. Avoid overreaching for the mouse. Your mouse should be near your keyboard.

5. Purchase a good chair.

6. Avoid slouching even though it may feel good at the time. Slouching eventually overstretches spinal ligaments and muscles, creating a vicious cycle oftentimes causing pain.

7. Sit back in the chair so your back is totally supported.

8. Take frequent breaks and avoid sitting for longer than 45 minutes at a time.

OK NOW GO TO PAGES 128-139 FOR SOME EXCELLENT WORKPLACE EXERCISES.

Seated Diaphragmatic Breathing.

WHAT TO DO:

1. Sit with good posture and place one hand on your chest and the other over your belly button.

2. Focus on your breathing. Breathe in deeply, expanding the belly outward and keeping the chest from moving too much. Then exhale with pursed lips to control the release of air, trying to keep the exhale longer in seconds than the inhale breath. For instance, exhale for eight seconds and inhale for four seconds.

3. When you inhale, think of the word stress and when you exhale, think of the word free.

4. Focus on releasing your PFM's when you do this technique and focus the PFM release with the inhalation breath.

WHAT TO WATCH OUT FOR:

1. Do not allow thoughts besides the words stress and free to enter your mind. If this occurs, say the word thinking and return to the words stress and free. This is a mantra, but feel free to use whatever words work best for you.

2. Avoid taking in too much air at once or holding your breath. Keep your breathing smooth.

3. Don't breathe with excessive chest and neck movements, which is the opposite of diaphragmatic breathing. Nondiaphragmatic breathing is ineffective in relieving stress and clearing the mind.

BENEFITS:

1. Reduces stress and anxiety. Men with stressful jobs or those experiencing flare-ups will benefit from practicing diaphragmatic breathing at work for 10 to 20 breaths every hour on the hour.

2. Helps with pain control.

3. Allows more oxygen to enter the lungs.

4. Facilitates healing by increasing proper diaphragmatic movement and excursion of the ribs. It's important to remember that the major vessels that bring blood to the pelvic and abdominal areas travel through the diaphragm. So if the diaphragm is not moving properly, blood flow is compromised to the pelvic and abdominal organs and muscles.

Foam Roller Myofascial-Massage and Release Techniques:

This program is very helpful for those who suffer from spasms, adhesions, knots and painful trigger points.

Most patients love this series and say that their muscles become softer, and pain and stress diminish. The object of these exercises is to find restrictions in the muscles, which tend to be hard, painful areas and to roll the painful areas slowly and deliberately for a minimum of two minutes until the pain decreases by at least 50%. Once you find a painful sport, you can also rock over the same areas from side to side to increase the release of the muscle.

Avoid rolling over bony areas.

Do not practice your contract/release series while doing these exercises.

OK NOW GO TO PAGES 144-158 FOR SOME EXCELLENT ROLLER EXERCISES.

The New Core for Male Pelvic Power and the Prevention of Incontinence:

Performing the same old abdominal crunches will not improve your male pelvic power. In this section, you will be working on your deepest abdominal muscle, the transversus abdominis, while simultaneously engaging your PFM's. This co-contraction creates power from within the body and can result in life long changes to your pelvic function. Proper co-contraction can results in improved sexual power, harder erections, better bladder and bowel control and less pelvic pain.

Diastasis recti separation:

Diastasis recti abdominis (DRA) is a separation of the rectus abdominis muscle at the linea alba. DRA can result from performing abdominal exercises incorrectly or by suddenly sitting up straight in bed from a horizontal lying down position, called "jack-knifing."

DRA has profound effects on the function of the PFM's and bladder and bowel function.

I would not recommend beginning the core series exercises until your DRA is two-fingers wide or less. Mine is only one finger wide!

If you find a DRA you must perform the corrective exercises in order to close the gap before progressing to the more advanced core program.

Tips to Avoid Making the DRA worse:

Avoid jack-knifing out of bed. Instead, logroll our of bed by engaging your abdominals, turning completely to the side and then use your arms to push yourself up to a seated position.

Avoid leaning forward such as bending from the hips to pick something up from the floor.

Before you correct DRA you must first understand how to maintain and achieve a neutral spine. Neutral spins is when all the parts of the spine, cervical, thoracic and lumbar, are in excellent alignment. This position is the most favourable to be in when performing the New Male Pelvic Power Core program because in this position your abdominal and PFM's can optimally contract and relax as needed while executing the program.

Neutral Spine (NS):

WHAT TO DO:

1. Lie on your back with your knees bent and your feet flat on the floor. Make sure your lower extremity is in great alignment. Imagine there is one continuous line from your hips to your knees to your feet. To accomplish this make sure your feet are parallel and not out to the side.

2. Keep your arms at your side and keep the body relaxed.

3. Exhale and use your abdominal muscles to press your lower back into the floor performing a posterior pelvic tilt (PPT). Inhale and release the PPT through the nose into your belly.

4. Exhale and pull your lower spine up and away from the floor creating an anterior pelvic tilt (ANT). Inhale and relax and release the ANT.

5. Most men have their spines in an anterior pelvic tilt or posterior pelvic tilt because of muscle imbalances and weaknesses. Neutral spine is a place in between these two extreme positions. You must practice this until you get a sense of what it means to be in neutral spine for you. Practice this exercise and know how to do it before moving forward.

There are several exercises to the New Core program for male pelvic power. It is important not to move to a more difficult exercise before you master the previous level. There are 8 Levels. When you can perform 20 reps, two or three times in great form you have mastered that level and can move to the next level.

Do not forget to co-contract the PFM's with the transverse holds while performing the New Core exercises. True core strength requires activation of both muscle groups through the entire set of exercises. This co-contraction is at about 30% of effort, not 100%.

OK NOW GO TO PAGES 170-179 FOR SOME EXCELLENT NEW CORE EXERCISES.

Decreasing PFM Pain with Internal Dilator Stretches and Hands-on Techniques:

GENERAL GUIDELINES:

1. If you feel tingling down the leg or in the perineum, stop and get off the spot as you are probably on a nerve.

2. If you feel numbness down the leg or in the perineum, stop and get off the spot.

3. If there's any rectal bleeding, stop immediately and go to a doctor.

4. If you get on a spot that has a pulse, you are probably on an artery and shouldn't compress into the blood supply.

5. Listen to your body and avoid eliciting excessive pain. Say with a three to five pain level.

6. Never insert a dilator all the way inside the rectum. Measure your index finger next to the dilator, that's how deep the dilator should go inside. It's about 3 inches. Start with just 1 inch inside though.

7. Clean your dilator and/or crystal wand with hot water and soap. Don't use antibacterial wipes.

8. Avoid inserting or pressing the dilator in the 12 o' clock position of the PFM's because your prostate is located there. (The 12 o'clock position is by the pubic bone on top, 6 o'clock is by the tailbone, 3 o'clock is to the left as you look down and 9 o'clock is to the right.) Working on the prostate is all about gentle back and forth massage - not pressing into it.

9. You are looking for areas that feel tight and you should hold against those areas until you feel the muscle melt.

Crystal Wand:

I recommend using the less sharp and pointed edge of the crystal wand to avoid hurting or pressing too hard on the delicate PFM's.

To start with you should have a mirror, pillows and sexual lubricant or Vaseline. Start in a semi-reclined position with a pillow under your head. Place other pillows under your thighs so that you knees are supported. Above all, be gentle and avoid heavy pressure.

Be sure to urinate after the prostate massage. This massage can be made pleasurable if your partner is willing to do it for you.

Decreasing PFM Pain with External Hands-on Techniques:

These techniques may help you locate trigger points that could be referring pain and other symptoms to the PFM's, hip/pelvic region and contributing to leaking, urgency, erectile dysfunction, testicular or penis pain.

GENERAL GUIDELINES:

1. You may experience soreness for up to 72 hours afterwards. This is normal.

2. These techniques can be very painful. Stay within a pain level of three to five.

3. You may see some bruising/redness on your skin after doing some of the rolling techniques.

4. Your PFM's may respond by tightening when you first start to use these techniques. If this occurs, do the reverse Kegel exercise and couple it with diaphragmatic breathing. Performing the breath with the reverse Kegel will help calm everything down.

5. Stay away from pulses especially in the abdominal and hip area. Never press into a pulse.

6. Always pat attention to your breathing. Breathe rhythmically and deeply. Avoid holding your breath. Keep your jaw relaxed.

7. Use aromatherapy oils of high quality quality such as basil, lavender and balsam fir.

OK NOW GO TO PAGES 209-215 FOR SOME EXCELLENT SKIN ROLLING EXERCISES.

External PFM's Trigger Point Therapy for Perineal Muscles and Surrounds:

External trigger points located anywhere in the lower back, hips and legs, and perineal area can cause pain in the penis, testicles, anus or cause a deep ache in the pelvis. Manipulating and shutting down these external trigger points will bring you a tremendous amount of relief. The external trigger points are so powerful that they can reproduce symptoms such as testicular pain even though you are not touching that area.

Eliminate the external trigger points by gently pressing into them for 90 seconds ore more. The pressure has to be sustained and merciless but within your pain tolerance. Trigger point therapy can reduce pain by allowing a muscle to come out of its contracted and shortened state to a more normal and lengthened state. When you take your finger off the trigger point, do it slowly or the muscle may spasm again.

Let's first look at the PFM's trigger points. The area in Diagram 12.1 (the perineum) on page 217 gives you a great perspective on which PFM's can be accessed externally.

For example, the Ischiocavernosus Muscle (which covers the crus of the penis) causes pain or symptoms such as base of the penis pain, perineal pain, testicular pain, pain with erections and difficulty maintaining erections. So try pressing into that muscle for 90 seconds.

To help with lower back pain:

Locate the muscle trigger point locations on page 223 (Quadratus Lumborum, Sacral Area, Iliac Crest Line) and work on those areas if you want help with (aside from lower back pain) groin pain, testicular pain, penile pain, hip pain, sacral pain, gluteal pain, sciatica, bladder symptoms and urgency.

The strain-counter strain technique was developed by Dr. Lawrence Jones, an osteopathic doctor. It is a gentle and safe technique that passively shortens the affected muscle areas by holding those muscles in a contracted state for 90 seconds. When the muscle is held in this position, it gradually returns to its original resting position and length and is therefore less painful. It's pretty easy to do as part of your self-care routine. The first two exercises on the pages below use the technique and can be done yourself.

OK NOW GO TO PAGES 225-234 FOR SOME EXCELLENT PRESSURE POINT EXERCISES.

Now that we have covered the internal and external techniques for the PFM's we will cover natural and holistic ways to keep the prostate gland healthy and vital. The prostate gland has a profound affect on the PFM's. If the prostate is inflamed, enlarged or painful, the PFM's will react to its condition by developing trigger points, spasms and tightness. Therefore, to maintain the health of the PFM's you have to keep your prostate gland healthy and happy!

Protecting your Prostate : Natural Solutions

BECOME AN EXPERT ON PROSTATE-PROTECTING HERBS AND VITAMINS

Pygeum (prunus africanus), saw palmetto and nettle root herbs have been shown to help keep the prostate healthy and reduce symptoms associated with benign prostate hyperplasia (enlarged non-cancerous prostate). Selenium, an essential trace mineral with antioxidant properties, has also been shown to have a powerful effect.

Zinc has been hailed as the male prostate mineral. Researchers have confirmed that zinc prevents prostate enlargement.

DIET : The best cancer-fighting foods are garlic, leafy greens, grapes, green tea, tomatoes, blueberries, flaxseeds, mushrooms, cruciferous vegetables, whole grains, watermelon, legumes, lentils and apples.

Walnuts, Brazil nuts and raw pumpkin seeds are all great cancer-fighting agents that can aid in keeping your prostate healthy and can easily be incorporated into your diet.

DON'T SMOKE : Smoking has been shown to have detrimental effects on prostate health.

EXERCISE: Exercise keeps a body strong and has many health benefits. Avoid riding a bike with a regular seat though. There are bike seats that take pressure off the prostate and PFM's by having a central opening. Walking, running and elliptical training are some alternatives to biking.

AROMATHERAPY - ESSENTIAL OIL THERAPY :

Frankincense oil appears to distinguish cancerous from non-cancerous cells in the bladder and has superb anticancer properties. Frankincense combined with myrrh and sage and/or anise has been cited to help improve prostate health. Mint, ginger, lemon, grapefruit, jasmine, lavender, chamomile, thyme, rose and cinnamon are also known as anticancer oils.

Many times these oils are applied to the feet, spine, abdomen , and perineum and/or are used as rectal enemas. Make sure you work with an aroma therapist who is certified, reputable and very familiar with using essential oils for prostate and pelvic health before using these oils on your own.

PROSTATE MASSAGE THE MALE G-SPOT

The prostate gland secretes seminal fluid, a fluid that carries sperm. During the male orgasm, the muscular part of the prostate helps to propel the prostate fluid and sperm into the urethra. The semen then leaves the body through the tip of the penis during ejaculation.

For added health benefits you can massage your prostate gland on a weekly basis by using a back and forth motion on it. This type of massage can be very erotic and can be part of your love making.

Regular prostate massage can help reduce the risk of prostatitis, genital pain, symptoms of erectile dysfunction and frequent night-time urination. This massage can also improve erectile function and increase seminal fluid circulation and chi to the pelvis. You can massage the prostate gland for one to five minutes as tolerated.

Next we will discuss bladder health and bathroom habits. Bladder health/habits and PFM's have a deep relationship to one another. If the PFM's are loaded with trigger points, spasms and tension, they will set off your bladder. Men who have undergone prostatectomy surgeries must focus on their bladder habits to avoid leaking.

Better Bathroom Habits:

My patients are surprised by how much relief they get once they make a few corrections to their basic voiding and bowel habits.

Correct Potty Posture, Positioning and Bracing

1. Many times men need to sit on the toilet not only for defecation but also for urination. I know this may be a foreign concept for many men, but it is necessary. Sit with knees above hips, legs wide apart and feet plantar-flexed, which means on your toes.

2. Lean forward and place elbows on your thighs. Keep the arch in your back and avoid slumping or round the lower back.

3. Gently bulge out your abdominals while simultaneously widening your waist if to "brace" yourself from a blow to the abdomen.

4. Once you can bulge and brace simultaneously this can be used as a toilet technique, as it will help relax the pelvic floor muscles and facilitate defecation and urination. Doing the "potty posture" takes time but with practice you will master it.

5. Avoid straining. Do not hold your breath. Instead, grunt and groan wile relaxing and releasing your PFM's. Play with different sounds such as ooh, ah, and shh to help further relax your pelvic floor muscles.

Top Bathroom Habits

1. Avoid constipation. Most individuals with constipation push and strain to get the stool out. This excessive straining adversely affects your PFM's, causing them to be more stressed, leading to increased muscle spasms, pain and weakness. Strategy: Make sure to get an adequate amount of fibre, drink plenty of water, and always use the "potty posture" as described in the earlier pages of this chapter.

2. Avoid pushing urine out. Pushing our forcing urination leads to PFM strain and weakness; this eventually will increase your pelvic pain and produce more incontinence. Strategy : If you are having trouble getting the urine out without pushing, perform quick Kegels and then return to the bathroom later, or try getting up from the toilet, standing for a few minutes, and then sit down again. You can also breathe deeply into the PFM's and do a reverse Kegel. This combination will facilitate urination and defecation.

3. Avoid poor potty posture. Do not slump your upper back while seated. Never hold your breath during defecation or elimination, as this will stress your PFM's.

4. Avoid poor bladder health and habits. Avoid urinating out of habit instead of when a proper urge is present to maintain excellent bladder health. Strategy : Normal voiding is six to eight times a day, with a four to five hour interval. If you do not meet the above criteria, get help in establishing better bladder health. You can also train yourself by using the bladder diary (page 248) and keeping track of your voiding and defecation.

Bladder Irritants that can Contribute to Irritation of the Bladder and Urgency

1. Fruit juices such as orange, cranberry, tomato, or lemon juice are bladder irritants.

2. Caffeine stimulates bladder nerves, causing pain, inflammation, and irritation to the bladder. Increased bladder stimulation will also produce an increase in urinary frequency.

3. Regular or green teas (because of the tannic acid found in them.)

4. Any kind of soft drinks or diet soft drinks.

5. Wine and alcohol are potential bladder irritants.

Ask Yourself the Following:

1. What is your voiding interval. Is it 15 minutes, 45 minutes, 4 hours, etc? Determine your voiding interval by looking at the time difference between voids. After you have determined your voiding interval you can try to lengthen the time on your own by as little as 15 minutes. You must be careful not to aggravate the bladder by trying to delay the voiding too much. You have to listen to what your bladder is saying.

2. Start to eliminate foods that are bladder irritants. You will be able to re-introduce them so don't worry, but in the beginning you have to be strict and eliminate all the foods and liquids that are causing you to have more frequent urges or are creating more bladder irritation and leaking.

3. Do you feel like you have to urinate all the time (urgency of urination)? If so, use the following urge-suppression techniques : Distraction of the mind to delay voiding, Quick-flick Kegels and Diaphragmatic breathing with reverse Kegels in the corpse pose. Crossing the legs in a way that no one notices can help you delay voiding by shutting down the urge. Use with quick Kegels.

4. How much water are you drinking per day? Pay attention to your intake. Many men restrict their liquid intake because they think this will help them with their bladder issues but this is ABSOLUTELY NOT TRUE. Concentrated urine as a result of dehydration is highly irritating to the bladder and causes more urge and frequency. Drink all through the day. However, avoid drinking large amounts of water at once as this willy definitely contribute to urge.

5. When you urinate, count Mississippi's : "one Mississippi, two Mississippi, three Mississippi," etc. If your void does not last at least eight Mississippi's, you did not have to go to the bathroom and you are urinating for other reasons. It takes the bladder a long time to fill and at the bare minimum you should be voiding for at least eight Mississippi's! Rate your urge for urination as low, medium, or high. Track this urge so you can compare it to what you ate, how much you drank or what activity you were doing. You'll be amazed to discover your triggers. Once you understand and know them you can work on these urge triggers also.

6. Don't rush to the toilet. Rushing heightens the nervous system and creates more urge and anxiety. Walk slowly and breathe deeply.

Bladder Habits:

Avoid "just in case" urination. Normalize the voiding interval. Normal is three to four hours. Start slowly and use the bladder diary on page 248. Avoid rushing and keep yourself calm. Avoid pushing your urine and faeces out and use correct potty posture.

Diet:

Drink enough water so that your urine is a pale colour. Eliminate soft drinks of all kind. Avoid lemon and lime wedges in your water. No caffeine or alcohol until you get your symptoms under control. Avoid cigarette smoking. Avoid foods that irritate the bladder.

These are the best things to eat:

Milk – low-fat & whole

Fruits – Bananas, Blueberries, Honeydew melon, Pears, Raisins, Watermelon

Vegetables – Broccoli, Brussels Sprouts, Cabbage, Carrots, Cauliflower, Celery, Cucumber, Mushrooms, Peas, Radishes, Squash, Zucchini, White potatoes, Sweet potatoes & yams

Poultry – Chicken, Eggs, Turkey

Meat – Beef, Pork, Lamb

Seafood – Shrimp, Tuna fish, Salmon

Grains – Oat, Rice

Snacks – Pretzels, Popcorn

Tricks of the Trade:

If you wanted to you could simply take lots of strong pain medication to control your pelvic issues, but at the end of the day these just mask the root causes of pain.

Many patients of mine swear by a simple tennis ball for pain relief in the lower back and gluteal areas. What I recommend is that they place a tennis ball on the painful body parts and roll it back and forth until the pain starts to dissipate. At first the pain can be truly excruciating, but the longer you do it the better you will feel. It's a trigger point release using a tennis ball instead of your hands. With consistency the results is almost always a reduction in pain and a loosening of painful trigger points with an increase in flexibility of the muscle you are working on. Simply lay the ball on the floor and press the body part into it.

However, if you experience numbing or tingling down the leg or into another body part, remove the ball immediately.

Thera Cane:

Is works great on muscles that are difficult to reach. Hold the cane on the painful spot with consistent pressure for 60 to 90 seconds. As with the tennis ball, if you experience numbness or tingling down the leg or another body part, remove it immediately. Chances are you are pressing into a nerve or artery.

The following areas work best for the Thera Cane : Inner thigh muscles, Gluteal muscles, Lower back muscles and Upper back muscles.

The Knobble:

The Knobble is essentially a smaller version of the Thera Cane and is a great tool to use on trigger points. For best results, find the painful spots and press the Knobble into the spot for 60 to 90 seconds. If you experience numbing or tingling down the leg or into another body part, remove immediately. The great thing about the Knobble is that it easily fits into your backpack and can be taken to work or on vacation.

The TENS Unit:

SEE PAGES 258-261 FOR MORE HELP WITH USING THE TENS UNIT.

Finally, this book would be incomplete without a discussion of the power of positive thinking. As Aldous Huxley said "There's only one corner of the universe that you can be certain of improving, and that's your own self."

Whenever you are faced with a flare-up, catastrophic thinking, or pain, do not despair. Get proactive with the following mind and body tools.

Mind/Body Visualizations and Life Strategy Techniques:

Many of my patients tell me their partners end up leaving them because they are unable to participate fully in s sexual relationship, causing depression, anxiety and pessimism to overtake their lives.

Although chronic stress does not cause pelvic pain or leaking, chronic stress and pessimism can make your pain and symptoms worse, making you more sensitive to pain and thus causing more flare-ups.

The Physiology of Stress

Your body undergoes many physiological changes when you become stressed out. The first thing that happens is that your endocrine system reacts by releasing many different types of stress hormones into your bloodstream, including adrenaline and cortisol. These hormones awaken you mentally and physically and prepare your body for an emergency response. The body goes through physical changes as well, including increased heart rate, tightening of the muscles, increased sharpness and keenness of the five senses, elevation of blood pressure and an increase in perspiration.

These bodily changes prepare you to either fight or flee from a dangerous situation.

If you're stressed over a busy schedule, an argument with a friend, a traffic jam, or a mountain of bills, your body reacts just as strongly as if you were facing a life-or-death situation. If you have a lot of responsibilities and worries, your emergency stress response may be "on" most of the time.

Long-term stress can even rewire the brain, leaving you more vulnerable to anxiety and depression. Researchers for that people suffering with chronic back pain, for example, not only demonstrate abnormal brain chemistry, particularly in the emotional centre of the brain, but also experience actual brain shrinkage.

STRESS REDUCTION TECHNIQUES.

Relaxation breathing

Exhaling longer than inhaling has a positive effect on the nervous system and promotes deep relaxation. To release more tension when you breathe out, purse your lips and exhale so the air comes out like a whisper. This kind of breathing is done in many yoga classes.

Cardiovascular Stress Reduction

The one exercise that anyone can do is walking, which is why I always recommend a walking progream to release stress. Practice the relaxation breath described above as you walk.

Try taking an evening walk after dinner instead of sitting in front of your TV.

Combine walking with a gratitude meditation (described later).

As an alternative to walking, try stationary biking and then see how you feel. Make sure you wear padded bike pants. Be careful of bikes, though, because they can add too much pressure on the perineum and pelvic floor muscles. If you have testicular pain or perineal pain, biking is not recommended until you have no pain.

Progressive Relaxation with Jacobson's Techniques

This relaxation technique require that you alternately tense and relax your muscles.

1. Contract the right arm for 10 seconds and then relax your right arm for 15 to 20 seconds. Do the same for the left arm.

2. Contract both shoulders for 10 seconds then relax your shoulders for 15 to 20 seconds.

3. Contract your neck muscles for 10 seconds and then relax your neck muscles for 15 to 20 seconds.

4. Contract your lips and eyes by closing them tightly for 10 seconds and then relax your lips and eyes for 15 to 20 seconds.

5. Contract your whole right leg including toes and ankles tightly for 10 seconds and then relax your whole right leg for 15 to 20 seconds. Do the same for the left leg.

6. This is a basic sequence, but you can separate out the body parts and tense and relax as many body parts as you want. The more body parts you individually contract and relax the longer this relaxation will take.

Positive Thinking versus Negative Self-Talk

You may be filled with thoughts such as "I'll never get better," and "This is the best I will ever feel."

I am a firm believer that the body will follow the mind. You can change your mind by changing your thoughts.

Mantras and Meditation

The most basic mantra is OM. This mantra can be repeated slowly for three to five minutes and it brings a calming feeling to your entire body. Allow the syllable or syllables of the mantra to resonate slowly inside your head and body like a bell, using it to clear out the "though clutter" that often prevents us from staying in the present moment.

Mantra examples : Om Shanti Om, I-Am-Pain-Free, I-Am-Healed.

Journaling

Write down the story of your pain as you perceive it. Once it has been written down, I often suggest my patients perform a ceremony where they burn or shred their story and release the past from their body and mind. Or write it on a stone or a piece of wood and throw it as far as you can.

Affirmations

As you go through your day, actually listen to the words you use to describe yourself and your various situations in life, from your job, to your relationships, to your perception of your own existence. You might find that you are actually saying out loud that you won't get better, you are destined to be in pain, or that it is your fate to be afflicted.

I like to have my patients write down their affirmations and say them while looking themselves in the eye in the mirror. Repeat the affirmations every morning before brushing your teeth and every evening before going to bed, and you will find your words will change your life.

Remember to write your affirmations in the present tense with words like "I am" or "I have".

Here are some great affirmations for men with pelvic pain.

1. I am healed.

2. I am having great and pain-free sex with my partner.

3. I have healed my prostate.

4. I do not leak anymore.

5. I am in a loving and satisfying relationship.

Keep it Simple : Stop Taking on too much in your Life

Space our your social calendar so that you have ME time.

Do something that brings you joy and happiness every day, even if it is as simple as looking at flowers for five minutes. Grow your own tomato plant.

Join a Self-Help Group

1. Join a Self-Help group and keep with it for several months.

2. Get a life-coach.

3. See a psychotherapist for your emotional pain.

4. Join an Internet Blog for Self-Help.

Gratitude Rocks

WHAT TO DO:

1. Find a rock small enough that you can carry with you everyday. I carry mine in my pocket. I collect rocks from the ocean or streams because they are smooth and have all the rough and symbolically "painful edges" smoothed off by the power of water. I let my patients pick a rock.

2. When you hare having a hard day and a pain flare-up, touch your rock and repeat to yourself : "I am grateful today for ____________________."

3. Put the rock next to your bed, and when you wake up sit on the edge of your bed. Take the rock in your hand and think about something you are grateful for.

Gratitude Walks

While you are walking, make sure to notice the beauty around you. If you are walking in the park, take notice of the birds, flowers, kids playing, sunlight shining through the trees, or any other visuals or sounds that should make you feel grateful and blessed.

Mental Suds Visualization

I like to use this visualization as a gauge to help me get a sense of how many thoughts are actually "on my mind." At first you will find how amazingly filled your mind is even when you think you are in the moment. I often use this visualization as I prepare to do a meditation and mantra to calm down my mind.

WHAT TO DO:

1. Sit comfortably, with your eyes closed, with your focus slightly upward toward your third eye. Your third eye is the area above your nose and in between your eyebrows.

2. Allow the thoughts in your head to flow freely into this area of focus. Don't worry whether the thoughts are good or bad; simply take notice of them as they cross your focus.

3. As each thought passes into your gaze, place it into a bubble and allow it to float in your perception. Don't let it float away, but keep it within your gaze.

4. Repeat this for each thought that is currently "on your mind." You may find in a short while that all of the bubbles you have created have made what I call "mental suds," where the bubbles are so close together that they look like suds in a bubble bath. If this is the case, don't worry, you have just created a mental picture of what is whizzing through your mind at the present moment.

5. Make an effort to pop the bubbles in your field of view, releasing the thoughts contained in each bubble, which are not important to your present moment.

6. Try to pop all the bubbles that relate to your past to to things that you have to do or that relate to relationships and how you need to talk to this person or that person, or how you are always going to be in pain, etc. Leave just a few bubbles in your field of view, maybe one bubble filled with a thought about your breath and how it can heal you, and maybe another bubble filled with a thought about something you are grateful for, and maybe one bubble with a thought about great it is to be pain-free.

Conclusion:

Now go back and reread the book and do all the exercises again and again. It's a lifetimes work. Enjoy the process and the journey. Keep on track by checking out my website, www.RenewPT.com. I am always adding new material.