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Peeling back the Onion: The Urethral Burning Layer

Posted Jan 15 2009 7:41pm 2 Comments

My PT, Julie, says healing pelvic floor dysfunction is like peeling back an onion; it usually happens one layer at a time. My therapy since having the surgery to remove that dang Bartholin’s abscess has focused mainly on lengthening and relaxing my overly contracted (hypertonic or shortened) pelvic floor muscles. And boy, have those suckers been stubborn! (Unfortunately, Julie hasn't treated me the entire time. It wasn't until I began seeing her that I began to improve and heal.) As you all know, I recently had two rounds of botox injections. Thankfully, the injections coaxed my muscles into a more relaxed, normal state. So, now Julie and I are free to turn our attention to other layers of my pain. One of those layers being my constant urethral burning.

Constant urethral burning has been the symptom of my pelvic floor dysfunction that has been the hardest to tolerate. Unfortunately, it’s also been the hardest to get to the bottom of. And not knowing what is causing the pain has made it a challenge to treat. But this month, thanks to Julie, there's been a major breakthrough in solving the mystery of my fired up urethra.

This month, Julie took a trip to Chicago and had the opportunity to shadow Rhonda Kotarinos, a fantastic PT there who is considered by many to be the mother of the successful PT treatments that are applied today for pelvic floor pain. Julie described my case to Rhonda, focusing especially on my stubborn urethral burning issues, and in return got some great advice. Rhonda said oftentimes the perineum and perineal muscles will refer pain to the urethra. So, she suggested that Julie check to see what that area was doing on me.

So, the week before last at PT, Julie assessed the area around my perineum, specifically, my perineum itself, my superficial transverse perineal muscles on each side and my bulbospongiosis muscles on each side, and what she found was that the muscles were taut and full of trigger points. And most interesting from the point of view of my urethral burning, she was able to reproduce and intensify my urgency and urethral burning by palpating my perineum and superficial transverse perineal muscles! When she was working on the muscles it was like she had taken a match to my urethra, and she was nowhere near the angry little organ! Afterward, while self-treating at home, I applied pressure to my poor little urethra, and wouldn’t you know it, doing so made my perineum burn more!

These findings have led us to conclude that at least part of, if not all of, of my urethral burning is due to referred pain from the perineal area. And, it makes sense that this area would be compromised on me as this is the area that is adjacent to where the Bartholin’s glands are located. On top of that, my Bartholin’s abscess burrowed inward, so that it spent much of its existence in close proximity to my left perineal muscle and bulbospongiosis muscle. Since my pain began, whenever pressure was applied directly to my perineum, I would feel a burning pain. Now that we’ve started working on the area, the burning has increased and is pretty constant; I seem to be in a bit of a flared state there, but I know it’s that good pain, the one that will ultimately come with gain. With PT, oftentimes things get stirred up before they settle down.

Now that Julie knows that the area influences my dreaded urethral burning, she’s launched a new strategy aimed at restoring the area to good health. Here’s how “Project Perineum” will go down:

Julie will apply her therapy techniques, such as skin rolling and trigger point release to the perineum and the adjacent muscles. In addition, there are two nerve branches that innervate the area: the perineal branch of the pudendal nerve and the posterior cutaneous nerve (the very end of it). Each week during PT, my doc will come in and give me an injection to shut down these nerves. I had my first of these injections last Friday. The good doc gave me the injection directly into my perineum. Although she only stuck me once, she managed to maneuver the needle so that she hit three spots on the perineum—in the middle and on either side. Immediately afterward, I could feel my urethral burning plummet; however, at the end of physical therapy, shortly after I stood up and started moving around, it was back, somewhat dented, but back to its usual tricks. I believe either we didn’t hit the nerves in the best place or the PT I had in the area caused a normal PT hangover, which sort of canceled out the block. Next week, I’m hoping the doc will try to hit the nerves from a different direction. Julie suggested going after it from the posterior aspect of my glute on the left (sort of in the area of my inner thigh where my gluteus maximus starts to happen). This is another major hub of my burning pain. As with my perineum, when I press down on this area, my urethral burning increases. I’ll be sure and let you all know how this second injection goes. In addition to the PT and the injections, I’m going to start using topical lidocaine and neurontin externally in the area to help soothe the burning I feel there. Also, the next time I visit my pain specialist, I’ll discuss the possibility of adding something orally to go after my nerve pain. So with PT we’ll hit the muscles and connective tissue, and with the injections and meds, we’ll hit the nerves.

Of all pelvic floor symptoms I deal with, it’s the urethral burning that bothers me the most. The pain meds that I take to manage my pelvic pain don’t dim the burning as much as they do the other layers of my pain, but thankfully, they do help me to not mind it as much. Without the pain meds, I’m not sure I could handle the constant burning right smack in the middle of me. Now, for the first time in what seems like a very long time, I really believe that someday this pain will go away.

While I know this explanation does not explain every case of urethral burning experienced by folks with pelvic pain, it’s another possible cause to add to the check list. In the next couple of weeks, I’ll be doing some in depth research to better understand all of the known and understood causes of this symptom as it relates to pelvic floor dysfunction, and I’ll be sure and post all that I uncover.

In the meantime, please share the experiences you’ve had with urethral burning in the comment section. How have you dealt with it? Have any of you ever gotten rid of it for good? And, please feel free to ask any questions you like of me, either in the comment section or directly via my e-mail address: I’m always willing to chat!

Until soon,

Comments (2)
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I also have pelvic pain, with pelvic floor dysfunction since 2006. Only have i been recently diagnosed. But i did start the Botox injections, and they make such a huge difference for me. The first set didn't work as good as the next 2 sets. I do also suffer from urethral burning with urination. It is much better with pt and the Botox, it almost goes away completely, well not completely but tolerable. What type of soap are you using with your under garments? That makes a big difference...
If possible, I would like to speak with you about this. I have urethral burning and have a couple of questions. Is there any way to send me your phone or email. I won't take up much of your time. I am just at my wits end trying to figure this out. I am receiving PT, but not sure it is working. Interested in where these nerves are that you are refering to.
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