Are you experiencing chronic constipation, pain, frequent urge to urinate, trapped gas, etc? Please read!!

TL;DR If you are experiencing any of these symptoms (chronic constipation, abdominal/groin pain, frequent urge to urinate, incomplete bowel movements, pain during sex, shallow breathing, increased/constant anxiety, please do yourself a favor and read below.

Backstory, I'm a 30M who has been experiencing some, or all, of the symptoms above for the past ~4 years. It has drastically impacted my quality of life and at times pushed me to my mental breaking point. I have seen countless specialists and had numerous tests done over the years (Colonoscopy, Endoscopy, Anal Manometry, MRI Defecography, etc.). If you are like me, please don't give up! You are not alone!

I'm going to go over the things I've done that have brought me relief and helped me start the road to recovery. I will go more in depth to my personal story at the end if you are interested in reading more about that.

STRESS - I can't express how important it is to focus on things that trigger stress and to avoid these triggers and learn mechanisms to better deal with it.

PROPER BREATHING - I know this may sound crazy but focusing on proper diaphragm breathing had a massive impact for me. I didn't realize at the time that I was guilty of Paradoxical breathing. Your pelvic floor muscles need proper diaphragm breathing to reach a relaxed state. Extremely tight PF muscles combined with paradoxical breathing increases pain and makes stretching/relaxing them much more difficult. It felt almost as if my abdomen was "frozen" since my tight muscles were leading to a constant engaged core and this also led to shallow breathing.

SITZ BATHS - This helps relax your tight PF and is best to do when pain is the highest which for me was after my daily bowel movement attempt.

YOGA/STRETCHING - This is imperative to the healing journey. Pelvic floor dysfunction related to tension (common PFD in males) is often a result of overall muscle weakness, sometimes combined with trauma. Doing commonly recommended PFD exercises such as kegels that are recommended for woman after childbirth to strengthen the lax muscles are NOT beneficial and actually counterintuitive if you are experiencing PFD due to tension. We want to relieve muscle tension by relaxing and gently stretching them. Once this is achieved we can focus on strengthening. Stretches/Exercises should not be significantly increasing your pain. Paying attention to your posture is important as well. I noticed that I had developed an anterior pelvic tilt which was causing further muscle imbalance as well as increased pain/constipation from the pressure it was causing on my intestines. oo

AVOID SITTING - If you are like me and experience abdominal/groin pain (specifically the LLQ for me), it is important to try to avoid sitting when you notice the pain.

AVOID STRENUOUS ACTIVITIES - This goes for heavy lifting, strenuous exercises (weight lifting, running, etc.), bike/motorcycle/horseback riding, intercourse/ejaculation, anything that engages your core excessively. If it causes or increases pain, avoid it for the time being.

BIOFEEDBACK - Get a PF PT referral and participate in biofeedback. This helps make a mental note on engaging/relaxing muscle groups and focus on independent control.

MEDITATION - This is kind of synonymous to breathing techniques, yoga, and overall reducing/avoiding stress. Personally, I was never an anxious person prior to this chronic condition. I found myself feeling a constant state of anxiety. This was mainly due to the paradoxical/shallow breathing, and tight Psoas muscles. It was unknown to me at the time but your Psoas muscles are part of your sympathetic nervous system, often nicknamed "fight or flight" muscles.

DIET - I recommend cutting out unhealthy processed foods. It's important to track your food intake in a diary and note any foods that cause digestive upset, increased pain, etc. Personally I had to avoid foods that caused excess gas because a lot of pain stemmed from trapped gas, as well as spicy foods that increased straining during BM because of damage to rectum/anus. I severely cut down on gluten and tried to focus on nutritionally dense foods. I ate small breakfasts because my pain was the worst after morning BM, followed by a moderate lunch/protein shake and normal dinner. I try to incorporate more fermented foods in my diet as well to help with gut health. Probiotics is another possibly beneficial but debatable topic. What works for some may not work for others.

CUPPING - Useful tool recommended by my PT to help relieve pain, as well as manually aiding the motility of gas/stool.

MUSCLE RELAXERS - I found that muscle relaxers were beneficial during the times of extreme tension/pain. They can be a helpful tool but are not an end-all-be-all solution. It's important to not just slap medical band aids and address the underlying issues which will take a lot of commitment and consistency on your part.

FIBER/HYDRATION - This can be helpful in increasing your BM urges and decreasing the amount of effort/straining. Try to limit your toilet time and always remember to only be gently pushing while exhaling. Do NOT hold your breath and strain, it will only further add to your PFD and muscle tension problems. Fiber needs increased water intake to be beneficial.

DILATORS - This can be helpful if you are experiencing chronic constipation and are struggling during BM with the feeling of stool being stuck near your rectum/anus. Also, I have learned over time that sometimes it is not actually stool despite the familiar feeling but actually trapped gas.

If I'm forgetting or leaving out anything that has been beneficial to my recovery I will add it down in the comments.

PERSONAL STORY: My PFD & tension myalgia started after years of being less physically active due to a back injury. After my back injury I went back to school and spent long days in class and sitting down studying. Then covid hit and I lived an even more sedentary lifestyle. After restrictions lifted I was sent to clinicals where I spent long days in a stressful environment and had long-continuous periods of engaged core. During this time I happen to be on antibiotics for an unrelated issue and they caused me to have constipation. These combined factors are ultimately what I believe led to my chronic condition. My GI/PT also mentioned that they notice a correlation between tension related PFD and people that work high stress/physically demanding careers. My original GI didn't take my condition seriously and told me I was an otherwise healthy young male and I should just take fiber supplements. Being in the medical field and having immediate family members in the medical field I began to get multiple opinions and do my own research. ALWAYS get multiple opinions! A good portion of my diagnosis was a result of my persistence and "connecting" the dots myself so to speak.

The first two years my constipation was so bad I went to the ER multiple times. I was taking magnesium citrate almost daily just to have bowel movements, which obviously created its own set of problems. My new GI prescribed Linzess as an alternative to the magnesium citrate but it still was no way to live. I was in constant agony from my LLQ pain and was stuck to a toilet for practically half of every day. My quality of life was so low at this point I questioned if I would ever get better or live a normal life again and I had to dig really deep mentally. At this point I was diagnosed as IBS-C, which IMHO isn't much of a diagnosis and more of a broad label of symptoms when there is lack of a definitive diagnosis. After having countless labs and tests done, most of the results came back inconclusive, although I had slightly elevated leukocytes which was interesting. After a few breath tests I came back positive for SIBO (small intestinal bacterial overgrowth) and was treated with Xifaxan but ultimately it was reoccurring from not treating the underlying issue.

During this period of time I severely decreased my caloric intake and combined with the constant laxatives I had went from 183-135lbs and frequently felt fatigued/lightheaded from the malnutrition and dehydration as a result from the laxatives. After discussing PFD and tension myalgia with my GI they agreed to send me to a PFPT. This benefitted me greatly and is really when I started connecting the dots thanks to my PT. I was chasing a definitive diagnosis for so long thinking surely there was something medically wrong with me that needed to be corrected. It hadn't even occurred to me that my wide range of symptoms were related and partly, or completely due to my lifestyle and neglecting my health and proper body mechanics. I am still not 100% recovered, there are days where I still struggle to have a complete BM and experience pain but I have been off of Linzess and any other laxatives for almost 1 1/2 years now. My pain is much more tolerable and I have slowly been increasing my caloric intake. Now that I have seen progress my mindset has completely changed for the better and am fully committed to the process. Trust me, I've been there. There were days I was in so much pain I didn't even want to move and had no motivation to do anything. I couldn't even sit, lay down, or ever relax due to the discomfort. You have to find the mental strength to overcome the physical pain and put in the effort to better your health. If I would have known back then what I know now I would have not gone through that severe misery for as long as I did.

I know this was an extremely long read and I apologize but if you made it this far, chances are you are going through a similar situation. If this post even helps a single person it was worth the effort. I wouldn't wish the last 4 years of misery on my worst enemy. I hope you know that you aren't alone. If you have any questions/comments I'd be happy to answer. If you just need someone to talk to that can relate, feel free to send me a DM. Don't give up!