Post Bowel Movement Pain... TMS?

I have been suffering with different symptoms of pelvic pain for almost three years now. When I first started experiencing pelvic pain my main symptoms were urinary frequency and urgency. I went to see my doctor to get tested for a UTI which came back negative. My doctor still prescribed me a round of antibiotics and about three weeks later I noticed that I no longer had any bladder issues. I stayed symptom free for a few more months until one day out of the blue they came back much worse. I was now waking up multiple times a night to use the bathroom and I felt like my bladder was ruining my life. I dropped out of all my college classes except one and spent a large portion of my time googling my symptoms and ruminating over my health issues. I saw a few different Urologists all of which were no help at all. After countless appointments my PCP finally gave the diagnosis of Interstitial Cystitis. I wasn't ready to accept this diagnosis so I didn't take any medications or have any IC treatments.


I started learning about pelvic floor dysfunction and decided that was more likely the root cause of my symptoms. I started doing regular PT which helped at first but after a few sessions I quickly became much worse again. I remember one night I didn't get any sleep because I kept having to pee every 15 minutes. I switched health care networks and started seeing a new PT who told me my pelvic floor muscles were very tight, just as I suspected.


Overtime I developed a myriad of other symptoms. I had pain that would move around in different areas of my pelvis and also developed anal fissures. I had intermittent bouts of rectal pain but my main symptoms were always urinary frequency and urgency until last September. Last September I started experiencing severe rectal pain that is always triggered by bowel movements. This rectal pain is much more distressing and has decreased my quality of life more than my urinary issues. Sitting has become very painful which is a problem because my line of work requires sitting for long hours. I started doing PT again and after one session my pain was gone. This lasted for exactly one week until the pain came back again and has stayed with me ever sense. For a while I thought the pain was coming from an anal fissure so I started seeing a colorectal surgeon. I spent hours lurking anal fissure support forums looking for answers. The CRN gave me topical ointments and botox injections which provided no relief. After months he finally scheduled an examination under anesthesia with possible LIS surgery but he found no fissure. I stopped seeing the CRN after this examination but I assume he would have given me a diagnosis of Levator Ani syndrome or Pudendal Neuralgia.


I am now considering the possibility that I have TMS. I have a history of anxiety and depression and I also feel that I have a lot of pent up resentment and animosity. I've also had the experience my symptoms disappeared while out having fun with friends. Also when I first started dating my GF there was a few months where my symptoms were very manageable and under control. My only concern is that my pain is always triggered by bowel movements and I wonder if this indicates a structural problem. I would be interested to hear if anyone has recovered from post bowel movement pain by treating it as TMS. My pain is pretty severe right now even as I'm typing this and I feel that this is my last chance for recovery. (Sorry for such a long post).

 

Hi Srkellz,
Just a few months ago I learned about TMS completely unexpectedly while searching about my physical symptoms-- my symptoms are not similar to yours--but my history with seeing doctors and therapists without lasting results is.... Obviously I can't comment on whether you have a structural problem or not--but I was convinced that I did have a structural problem causing my symptoms and I saw Dr. Schubiner (a TMS/mind body doctor in Michigan) and he diagnosed me with MBS/TMS and explained that some of my symptoms were happening as a conditioned response. My brain was associating certain activity with my symptoms. I have learned since being on this forum that this is common in people with TMS. I wonder-- is there any chance you could see a TMS doctor in your area for confirmation and to rule out anything structural?

 

I had anal fissures before starting PT and I often got *strong* cramps after bowel movements that would radiate from my rectum all through my pelvic floor. It was excruciating and often almost nauseating. It would almost knock the wind out of me. I had/have lots of other pelvic, abdominal, and gastrointestinal issues to go along with it. Is your post-poop rectal pain like a really bad cramp in your pelvic floor? Different from the pain of fissures which is (in my experience) very acute and sharp and localized?

If so, and especially since a doctor prodded around in there and found nothing, I’d say consider TMS. Obviously if you feel more tests are needed to rule out other issues, definitely get them done for peace of mind.

PT didn’t solve all of my problems, but it did seem to end the anal fissures. I still occasionally cramp, but very rarely and almost never as severely (especially since discovering TMS). I did PT for quite a few months because it took that long to retrain my pelvic floor muscles to relax. It is not a fast process.

Anal fissures suggest a tight (hypertonic) pelvic floor. Your urinary issues could support that as well. With the fissures, essentially you have tight tissues trying to clamp your anus shut while the stool pushes it to stretch. The stretching of the taut tissues causes the fissures. So PT is about retraining the muscles to relax and stop fighting the stretch. If your pelvic floor is where you tend to hold your stress, it will take lots of sessions, and homework, to retrain. I don’t regret all the time spent at all. I do recommend doing your research and making sure you find a PT who did their thesis work on the pelvic floor if possible. There are a lot of weekend seminars that PTs can take and call themselves a qualified pelvic floor therapist, but the difference in care is significant.

It’s possible that TMS work alone could help. I can’t say because I did PT before I learned about TMS and I still use the tools I learned in PT to keep my pelvic floor (somewhat) relaxed. But I definitely believe my pelvic floor issues are TMS, and my PT was not complete until I started the emotional work.

I’m still dealing with other pelvic floor and digestive issues, but they are slowly softening with TMS work, and the fissures and cramps (for the most part) are gone. So there’s hope for you here!