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Information for Urologists

©Devin Starlanyl MD 1995-1998

There is a type of insomnia called Compulsive Urination Insomnia that I've found very common in FMS&MPS Complex. Most people urinate before they go to bed. There is usually a small amount of urine left in the bladder. People with FMS have hypersensitive nerve endings, and can feel the pressure, so we get up and go again. We are also conscious of how hard it is for us to get some sleep, and we don't want to take a chance on being wakened in the night by having to go again, so whenever we wake (sometimes with every alpha intrusion we get) we take a trip to the bathroom. This can happen over 30 times a night. Lidocaine ointment on the urinary opening will stop some of the sensitivity, but first be check for a possible yeast or low-grade bacterial infection, or myofascial trigger points. Check the area around the pubic bone and the high adductor magnus for TrPs.

There are many medications to help FMS&MPS Complex, as well as physical therapy modalities that are effective in defusing the TrPs of myofascial pain syndrome.

Irritable bladder, bowel: This can be due to the pyramidalis, multifidi, and abdominal TrPs, as well as yeast overgrowth in the gastrointestinal tract. I have found that TrPs in the upper rim of the pubis add to the irritability and spasm of the genital-urinary tract. This is as least part of the reason so many of us have urinary frequency. Not only is the bladder hypersensitive, it won't hold as much. In addition, we can't empty the bladder totally. There is also a TrP that can form high on the adductor magnus, about an inch from the join of trunk to leg. Often you will be able to feel a taut band of TrPs in this region. This refers a diffuse soreness and pain throughout the pelvis, which can mimic PID, prostate trouble, and other visceral conditions. I have a theory that we also can lose bladder elasticity, as the myofascia in that area tightens and "splints" the stressed muscles. This is also a common occurrence as we age. It just can happen earlier for those of us with FMS&MPS Complex. Fortunately, there are often ways to reverse this process. Often, in cases of irritable bladder and bowel, the lower internal oblique muscle and possibly lower rectus abdominus are involved.

Burning or foul-smelling urine: This is fairly common, and also occurs with guaifenesin treatment for FMS reversal. It can mimic a urinary infection.

Impotence Occurring Secondary to Myofascial Trigger Points: This information is taken directly from "Myofascial Pain and Dysfunction: The Trigger Point Manual Volume II" by Janet G. Travell M.D. and David G. Simons M.D., and references are to those volumes.

Both the bulbospongiosus and ischiocavernosus muscles enhance erection of the penis. These muscles can develop TrPs. The bulbospongiosus essentially wraps around the corpus spongiosum of the penis, which is the central erectile structure through which the urethra passes. The anterior and middle fibers of the bulbospongiosus and ischiocavernosus muscles contribute to erection by reflex and voluntary contraction that compresses the erectile tissue of the bulb of the penis and also its dorsal vein. Contraction of the ischiocavernosus muscle maintains and enhances penile erection by retarding the return of blood through the crus penis. TrPs in the bulbospongiosus muscle can cause impotence (page 118). TrPs in scar tissue produced by surgical incision are well known (page 121). TrPs in the pelvic floor muscles are sometimes activated by surgery in the pelvic region (page 121).

The piriformis is a major intrapelvic muscle which is a frequent site of TrPs. Entrapments are numerous. The nerves and blood vessels that pass through the greater sciatic foramen along with the piriformis are subject to entrapment (page 187). Exiting the pelvis along the lower border of the piriformis are the pudendal nerve and blood vessels. The pudendal nerve innervates the bulbocavernosus, ischiocavernosus, and sphincter urethrae membranacea muscles and the skin and corpus cavernosus of the penis. Innervation of these structures is essential to normal sexual function (page 191). "Patients may complain of...sexual dysfunction...impotence in the male" (page 192). "Pudendal nerve entrapment may cause impotence in men" (page 194). The piriformis TrP is most commonly found with a complex of other TrPs (page 203). This is a complex area with multiple layered muscles and opportunities for entrapment. After a surgical procedure, such as a hernia repair, a regimen of stretches can often help prevent adhesions and TrPs.

Pain during coitus can be caused by TrPs in the surrounding muscles. Sharp, shooting pain is most often caused by piriformis entrapment of the pudendal nerve.

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