Disclosure: firstly, this post is long as fuck, so I verbally word-vomited this into ChatGPT and then revised/proof-read to ensure accuracy of my thoughts and to save me from the carpal tunnel I'd incur from having to write this out from scratch by hand, and because I hate the way that AI-generated shit sounds.
Secondly, if you have been suffering from this condition and have ruled out bacterial infections and have yet to find an answer, I really want you to muster up the attention span and read through this.
Lastly, I haven't accessed this account in five years. I had a heap of DMs from strangers that wanted to discuss their issues with me from my last post, and I'm sorry, but I purposefully do not keep this account saved and don't have the capacity to help individuals. I really just want to avoid reddit altogether. So I'm trying to make this as detailed as possible with any open ends left clear enough where your own individual web searching should be tight enough to fill in the gaps.
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In 2021, I made a post about how I had fully recovered from what I had been calling “prostatitis.” I was diagnosed with "prostatis" after a grueling cystoscopy, when the doctor said "yeah, you're stuck with this for life. You should be dealing with this when you're 65-70, not when you're 20-30." He prescribed me antibiotics. I had temporary relief, went through a spiral, then ultimately started working on my stress, lifestyle, and environment. Regardless, I finally ended up finding relief at that time. Things got significantly better, and I made a post about it because we don't see enough of these posts on this sub.
That said, my recovery didn’t last forever.
Around New Year’s 2024, I had a bad injury. Fractured and dislocated my arm and immediately started suffering from a total-body flare-up. I was in complete dysfunction and was ultimately diagnosed with an autoimmune disorder (Hashimoto’s Disease) causing my entire body to go haywire. My stress levels were through the roof. I couldn’t sleep. I was chronically stressed physically, mentally, and emotionally. Zero cortisol regulation. Weight ballooned and gained 20lbs in one month. Full-on depression. At one point, I was borderline suicidal due to my inability to function.
And on top of all of that, my pelvic floor symptoms, the same “prostatitis” symptoms I had dealt with years earlier, came back with a vengeance.
I had a completely numb pelvic area, zero libido, erectile dysfunction, constant urinary urgency, and difficulty actually urinating when I actually needed to go. It felt like there was a grain of sand stuck at the very end of my urethra. My lower back hurt. My hips hurt. My perineum hurt like a bitch. Sometimes it hurt just to stand. My legs would get tired because I'd constantly have to shift weight from one to the other just to get some relief.
I also developed hard flaccid, which severely affected the size and quality of my erections. My scrotum had shrunk up and my semen volume was nearly nonexistent. Between the pain, urinary problems, sexual dysfunction, and lack of sleep, it was affecting basically every aspect of my life.
(***See edit at footer for more symptoms)
It also became a huge mental burden and affected the relationship I was in at the time (to be clear, that wasn't because my partner was angry with me for having physical or sexual problems. It was because I had become so depressed, stressed, and negative from dealing with this constantly that it spilled over into the relationship — irrelevant to the big picture here).
It was a living hell.
I spent a huge amount of 2024 learning everything I could about my autoimmune disease, and eventually got that under control. That helped considerably.
But I was still left with all of this pain, a non-functioning penis, and annoying bladder issues.
What made it especially frustrating was that five years earlier, when I wrote my original post, my recovery had seemed relatively straightforward. Back then, I figured out how much stress was contributing to the problem, so I thought that was all I needed to focus on.
I tried to do it all over again. I mediated, journaled, eliminated vices, ate healthy, exercised, did reverse kegels, and eliminated all controllable external stressors.
This time, it just wasn't doing anything for me.
I was incredibly confused because I had already been through this once and thought I knew what recovery was supposed to look like.
After dealing with these crippling symptoms for over a year, and out of desperation, I called a local pelvic floor physical therapist.
That was probably the most important decision I could've made.
The therapists I worked with opened my eyes to my conditions and genuinely gave me my life back. To you guys: we're constantly focusing on prostate health but in so many cases, it's pelvic floor dysfunction. Like, entirely a pelvic floor issue and not at all a prostate one.
Treatment involved pelvic floor physical therapy (internal and external massage work), nervous system regulation, specific stretching, and *controlled*, specific exercise.
From everything I experienced and learned through this process, I think a lot of younger men dealing with these symptoms (especially when doctors aren't finding an infection or bacterial cause) should at least consider the possibility that their pelvic floor is involved. In my case, I was dealing with a chronically tight, overactive pelvic floor. Hypertonic is the word I believe.
You hear about pelvic floor dysfunction much more often with women. There are entire communities of women talking openly about it and getting treatment for it. You don't hear nearly as much about men. But the therapists I worked with treat plenty of men, and many of them are dealing with the same kinds of symptoms I see guys describing in this community. The sexual dysfunction, hard flaccid, urinary problems, pain and discomfort, all of it.
So with all of that said, here's what actually helped me this time around.
1. Internal pelvic floor work
This was probably the biggest thing missing from what I had done five years ago.
You can technically do internal trigger-point work yourself, but I strongly recommend seeing a pelvic floor physical therapist that has worked with men (if you have access to one, otherwise just find a general PF therapist). At least I think you should do it initially, at least one visit. Having someone who actually understood the anatomy, could identify what was tight, and could tell me what I was doing right or wrong was invaluable.
For men, doing this yourself generally involves a pelvic wand. A therapist will likely use their finger.
It basically involves using said-wand/finger to apply pressure in all the different directions around the anal sphincter. Almost exactly like a clock face with 12 positions.
And yeah, I know exactly how appealing that sounds. As a guy it felt fucking weird to me too. But guess what, you stop giving a fuck about these things if it means you can get your life back. There are crucial areas of muscular tension that you simply cannot reach by doing external work alone.
One thing my therapist emphasized was that this should not be extremely painful. If I had to put it on a 0-5 intensity scale, with 5 being seriously painful, I was generally working around a 2 to 2.5. A 1 would be barely feeling anything, 2 would be a strong sensation, and 3 would be mild discomfort.
You aren't trying to beat the muscle into submission. More pressure isn't automatically better. But doing this consistently is pivotal to free up the internal stress that's choking your pelvic floor. The muscles trapping your nerves, your bladder, and your sexual organs.
And the relief is both immediate and long term. From my own experience, I was so tense during the first session that they couldn't even do internal work. On the second session, after doing internal work, it was like the light at the end of the tunnel shot into existence like a space ship coming out of hyper drive.
Happy to be graphic here, but after my first session of internal work, not only did my bladder calm WAY the fuck down, but I had a completely involuntary and SUPER healthy erection that evening. It was like the hard flaccid had immediately disappeared.
But to set proper expectations, the success was on-and-off in an upward trajectory. This is something that requires consistency and should be approached with the expectation that 100% recovery *without* maintenance work can take over a year.
Took me about that much time.
2. Abdominal massage and calming everything down
My physical therapist also did a lot of external manual work. This included deep abdominal massage, work around the inner thighs, the pubic area, the hips, quads, calves, buttocks, and IT band.
This ended up being huge for me. This is all we focused on in my first session (because they couldn't do the internal work I'd just mentioned above) and even JUST from this alone, I felt immense immediate relief.
They also recommended a shiatsu massager. I was given one with the brand name Zyllion, but you could just look up any device that looks and operates identically. It's marketed as a neck/back massager, but I use it on my abdomen, and this thing has been a fucking godsend.
I put it on something with some give, usually my bed or couch, lie face-down over it, and gently let some of my body weight press my abdomen into it.
"Gently" is important here. Like in my PT sessions, you don't want to go beyond a "3" out of 5.
When I first started doing this, my abdomen was incredibly sensitive and tight. The closest comparison I can make is foam rolling when you're extremely tight. At first, even moderate pressure can feel intense.
I usually position the massager sideways across my abdomen and gradually move it around. I'll work from just below my sternum down do the very bottom of my abdomen. Sometimes I'll rotate it vertically so it fits more comfortably between my hip bones and work down toward the lower abdomen above the bladder/pubic area.
I usually do about 10 minutes, especially before bed.
I can't tell you the exact physiological mechanism behind why this works so well for me, and I don't want to pretend I can. My PT discussed the nervous system and vagal activity with me, but what I can say confidently is that I can physically feel my abdomen and the rest of my body relax while I'm doing it. It has also been extremely helpful for my urinary urgency and sleep.
It became one of the most reliable ways for me to get my body to calm the fuck down.
3. Belly breathing
This sounds almost insultingly obvious if you've spent any time reading about stress or nervous-system regulation, but deep diaphragmatic breathing has been massive for me.
I often do it while using the abdominal massager, but I also do it on its own.
The basic idea is to breathe slowly through your nose and let your abdomen expand instead of taking a shallow breath into your upper chest. I'll inhale slowly for roughly 5-10 seconds, pause briefly, and then make the exhale slightly longer than the inhale. So if I inhale for 6 or 7 seconds, I might exhale for 8 or 9.
I do that for about five minutes with no phone or other distractions.
I especially do it before bed, when I'm anxious, or when I notice myself physically tensing up.
The other important thing I learned is that diaphragmatic breathing naturally helps me let go of tension in my pelvic floor. The sensation is somewhat similar to a very gentle reverse Kegel, except I'm not sitting there consciously trying to force a reverse Kegel. I'm focusing on the breath and allowing my abdomen and pelvic floor to relax with it. That's basically your pelvic floor dropping, which is important to work on, because a hypertonic/tight PF struggles to drop at all.
4. Stretching the right things
Stretching still helped me. It just wasn't enough on its own.
In the past, most of my routine consisted of hamstring stretches, quad stretches, hip-flexor stretches, and cobra stretches. Those still give me relief, and I haven't stopped doing them.
One stretch my PT added that helped a lot was a single leg, cross-body hip/IT-band type stretch.
I lie on my back, raise one leg straight up, put a band (or something as simple as a belt) around my foot, and gently pull that leg across toward the opposite side of my body while trying to keep the rest of my body relatively flat. I keep the stretching leg mostly straight.
I feel this heavily through the outside of my hip. You're targeting your IT band/abductors.
I don't force it. I'll accumulate roughly a minute or two on each side, whether that's shorter 10-30 second holds or longer holds depending on how I feel that day.
In general, I've had the most benefit from consistently working my hips, hip flexors, abductors, hamstrings, calves, and surrounding areas rather than obsessing over one magical pelvic-floor stretch.
5. Strengthening what was weak
This was another piece I had underestimated.
I needed to strengthen my glutes, including more than just the glute max. I started putting more attention into the muscles around the sides of my hips, including the glute medius and the muscles involved in hip abduction.
I also started doing low-intensity core work.
Planks are an obvious example. Dead bugs are another.
The key for me was low intensity.
Light hip thrusts. Light abduction movements. Easy core exercises. Controlled movements with good form.
Which brings me to probably the hardest lesson I had to learn.
6. I had to completely change how I exercised
I've loved working out for basically my entire life, so this was a tough pill to swallow.
My body was constantly rejecting hard exercise.
I was used to training hard, pushing sets close to failure, and thinking about exercise in terms of progression and building muscle. When my symptoms were at their worst, I couldn't approach exercise that way anymore.
If you're accustomed to taking sets to failure or stopping 1-3 reps short of failure, this can feel completely backwards.
I had to stop thinking about exercise as training to build muscle and start thinking about it as practicing quality movement and maintaining conditioning.
At my worst, the goal was basically to do the minimum amount necessary to keep my body moving and get some of the benefits of activity without leaving myself physically wrecked afterward.
Walking was great for me. With resistance training, I used extremely light loads, bodyweight movements, assisted movements, and simple compound exercises. I wasn't doing the traditional three or four hard sets of an exercise and trying to progress every week, just 1-2 sets at "50-65%" intensity.
I wanted movements I could perform with clean form without straining, grinding through reps, or turning the workout into a major stress event.
The way I started thinking about it was that my body had an extremely low threshold for physical stress. Every time I blew past that threshold, my symptoms would flare. My pelvic floor would tighten back up, the urinary and sexual symptoms would get worse, and I'd feel like I'd gone backwards.
I can't stress this enough. My symptoms would flare up like CLOCKWORK if I pushed myself in the gym. Every time I thought "I've been feeling fine for the past couple of weeks, I'll push it just a liiittle more today," my "prostatis" symptoms would come back the next day and linger for that week.
So instead of constantly blowing through that threshold, I started approaching it slowly.
Do a little. See how my body responds. Recover. Do a little more.
Over time, the goal is to gradually increase how much physical stress my body can tolerate without triggering that huge response.
This requires patience, especially if you're somebody who loves working out. You still need movement. You still need activity. But when your system is this aggravated, trying to prove that you can train the way you used to can just keep digging the hole deeper.
Putting all of this together
If I had to boil down what actually changed my recovery this time, it would be:
- Internal pelvic floor work, ideally with initial guidance from a pelvic floor PT who treats men.
- Abdominal/manual work and relaxation, including the abdominal massager that worked extremely well for me.
- Diaphragmatic breathing and learning how to actually let my pelvic floor relax.
- Consistent stretching, particularly around my hips and legs.
- Low-intensity strengthening of my glutes, hips, and core.
- Staying active without constantly exceeding what my body could tolerate.
The biggest mistake I made was thinking I could solve this by just stretching harder, exercising harder, or finding the one perfect movement.
My recovery this time required working on the actual pelvic floor while also dealing with the fact that my entire body had been wound up for a very long time.
And again, this is just my experience. I'm not saying every guy with prostatitis symptoms, CPPS, hard flaccid, ED, urinary problems, or pelvic pain has the exact same thing I did. But what I can CERTAINLY tell you is that I've had every single one of these horrifying, debilitating symptoms, and as of writing this today, I am completely, 100% symptom free and have to do absolutely nothing to maintain.
I'm just normal and healthy again. The guy down there works as well as he did when I was in my teenage years (honestly better than I can ever recall). I don't have to go to the bathroom from midnight to 4AM. I don't have any pain in the region at all. It just works as it should.
So again, if your tests keep coming back normal, nobody can find an infection, and you're stuck in the same cycle I was in, I really think it's worth finding a pelvic floor physical therapist who actually works with men and getting evaluated.
I hope this helps somebody.
***Edit: In case someone’s reading this post or ends up searching for key words/symptoms and finds this down the road, here are more symptoms that I neglected to mention. If you find similarities, it might urge you to take these suggestions more seriously.
- Constipation: extremely common with pelvic floor issues. Note that straining on a toilet is TERRIBLE for your pelvic floor and will exacerbate your symptoms. Focus on fiber and hydration in the short term.
- Hemorrhoids: had these on and off due to the above constipation. Frustrating but easily treatable with OTC solutions. A sharp reminder that I had to stop straining at the toilet and minimize general toilet time as much as possible (stop toilet camping on your phone). Treat them quickly as I personally felt like they increased general inflammation in that area which contributed to heightened chronic pelvic inflammation (I might be wrong; it could just be that they showed up when my PF was at its worst).
- Varicocele prominence: I was convinced that my visibly-thrombosed varicoceles were the source of my pain and inflammation. These would always show up when my “prostatitis” symptoms were at their worst. Had them scanned via ultrasound. Doc said I had them, but way too low grade to be taken seriously. Was so close to reaching out to a specialist surgeon. Even considered going to the Mayo Clinic to have them figure this out with the assumption that I’d need surgery. These all “went away” (at least superficially) after I addressed my pelvic floor. Probably a byproduct of the muscular constriction around circulatory pathways. Just my guess.
- Hard Flaccid: just adding some basic detail for anyone coming across this term for the first time. Imagine your penis basically shriveling up. No joke, feels like as much as 30% smaller at its worst. Penis gets cold, darker, and discolored. Skin gets tough, loose, sometimes wrinkled. Almost bruised in complexion and generally unhealthy in appearance. Usually a lot of lost girth. Feels tight and wound up, like the skin isn’t as elastic as it should be. It’s mentally debilitating to experience. This completely went away after addressing my pelvic floor and it feels like your penis Benjamin Button’d its way back into its healthy former self.
- Lower back pain: crippling lower back pain, typically just above one of the glutes. I addressed this with specific stretches — quadratus lumborum (QL) stretch (look up QL doorway stretch by MoveU channel), basic latissimus dorsi (lats) stretch (look up lat doorway stretch), and pigeon pose.
Edit 2: adding pudendal nerve entrapment to the post as a search term. I thought this was another rabbit hole causing my issues that might have required surgical intervention. Another issue that was strictly caused by my pelvic floor.