Exertional Rhabdomyolysis Following Concurrent Exercise Including Pelvic Floor (Kegel) Training in a Previously...

Rhabdomyolysis is a potentially life-threatening condition characterized by skeletal muscle breakdown and release of intracellular contents into the systemic circulation. Exertional rhabdomyolysis (ER) most commonly occurs after high-intensity exercise involving large muscle groups, but cases related to lower intensity or repetitive activity have also been reported. We describe a case of acute ER in a previously healthy 36-year-old man who developed the condition after initiating a workout regimen for erectile dysfunction that included gluteal exercises and pelvic floor muscle training (PFMT), including Kegel exercises, demonstrated in YouTube (Google, San Bruno, CA) videos. The patient presented with dark, reddish-brown urine and mild soreness in the hips and lower back several days after a workout consisting of repetitive pelvic floor contractions, glute bridges, and pelvic tilts. He noted that he had difficulty walking two days after completing the exercises, which had resolved by the time of his visit. Physical examination was unremarkable; however, laboratory testing revealed markedly elevated creatine kinase levels (>22,000 U/L) with associated transaminase elevation. Urinalysis demonstrated positive blood on dipstick without microscopic hematuria, consistent with myoglobinuria. The patient was admitted for aggressive intravenous hydration and monitored closely, with gradual improvement in laboratory values during a four-day hospital course and full recovery without renal complications. This case highlights an uncommon presentation of ER following initiation of an unsupervised exercise regimen that included PFMT, along with gluteal and core exercises. It illustrates that even exercises generally considered lower impact may contribute to significant muscle injury when performed without appropriate instruction and gradual conditioning or in previously unaccustomed individuals. Awareness of atypical triggers and subtle clinical presentations may help clinicians recognize rhabdomyolysis earlier and initiate prompt treatment to prevent serious complications.