Paradoxical Relaxation and the Treatment of Chronic Pelvic Pain Syndrome

Paradoxical Relaxation and the Treatment of Chronic Pelvic Pain Syndrome

In a recent New York Times article (see excerpt below), the usefulness of concentration as an integral part of a discussion of mindfulness is discussed. The ability to concentrate is not a subject that is often discussed in the psychological literature on pain reduction; thus, this article is a welcome addition to the narrative of what we consider a critical issue in dealing successfully with chronic pelvic pain.

[embed]https://www.youtube.com/watch?v=0tWwgnT_8x8[/embed]

It has become clear over the last decade that nervous system arousal is a central issue to treat in those suffering from chronic pelvic pain syndromes. Gevirtz and Hubbard have convincingly shown emotional arousal raises the level of electrical activity in pain referring trigger points in those with myofascial-related pain. There have been recent studies evaluating the usefulness of hypnosis and cognitive therapy to deal with nervous system arousal, but it has been our observation that psychotherapy by itself has little effect on modulating or reducing chronic pelvic pain. Traditional methods of cognitive therapy help patients recognize their dysfunctional thinking and analyze distorted thoughts in order to discard them. In our work using the Wise-Anderson Protocol over the last 18 years, we have observed that these methods are not greatly helpful when patients’ pain goes on unabated and they remain helpless to do anything about it.

The method of Paradoxical Relaxation used in the Wise-Anderson Protocol is one of the main ingredients we use to help those with pelvic pain lower their autonomic nervous system arousal. Many of our patients who become competent in this methodology commonly report that they can significantly reduce their pain using this relaxation method.

Paradoxical Relaxation is the practice of focusing attention on sensation rather than mental thought. The aim is to take attention away from all thought—not analyze any of it. While it is sometimes useful to analyze dysfunctional thinking, that is not the aim of Paradoxical Relaxation. If someone is helpless to stop their chronic pain, it doesn’t matter how much analysis of dysfunctional thinking is done because the inability to affect the pain is the main driver of the sense of helplessness and disempowerment.

In the Paradoxical Relaxation session, the nervous system is deliberately deprived of the symbolic stimuli that cause it to become aroused. This break in arousal can help break a flare up of symptoms and moves in the direction of downwardly resetting the nervous system ‘idle speed.’

The most profound relaxation occurs when attention is controlled and kept focused in sensation. Just as the deepest sleep is dreamless (non-REM) sleep, relaxation that is void of thinking produces the deepest level of relaxation. This type of deep relaxation allows for an up-regulated nervous system to quiet down. The idea of relaxation depending on the control of attention rather than the releasing of such control is counter-intuitive, yet over the years patients using Paradoxical Relaxation in the Wise-Anderson Protocol have experienced the ability to control attention, to reduce pain, and ‘down regulate’ the nervous system.

Training attention to stay focused is a discipline that, as the New York Times article we quote below understands, has many benefits. In our work with pelvic pain, calming down nervous arousal to reduce pain is the most important of these benefits.

Excerpt from “The Power of Concentration” by Maria Konnikova in the New York Times on December 16, 2012.

The Power of Concentration

By MARIA KONNIKOVA

December 16, 2012

“MEDITATION and mindfulness: the words conjure images of yoga retreats and Buddhist monks. But perhaps they should evoke a very different picture: a man in a deerstalker, puffing away at a curved pipe, Mr. Sherlock Holmes himself. The world’s greatest fictional detective is someone who knows the value of concentration, of “throwing his brain out of action,” as Dr. Watson puts it. He is the quintessential unitasker in a multitasking world…

In 2011, researchers from the University of Wisconsin demonstrated that daily meditation-like thought could shift frontal brain activity toward a pattern that is associated with what cognitive scientists call positive, approach-oriented emotional states — states that make us more likely to engage the world rather than to withdraw from it.

Participants were instructed to relax with their eyes closed, focus on their breathing, and acknowledge and release any random thoughts that might arise. Then they had the option of receiving nine 30-minute meditation training sessions over the next five weeks. When they were tested a second time, their neural activation patterns had undergone a striking leftward shift in frontal asymmetry — even when their practice and training averaged only 5 to 16 minutes a day.

…But mindfulness goes beyond improving emotion regulation.”

Read the rest of the article here.

The Invisible Patient: The Symptoms of Chronic Prostatitis and Chronic Pelvic Pain Patients

Pain Blog – The Invisible Patient: The Symptoms of Chronic Prostatitis and Chronic Pelvic Pain Patients

Our Pain Blog covers research on chronic prostatitis and chronic pelvic pain.

A recent article in the Korean Journal of Urology (see below) documented that men diagnosed with chronic prostatitis/chronic pelvic pain syndrome (chronic prostatitis, chronic pelvic pain syndrome) were significantly more stressed than control groups. The report showed that higher levels of depression, anxiety, and perceptions of stress were closely related to increased levels of pain and decreased the quality of life levels.

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The symptoms of chronic prostatitis, chronic pelvic pain are invisible to the eye and x-ray. 

Many of our patients have reported their distress in hearing from bosses, friends, or family members that they looked fine. The fact is that the greatly distressing symptoms of chronic prostatitis —urinary frequency and urgency, genital and rectal pain, pain associated with sex, and sitting discomfort among others—are neither visible to the eye nor any imaging technology that currently exists. It is for this reason that examining physicians will often scratch their heads and tell the patient that there is nothing wrong with him, and perhaps his problem is psychiatric. This experience has left more than a few of our patients describing their time with the doctor as one of the most upsetting in memory. To be told that there is nothing wrong with you and that you don’t look like you have a problem when you’re suffering greatly, often leaves the patient feeling frightened, lost with nowhere to go and catastrophizing about the future.

While the eye can’t see the problem, a physician or physiotherapist experienced in treating prostatitis, chronic pelvic pain can detect the disorder with an educated finger.

Many patients have undergone expensive, high-tech evaluations complete with blood, urine, and other testing that yielded no useful information. When a physician is familiar with muscle-based pelvic pain and has been trained to evaluate trigger point and myofascial constriction inside and outside the pelvis, the problem of prostatitis and most causes of pelvic pain can be easily diagnosed within the time frame of a conventional medical appointment. More important, this diagnosis can point in the direction of a real solution to the problem. Unfortunately, many urologists who are consulted for chronic pelvic pain are not trained to evaluate the presence of trigger points and myofascial constriction in the pelvic muscles. Their focus typically remains on the organs.

The Wise-Anderson Protocol has pioneered a new understanding that many cases are caused by an ongoing charley horse in the muscles of the pelvis.

The Wise-Anderson Clinical Protocol was developed and researched at Stanford University between 1995 and 2003 and continues to be offered monthly in a 6-day immersion clinic in Santa Rosa, California. A number of research articles have documented its effectiveness. This protocol represents a new and pioneering understanding of symptoms typically diagnosed as prostatitis. It focuses on teaching men to release the chronic spasm in the pelvic muscles and calm the nervous arousal that perpetuates their symptoms. A popular book called “A Headache in the Pelvis,” now in its 6th edition, offers the most detail of this new understanding and treatment.

In reviewing the data from an ongoing study we are conducting, we find that men and women who have undergone the Wise-Anderson Protocol experience a significant reduction in their emotional distress when they are able to reduce the symptoms of chronic prostatitis by virtue of their own trained self-treatment.

Korean J Urol. 2012 Sep;53(9):643-8. doi: 10.4111/kju.2012.53.9.643. Epub 2012 Sep 19.

Depression, anxiety, stress perception, and coping strategies in Korean military patients with chronic prostatitis/chronic pelvic pain syndrome.

Ahn SG, Kim SH, Chung KI, Park KS, Cho SY, Kim HW.

Source

Department of Urology, St. Paul’s Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.

Abstract

PURPOSE:

The objective of this study was to examine the psychological features and coping strategies of patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).

MATERIALS AND METHODS:

The participants consisted of 55 military personnel suffering from CP/CPPS and 58 military personnel without CP/CPPS symptoms working at the Military Capital Hospital. The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) was used to assess CP/CPPS symptoms. The Responses to Hospital Anxiety and Depression (HAD) scale, Social Readjustment Rating Scale, and Global Assessment of Recent Stress (GARS) scale were compared between the two groups. The Weisman Coping Strategy Scale was used to assess coping ability with CP/CPPS.

RESULTS:

The NIH-CPSI score of the CP/CPPS group was significantly higher than that of the control group for all domains including pain, urinary symptoms, quality of life, and summed score. The Anxiety and Depression domain of the HAD showed significant differences between the two groups. There were no significant differences in the Social Readjustment Rating Scale between the two groups, but the sum of the GARS score was higher in the CP/CPPS group than in the control group. These were correlated with the pain, quality of life, and sum domains of the NIH-CPSI. The Weisman Coping Strategy Scale showed that intellectualization, redefinition, and flexibility were higher in frequency in descending order, and that fatalism, externalization, and self-pity were lower in frequency.

BLOG ABOUT PELVIC PAIN – CONCLUSIONS:

The CP/CPPS patients had depression, anxiety, and higher perception of stress. In particular, these were closely related to the pain and quality of life of the patients

New Findings About Emotional Brain Changes in Prostatitis: What to do About it

New Findings About Emotional Brain Changes in Prostatitis: What to do About it

Swiss researchers looking into brain activity in men with prostatitis, chronic pelvic pain syndrome report that in a small group of men there is a reduction in relative gray matter volume in a part of the cortex.

A new article written in the October 2012 Journal of Urology identifies some changes in the anterior cingulate part of the brain in men suffering from prostatitis, chronic pelvic pain syndrome. The anterior cingulate cortex and other related parts of the brain, comprising part of the limbic system, are known to be connected with the perception of pain and emotion. The Swiss researchers’ observations of changes in this area of the brain may support the idea that when one has changes in prostatitis, chronic pelvic pain, the chronic anxiety fed by catastrophic thoughts that the pain will never go away is reflected in some changes in the brain.

[embed]https://www.youtube.com/watch?v=_ayvQIfLoTc[/embed]

That chronic pelvic pain and emotions are intimately connected and probably affect the brain is no surprise to any of us who have been treating chronic pelvic pain over the years. Many of our patients agree that the feelings of helplessness, hopelessness, and fear can be worse than the actual physical pain.

As with all the research that documents certain relationships, the “elephant in the room” type of question, in this case, is if pain and emotions are strong enough to affect the brain in the way the Swiss researchers have recently documented, what does it mean and what can be done about it? Over the years, our answer has been simple: empower patients to reduce or stop their physical pain and help them reduce their emotional distress.

Wise-Anderson Physical Therapy Self-Treatment and Paradoxical Relaxation

In our latest review of data from patients we have seen in the last four years, we discovered—not surprisingly—that when you give patients the ability to reduce their pain, their emotional distress calms down. In the Wise-Anderson Protocol, the two major methods we use are focused on reducing pelvic pain mentally and physically. We have documented (see 2011 articles in the Journal of Urology and the Clinical Journal of Pain) that physical therapy self-treatment in combination with Paradoxical Relaxation significantly reduces pelvic muscle sensitivity/pain. In additional data, we found that this reduction in pain is associated with a significant reduction in emotional distress. More information on treatment here

In future research, it would be interesting to observe whether the reduction or resolution of symptoms of prostatitis and related pelvic pain syndromes, as experienced after doing our protocol for 6 months, reverses the brain changes this recent study found.

 

Below are articles on the subject of brain changes related to changes in prostatitis, chronic pelvic pain syndromes.

1. Chronic Pelvic Pain Syndrome in Men is Associated with Reduction of Relative Gray Matter Volume in the Anterior Cingulate Cortex Compared to Healthy Controls.

Mordasini L, Weisstanner C, Rummel C, Thalmann GN, Verma RK, Wiest R, Kessler TM.

J Urol. 2012 Oct 18. pii: S0022-5347(12)04500-4. doi: 10.1016/j.juro.2012.08.043.

Source

Department of Urology, University of Bern, Bern, Switzerland.

Abstract

PURPOSE:

Although chronic pelvic pain syndrome impairs the life of millions of people worldwide, the exact pathomechanisms involved remain to be elucidated. As with other chronic pain syndromes, the central nervous system may have an important role in chronic pelvic pain syndrome. Thus, we assessed brain alterations associated with abnormal pain processing in patients with chronic pelvic pain syndrome.

MATERIALS AND METHODS:

Using brain morphology assessment applying structural magnetic resonance imaging, we prospectively investigated a consecutive series of 20 men with refractory chronic pelvic pain syndrome, and compared these patients to 20 gender and age matched healthy controls. Between group differences in relative gray matter volume and the association with bother of chronic pelvic pain syndrome were assessed using whole brain covariate analysis.

RESULTS:

Patients with chronic pelvic pain syndrome had a mean (±SD) age of 40 (±14) years, a mean NIH-CPSI (National Institutes of Health Chronic Prostatitis Symptom Index) total score of 28 (±6) and a mean pain subscale of 14 (±3). In patients with chronic pelvic pain syndrome compared to healthy controls there was a significant reduction in relative gray matter volume in the anterior cingulate cortex of the dominant hemisphere. This finding correlated with the NIH-CPSI total score (r = 0.57) and pain subscale (r = 0.51).

CONCLUSIONS:

Reduction in relative gray matter volume in the anterior cingulate cortex and correlation with bother of chronic pelvic pain syndrome suggest an essential role for the anterior cingulate cortex in chronic pelvic pain syndrome. Since this area is a core structure of emotional pain processing, central pathomechanisms of chronic pelvic pain syndrome may be considered a promising therapeutic target and may explain the often unsatisfactory results of treatments focusing on peripheral dysfunction

2. Limbic associated pelvic pain: a hypothesis to explain the diagnostic relationships and features of patients with chronic pelvic pain.

Fenton BW.

Med Hypotheses. 2007;69(2):282-6. Epub 2007 Feb 9.

Source

Summa Health System, Department of Obstetrics and Gynecology, MED-2, 525 E Market St., Akron, OH 44303-2090, United States. fentonb@summa-health.org

Abstract

Limbic associated pelvic pain is a proposed pathophysiology designed to explain features commonly encountered in patients with chronic pelvic pain, including the presence of multiple pain diagnoses, the frequency of previous abuse, the minimal or discordant pathologic changes of the involved organs, the paradoxical effectiveness of many treatments, and the recurrent nature of the condition. These conditions include endometriosis, interstitial cystitis, irritable bowel syndrome, levator ani syndrome, pelvic floor tension myalgia, vulvar vestibulitis, and vulvodynia. The hypothesis is based on recent improvements in the understanding of pain processing pathways in the central nervous system, and in particular the role of limbic structures, especially the anterior cingulate cortex, hippocampus and amygdala, in chronic and affective pain perception. Limbic associated pelvic pain is hypothesized to occur in patients with chronic pelvic pain out of proportion to any demonstrable pathology (hyperalgesia), and with more than one demonstrable pain generator (allodynia), and who are susceptible to development of the syndrome. This most likely occurs as a result of childhood sexual abuse but may include other painful pelvic events or stressors, which lead to limbic dysfunction. This limbic dysfunction is manifest both as an increased sensitivity to pain afferents from pelvic organs, and as an abnormal efferent innervation of pelvic musculature, both visceral and somatic. The pelvic musculature undergoes tonic contraction as a result of limbic efferent stimulation, which produces the minimal changes found on pathological examination, and generates a further sensation of pain. The pain afferents from these pelvic organs then follow the medial pain pathway back to the sensitized, hypervigilant limbic system. Chronic stimulation of the limbic system by pelvic pain afferents again produces an efferent contraction of the pelvic muscles, thus perpetuating the cycle. This cycle is susceptible to disruption through blocking afferent signals from pelvic organs, either through anesthesia or muscle manipulation. Disruption of limbic perception with psychiatric medication similarly produces relief. Without a full disruption of both the central hypervigilance and pelvic organ dysfunction, pain recurs. To prevent recurrence, clinicians will need to include some form of therapy, either medical or cognitive, targeted at the underlying limbic hypervigilance. Further research into novel, limbic targeted therapies can hopefully be stimulated by explicitly stating the role of the limbic system in chronic pain. This hypothesis provides a framework for clinicians to rationally approach some of the most challenging patients in medicine, and can potentially improve outcomes by including management of limbic dysfunction in their treatment

3. Amitriptyline reduces rectal pain related activation of the anterior cingulate cortex in patients with irritable bowel syndrome.

Morgan V, Pickens D, Gautam S, Kessler R, Mertz H.

Gut. 2005 May;54(5):601-7.

Source

Department of Radiology and Radiological Scienes, Vanderbilt University, Nashville, TN 37205, USA.

Abstract

BACKGROUND AND AIMS:

Irritable bowel syndrome (IBS) is a disorder of intestinal hypersensitivity and altered motility, exacerbated by stress. Functional magnetic resonance imaging (fMRI) during painful rectal distension in IBS has demonstrated greater activation of the anterior cingulate cortex (ACC), an area relevant to pain and emotions. Tricyclic antidepressants are effective for IBS. The aim of this study was to determine if low dose amitriptyline reduces ACC activation during painful rectal distension in IBS to confer clinical benefits. Secondary aims were to identify other brain regions altered by amitriptyline, and to determine if reductions in cerebral activation are greater during mental stress.

METHODS:

Nineteen women with painful IBS were randomised to amitriptyline 50 mg or placebo for one month and then crossed over to the alternate treatment after washout. Cerebral activation during rectal distension was compared between placebo and amitriptyline groups by fMRI. Distensions were performed alternately during auditory stress and relaxing music.

RESULTS:

Rectal pain induced significant activation of the perigenual ACC, right insula, and right prefrontal cortex. Amitriptyline was associated with reduced pain related cerebral activations in the perigenual ACC and the left posterior parietal cortex, but only during stress.

CONCLUSIONS:

The tricyclic antidepressant amitriptyline reduces brain activation during pain in the perigenual (limbic) anterior cingulated cortex and parietal association cortex. These reductions are only seen during stress. Amitriptyline is likely to work in the central nervous system rather than peripherally to blunt pain and other symptoms exacerbated by stress in IBS.

Reflections on Prostatitis and Chronic Pelvic Pain Treatment

Reflections on The  Prostatitis and Chronic Pelvic Pain Treatment and the path to Recovery

By David Wise, PhD

This paper is about sharing my observations about healing my own pelvic pain and my road to recovery.

Millions of men suffer from urinary frequency, urgency, pain with sitting, pain after sex, genital pain and pelvic pain and other symptoms called prostatitis/chronic pelvic pain syndrome. I suffered for over 20 years from what was is now diagnosed as prostatitis/chronic pelvic pain syndrome. This diagnosis is confusing to patients and doctors alike, and the story about this confusion surrounding the treatment of the condition remains to be told to a large audience.

Today, gratefully, my pain is gone and I have become an expert in a field I never wanted to be an expert in. As I think about it now, I can’t imagine the devastation of my life had I continued to be in pain. I always feel grateful. I hope this article can help clarify the confusion, misdiagnosis, and ineffective treatment of what is diagnosed as prostatitis in men and help many silently suffering men find a way back to having a life again.

I observed my own slow and awkward healing.

I am someone who has been interested in my internal life and its process, whether it is related to pelvic pain or to my interpersonal relationships. Naturally, over the years, I observed with great interest the mental and physical happenings in my body through the process of the resolution of my pelvic symptoms. In this essay, I want to share my experience of coming out of pain and what I have observed and learned about this experience in the hope that it can offer a roadmap to others.

When I was a young man experiencing the symptoms our patients come to see us with, I dutifully and sincerely went to the urologist trusting he would help me. I saw him for many years and was never helped by his methods. I was told that I had ‘prostatosis’. The doctor explained, as best he could, that what I had was like prostatitis, except there was no inflammation or infection. He said my prostate was ‘boggy’.

I never quite understood what he was saying. In retrospect, I can’t imagine he understood his explanation either even though he was a kind and intelligent man. It was clear he was telling me that my prostate gland was my problem except for the peculiar explanation that there was no problem with it except it was ‘boggy’. To me ‘boggy’ means soft or spongy. I didn’t understand how something spongy could cause me the pain and symptoms I had, but he was the doctor and I trusted him. Gratefully he told me that my symptoms would get better as I got older (he was wrong) but I appreciated that he gave me the hope that somehow, at some time, my symptoms would get better. As the doctor couldn’t help me, I lost faith seeing doctors. I had nowhere to go and no one to help me. People have asked me how I dealt with my symptoms for over two decades. My answer is that there was nothing heroic about it. I muddled through my life dealing with the symptoms day by day, as all of our patients do.

I took the insights of my recovery to Stanford.

After doing a version of the protocol we now offer, my pain went away in the 1990’s. Excitedly, I called Dr. Rodney Anderson, one of the world experts in prostatitis and pelvic pain and the head of the Pelvic Pain Clinic at Stanford University Medical Center in the Department of Urology, and shared my experience with him. For many years at Stanford Dr. Anderson worked closely with Dr. Thomas Stamey, who co-invented the test for bacterial prostatitis. Dr. Anderson finally came to the conclusion that what was typically diagnosed as prostatitis was not a prostate condition but a condition of the contracted muscles of the pelvic floor and as such was not helped by the conventional standard of treatment using antibiotics and anti-inflammatories.

My call to him that day in 1995, sharing my recovery, found him open to listening about my experience. Gratefully, he recognized the importance of what I told him about how I got out of pain after 22 years of suffering.

From that time Dr. Anderson and I immediately began working together at Stanford. At Stanford was where we saw pelvic pain patients and developed the Wise-Anderson Protocol (popularly called the “Stanford Protocol” in internet discussions) detailed in the first edition of our book, A Headache in the Pelvis. In our protocol, we saw and treated the muscles of the pelvis as the sources of what are commonly diagnosed as prostatitis symptoms and anxiety that inflamed them. We began treating the pelvic muscles and emotions of men’s anxiety related to them, as the key treatment for prostatitis with typical symptoms of prostatitis—not their prostates. I worked with Dr. Anderson as a Research Scholar at Stanford for 8 years.

Later, after I left Stanford, Dr. Anderson and I, along with Tim Sawyer, our senior physical therapist, continued our close collaboration and research into our protocol. The form of treatment changed from a conventional weekly visit format, to what has evolved into a 6 day monthly immersion clinic. In total, I have spent 18 years treating patients with the Wise-Anderson Protocol. We have published a number of papers and have presented our work in major scientific meetings in the US and internationally.

Getting to the top of the mountain to see below: how the discovery of San Francisco Bay is similar to finding the route out of pelvic pain.

When someone’s prostatitis symptoms go away, what happens? How does this healing occur? Here is an analogy that is helpful to me in explaining why conventional medical treatment has been unsuccessful in finding a prostatitis cure: Many years ago, European explorers sailed up and down the coast of California, yet from the ocean they could not see San Francisco Bay. Then, in 1769 Spanish explorer Gaspar de Portola set out for the port at Monterey. Believing he had missed the port, he continued sailing north up the coast. After a time at sea, short on food and water, Portola sent an expedition ashore. They landed in what is today known as Pacifica, and it was looking out from a ridge that they finally saw the San Francisco Bay.

The pathway out of symptoms diagnosed as prostatitis has not been visible from the ‘ocean’ of the conventional medical perspective, or even any common sense perspective. The symptoms are, frankly, weird, and only if you have experienced them can you really understand them. Just like de Portola, after many years of experimentation, blind alleys, hit and miss attempts and trying different ways to stop my pain, I too found the ‘ridge’ of understanding; that my pelvic pain was not an infection or problem with my prostate gland, as my urologists had told me, but was in fact a problem of chronically tightened muscles inside my pelvic floor. This chronic tightening in my pelvis was where I held my anxiety. Some people would call it me being “anal,” and that’s probably true.

I found relief when placing a finger inside, I pressed on these tightened muscles and stretched them or relaxed them. I noticed stress made my symptoms worse and alternatively I felt some temporary relief from a hot bath, a good night’s sleep or the resolution of some worry. I came to see that what made my symptoms better or worse was the tightening or relaxation of my pelvic muscles. While that might seem easy to fix, I found that the fix was neither easy nor obvious.

Why pelvic pain symptoms do not act like other symptoms.

Symptoms commonly diagnosed as prostatitis rarely respond to the normal treatments for pain. One of the reasons that these symptoms have fooled conventional medicine is that they are referred from places in the pelvic floor that are remote from the pain. For example, the cause of pain in the penis is typically found inside the pelvic floor, 10 inches away from where the pain is felt, on the anterior portion of the levator muscles. The cause of muscle based testicular pain can be muscle restriction and trigger points in the quadratus lumborum, an external muscle a good foot away from the testicles. Abdominal pain, urinary frequency and urgency, sexual pain, post-bowel movement pain, and other associated pain are typically caused by tenderness in the muscles inside and outside the pelvic floor.

Most doctors treating pelvic pain do not examine the muscles of the pelvic floor and related areas. In not examining these muscles, they fail to see that the symptoms of what is called nonbacterial prostatitis in the vast majority of cases can be recreated by pressing on specific muscles inside and outside the pelvic floor. Most importantly, when these sore and tender areas of muscle are loosened and what are called trigger points released, done in conjunction with reducing the anxiety that typically flares them up, symptoms diagnosed as prostatitis can reduce or go away.

Doctors typically treat men with prostatitis with medications. The National Institutes of Health have has done an exhaustive, careful study of antibiotics, alpha blockers and anti-inflammatories—the most commonly used drugs for pelvic pain in men diagnosed as prostatitis—and the conclusion of this and other studies was that these medications do not help. While surgery was never suggested to me when I was in pain, in hearing the reports of many patients I have treated who had surgery, I have concluded that surgery, another common ‘solution,’ is a bad idea. It almost always complicates the symptoms or makes them worse. I have never heard patients report that a nerve block or any surgery, including pudendal nerve or prostate resection surgery, resolved prostatitis symptoms. Exploratory procedures, CAT scans and other high tech imaging tests typically cannot find anything wrong. Blood and urine tests are typically normal. The conventional ways of diagnosing and treating what is diagnosed as nonbacterial prostatitis do not help. All of the men (and women) who have come to see us for treatment have been refractorily unhelped by all of their prior drug and surgical treatments.

A heart transplant won’t stop heartburn: treating the prostate will not help the chronic contraction of the pelvic muscles.

I’ve come to understand the importance of the insight that, how you look at a problem determines the method you use to fix it. My view that I had a muscle problem and not a prostate problem changed everything for me. When I witness the suffering of our patients, I see myself before I changed my viewpoint about my problem. Most men we see continue to think in some way that they have a prostate-related problem. Below are my thoughts about the confusion in the diagnosis and treatment of prostatitis.

A heart transplant is a wrong the treatment for heartburn. Cutting down pine trees doesn’t get rid of poison oak rashes. You have to be able to make a differential diagnosis to distinguish reflux pain in the esophagus from pain coming from the heart muscle. You have to distinguish poison oak from pine trees. My experience with men diagnosed with prostatitis over the years is that conventional medicine has erred in its differential diagnosis of their symptoms as pelvic pain. Most of our patients have reported that their doctor never did a culture for infection before prescribing antibiotics. Just as you have to know the difference between pain from a heart attack and pain from acid in the esophagus, so must you differentiate between pain coming from an infected or inflamed prostate gland and pain coming from the muscles inside and outside the pelvic floor. The distinction must be made between symptoms of prostatitis caused by prostate infection, which occurs in a tiny proportion of men diagnosed with prostatitis, and symptoms that are caused by a chronically tightened pelvis, which occur in the large majority of men. This is one of our original contributions to prostatitis treatment.

The misdiagnosis of chronic prostatitis.

All too often we see patients whose doctors ignorantly recommended they undergo invasive surgeries and treatments. All of them which failed to end the symptoms. A doctor who saw one of our patients for testicle pain recommended that he have the offending testicle removed. The patient gladly agreed to surgery with the hope it would end his pain. When surgery didn’t end the pain, the doctor told him they must’ve removed the wrong testicle. Tragically, the surgery to remove the second testicle also failed to stop the pain.

To my great dismay, we’ve seen men who’ve had their prostate glands removed, re-sectioned, and “roto-rootered.” We’ve seen men and women who’ve had their anal sphincters cut. One man elected to have a colostomy with the hope that not having bowel movements would cause his pain to stop. It never did. We have seen many patients addicted to narcotics and other medications that did little good for them and whose efficacy wore off.

In our practice, we’ve seen three women who had their bladders removed and many who’ve undergone hysterectomies, laparoscopies, and urethral dilations. None of it helped. Of course, we’ve seen a number of people who’ve had the pudendal nerve surgery, in which the ligaments that stabilize the pelvis are cut—and we have never seen any resolution of symptoms from this surgery or any surgery. From Botox and electrical stimulation to acupuncture and faith healing, nothing has been effective if the spasticity of the muscles and arousal of the nervous system is not addressed.

The patients who have done best in our program took ownership of their own healing

As the doctors couldn’t help me, I lost faith in them. I had nowhere to go and no one to help me, but I believed the doctor who told me my problem was related to my prostate gland. For years I went along in pain not knowing what to do and inadvertently experimenting with different methods of treatment.

One of the many difficulties of someone diagnosed with prostatitis or chronic pelvic pain syndrome is moving into the position of being your own researcher and doctor. It is not easy or comfortable for many people to abandon trust in the conventional viewpoints in favor of their own research and intuitive judgment. The most common form of muscle based pelvic pain in men is incorrectly named ‘prostatitis’ and both urologists and family practitioners continue to treat it as if it is a prostate problem rather than a problem of the pelvic muscles. I see now that healing muscle based pelvic pain in most of our patients required a journey away from this idea and the authority of the doctors who treat it with this conventional wisdom. This is not easy for many people.

I never wanted to know anything about the pelvis. When I first started having my problem, I wanted to go into the doctor and have him fix it and send me on my merry way. No patient wants to have to learn about this area of the body or its treatment. If you were to ask any pelvic pain patient whether they want to learn to be their own doctor, they would all say, “Don’t call me, I’ll call you.” But, the pelvic pain patient who is able to find a solution to their own pain is the patient who becomes their own researcher and ultimately relies on their own intuitions on what to do and who to believe.

This is a difficult situation for most of us. The patients I have seen who insist on listening to their doctors about this problem, remain in pain or in some cases get into trouble with surgery, narcotic medications and other drugs.

The maddening refusal of conventional doctors to understand most pelvic pain is a muscle-based problem and not an infection or inflammation based problem.

Despite the decision of the National Institutes of Health to change the name of nonbacterial prostatitis—by far the largest category of pain in men—to chronic pelvic pain syndrome, men who seek chronic pelvic pain treatment are routinely treated as if their problem comes from their prostate gland. When I was at the National Institutes of Health (NIH) meeting on prostatitis in 1999, it became very clear that there was only a handful of us who understood the majority of prostatitis cases to be the misdiagnosis of conditions unconnected to the prostate.

When Leroy Nyberg, then head of the section of the NIH covering prostatitis, was asked about the urology community’s refusal to shift paradigms about prostatitis from a prostate infection model to a pelvic floor muscle pain model, he said, “It doesn’t go over well when a big organization loses a disorder.” What was left unsaid was the ideological and economic disincentive of shifting perspectives. Unfortunately, the person who suffers from this is the patient.

Why healing muscle-based pain follows a circuitous route.

As I see it now, several major systems of the body converge in the precipitation and perpetuation of symptoms diagnosed as prostatitis. There is tender pelvic tissue that one cannot see, is hard to reach and is usually in motion. You also typically have to deal with what turns out to be a typical chronic prostatitis patient’s long-standing habit of catastrophic thinking and anxiety. (Elsewhere I’ve discussed literature that documents the relationship between anxiety, emotional distress, family dysfunction and pelvic pain). And then, of course, there is the unfortunate, dysfunctional tendency of the pelvic muscles to reflexively tighten against the pain, which instead of protecting the individual exacerbates the problem. I discuss this cycle in detail below.

One of the problems of conventional medical treatment for pelvic pain is that healing requires the expertise of a number of sub-specialties that do not talk to each other.

Pelvic pain tends to be treated by a variety of different medical sub-specialties—urology, gynecology, colo-rectal surgery, chiropractic, physical therapy, and psychology/psychiatry. The lack of communication between these subspecialties around pelvic pain leads to a piecemeal treatment of the problem. This is especially true in the treatment of the physical and mental aspects of the disorder, which are intimately intertwined. Finally, as is the theme of our program, the concept of teaching patients how to treat themselves is not the major focus of any of these subspecialties. As far as I’m concerned, the aspect of self-treatment as a therapeutic regimen is critical for most pelvic pain patients to get better.

The huge stress-related dimension of muscle-based pelvic pain is only recently being recognized and treated.

The stress/psychological dimension of pelvic pain wasn’t recognized for many years. Even today, many urologists not only have little understanding of the psychological dimension of pelvic pain, but they continue to look for its origin in men in the prostate gland. This completely ignores the central focus of the problem, which is in the muscles of the pelvis. Physical therapists who have somehow established themselves as those who can enter inside the pelvis to do physical treatment have little training in urology or psychology, and physical therapy treatment tends to focus on the treatment of myofascial tissue. Each medical subspecialty has its own strengths and limitations. I am clear that the skills that are required to treat pelvic pain are cross-disciplinary, and all of them cannot be found in any one specialty.

When someone is scared, frightened, or stressed the core of the body tightens in a guarded posture.

As I became aware of the continual muscle tension in my pelvis and began to work with it, I saw how difficult it was to relax. I didn’t understand then, as I do now, that muscles that have become shortened and developed the taut bands called trigger points cannot relax until the trigger points are physically released. This was a huge insight and explained a lot to me. It convinced me that treatment for prostatitis has to be cross-disciplinary and must go beyond the limited skill and understanding of conventional treatment. I understand now that chronically tightened pelvic muscles get stuck in that state and at a certain point begin to cause pain, which triggers a self-perpetuating cycle that has a life of its own even after the precipitating stress goes away.

Someone with pelvic pain typically walks around guarded and tight in the pelvis. ‘Girding your loins,’ a biblical euphemism, describes the tightening, guarding or protecting of the genitals. When we are not stressed, it’s difficult to appreciate the strength this physical contraction has, but muscle tightening in periods of ongoing stress can be profound.

The painful pelvic muscles have shortened, predisposing them to pain and dysfunction.

For years I meditated on and observed my symptoms, but never understood why I could do nothing about them. As I visualize it in my mind now, once pelvic muscle tightening occurs for a certain period of time, I imagine that the microscopic distance between the muscle tissues reduce, creating less air and less space in between these muscle fibers. After a while, taut bands of muscle called trigger points form. These trigger points can refer pain to other places in the pelvis. We illustrate and describe these trigger points and the areas to which they refer pain in our book A Headache in the Pelvis. These trigger points are pivotal in creating, “an inhospitable environment for the muscles, nerves, and structures within the pelvic basin.”

It’s clear to me that the tension-anxiety-pain-protective guarding cycle is the major obstacle to healing muscle based prostatitis.

The Tension-Anxiety-Pain-Protective Guarding Cycle

Chronic Pelvic Pain Treatment

For many years I experienced the tension-anxiety-pain-protective guarding cycle, but it wasn’t until we wrote A Headache in the Pelvis that I put it into words. This cycle is what I believe is at the heart of muscle based prostatitis symptoms. This cycle is the meeting of body and mind within the pelvic floor. I lived within the grip of this cycle for many years.

Men with chronic muscle based prostatitis are caught in the tension-anxiety-pain-protective guarding cycle, in which the pelvic muscles causing the pain can no long relax. They remain tense and sore making them subject to a reflexive protective guarding that makes the pain worse.

Protective guarding occurs as a reflex when we pull our hand away from a hot stove, when our eye flinches after something gets in it, or when we tighten up and withdraw from something that causes us pain. This reflex to tighten and pull away is very important for our survival and indeed it usually protects us.

The instinct to tighten up against pelvic pain diagnosed as prostatitis is dysfunctional because instead of helping, it makes the pain worse. Protective guarding against sore pelvic muscles further tightens them up. This dysfunctional protective guarding is intimately connected to the chronicity and perpetuation of chronic pelvic pain. This is why studies have shown that the muscle tone in the pelvic floor tends to be abnormally high in sufferers of chronic pelvic pain syndromes.

When I gave a talk at the National Institutes of Health, I asked participants to tighten up their pelvic muscles for a minute. I speculated that few would be willing to tighten up like this for the entire minute. I told them that if I asked everyone in the audience to tighten up the pelvic muscles for an hour no one would be surprised if there wasn’t anyone willing to do this. I then took them on an imaginary journey of tightening up their pelvic muscles for a whole day, and then a week, and then a month, and then a year. To someone without pelvic pain, such chronic contraction would be unimaginable.

Those who have symptoms diagnosed as prostatitis and chronic pelvic pain syndrome, experience this dysfunctional protective guarding for months and years. This is why many patients report that when they follow the instructions in our book to do “moment to moment relaxation of the pelvis,” their pelvic muscles invariably tighten up immediately after they stop. It was only after my pain went away that I stopped protectively guarding in the way that I had when I was symptomatic.

Pain prompts protective guarding which increases the pain, which then triggers catastrophic thinking and anxiety. Anxiety feeds into the pain and increases it as Gevirtz and Hubbard have demonstrated in many experiments showing trigger point activity increasing with anxiety. The tension-anxiety-pain-protective guarding cycle has resisted all conventional attempts at resolution.

The challenge of repetitively rehabilitating painful pelvic tissue. The necessity of repetitive loosening of the pelvic floor and of the anxiety related to it. Teaching our patients to do their own internal and external trigger point release.

We begin our treatment by teaching patients how to soften and release the trigger points of contracted pelvic tissue. This means identifying the sore trigger points and palpating them in specific ways for a certain period of time. (see article on physical therapy for pelvic pain)

Using our internal trigger point wand.internal trigger point wand.

To treat the hard-to-reach internal muscles, we developed an internal trigger point wand, which we have been using as part of a treatment study for the past four years. Our clinical study found that patients who did our protocol using the wand for six months saw their median level of pain/sensitivity in the trigger points in the pelvic floor muscles decrease from 7.5 to a 4 (on a scale of 1-10).

It’s clear to me now that repetitively loosening and softening the pelvic floor muscles is central to healing muscle based pelvic pain.

Restoring the pelvic muscles to a normal length and pain-free state requires repetitive, ongoing physical therapy self-treatment. Just as you would change any bad habit, repetition is key. You must repeatedly restore the tissue to a normal state until you over-ride its conditioned tendency to remain contracted. In the book Blink, author Malcom Gladwell restated an observation that a number of researchers have made, which is that mastery requires 10,000 hours of repetition. While 10,000 hours of repetition is not required to loosen a painful pelvis, repetitive physical loosening and relaxation are necessary for my experience of pelvic pain healing.

Along with releasing the tissue physically, I experienced daily the necessity of calming my nervous system down. If I didn’t, my symptoms seemed to stick around. I will discuss the focus on the nervous system below.

Not too much or too little pressure.

When I treated myself physically, I learned that I had to be careful about the level of pressure I used to working with my painful muscles.

I found that when one does myofascial/trigger point release on muscles inside and outside the pelvic floor, chronically tight pelvic muscles have to be rehabilitated within certain specific parameters of pressure and within certain time frames. Too much pressure created a flare-up and caused my pelvic tissue to guard; too little pressure did little good; stretching the tissue for too little time did not seem to give the tissue a chance to lengthen; stretching the tissue too long tended to create guarding and continuing soreness

I have noticed over the years that extremely sore and sensitive tissue in patients can be, as our senior physical therapist Tim Sawyer calls it, “hyperirritable.” Tim says that hyperirritable trigger points and pelvic tissue must be treated like you would hold a wounded dove in your hands. If you physically treat hyperirritable tissue with inappropriate pressure, you can cause long flare-ups of pain and increase anxiety. We have developed a guideline that pelvic floor trigger points and areas of sore muscle restriction should at first not be pressed beyond a 3 on a 0 to 10 pain scale. We then suggest increasing the pressure up to 7 on the 0 to 10 scale as long as the area doesn’t flare-up unduly. If there is a flare-up that continues for more than 24 hours, we believe too much pressure has been applied and it has to be reduced. When patients are treating themselves we ask them to stop their own physical therapy self-treatment for several days to allow the flare-up to calm down. Eventually, as trigger point sensitivity reduces, pressure can be increased to 7 on the 0-10 scale as long as there is a little flare-up of symptoms. If a sore tissue is properly palpated, the trigger point sensitivity and pain can significantly reduce or go away.

Unless we train our patients otherwise, some treat their sore pelvis roughly like a piece of meat; distancing themselves from it and using undue pressure. We train them to feel their pelvic muscles as they treat these muscles so that they do not flare themselves up from self-treatment.

Showing the pelvis unconditional kindness.

In my journey of healing my pelvic pain, I made a choice to listen to my pelvis. I adopted an attitude of kindness and unconditionality in which I came to understand that my pelvis did not want to hurt. I saw that my pelvis reacted to my impatience or negativity like I would react to someone else’s impatience or negativity. Absent words, the only way my pelvis spoke to me when it was not happy was with pain. In my own journey, I had to say, “I’ll do whatever it takes to help myself out of pain.” I’ve noticed that people who assume this attitude tend to do better because they’re forced to give up their own agenda and become interested in what it takes for their pelvis to calm down.

God heals and the physician collects the fee: learning to be kind to your own physician?

The body has a miraculous capacity to heal, and it is possible to recover from pelvic pain. During our body’s noble journey, however, we must consistently act in a way that helps the pelvis to heal and resist doing what interferes with its healing. In short, we have to be mindful of creating an environment that is hospitable for the sore contracted pelvic tissue to become normal.

Changing your attitude toward your pelvic pain.

At the end of our clinics, I do a process with our patients called, “talking to your pelvis.” I have patients feel their painful pelvis while I ask it questions. It is not uncommon for my patients to say, “I can’t believe how I’ve hated my pelvis” or “How unkind I’ve been to my pelvis.” Some have said, “Every time my pelvis hurts, I become frightened or angry or feel dread.” Others have said, “I felt that my pelvic pain was a way in which God was punishing me.” Patients attribute all kinds of motives and attributes to a sore, painful pelvis. They can assume different attitudes toward it that are often hateful, frightened, angry or frustrated. These kinds of attitudes toward the pelvis only tighten the pelvis, increase anxiety and nervous system arousal, and make things worse. When I speak to my pelvis now and ask it if it has anything to say to me, it says ‘Thank you.’

Calming down emotionally.

My journey with relaxation has been long. If I could have found a teacher like the one I am today when I was symptomatic, my journey would have been immeasurably easier. Relaxation did not come easily to me then, despite the fact that I had studied with Edmond Jacobson, who is considered the father of relaxation therapy. I tried to relax for many years, but I failed. Finally, I applied to my relaxation practice the principles I learned from Jacobson as well as those from my own spiritual exploration; to accept what is, to stop resisting the experience within that I couldn’t change, to let go of effort and of trying to achieve something with my relaxation, and to accept my pain and anxiety instead of fighting them. In my book Paradoxical Relaxation, I describe this method.

I have observed that it takes dozens of hours of Paradoxical Relaxation practice for people to begin to learn how to calm down the nervous system, especially when they’re in pain and anxious. Reducing emotional arousal and managing anxiety are the key issues addressed by our Paradoxical Relaxation method.

Becoming emotionally intelligent: managing the tendency to get lost in catastrophic thinking.

When I was beginning to do relaxation for my pain, I came to see that there was always the issue of my pain, and then there was the issue of my attitude toward my pain. They were two different things. As I was able to work with my pain physically and reduce my symptoms, I slowly stopped catastrophizing each flare-up because I came to see that I could reliably calm them down myself.

I’ve observed that for most of our patients, despair, anxiety, and pain tend to be waiting in the wings and ready to pounce when one begins treatment. It is important for patients using our protocol to be able to witness their catastrophic thinking so that they can release it instead of allowing it to sabotage their treatment. I often say to patients that they don’t have to believe everything they think, and that when they catastrophize they will typically confuse their thinking for reality.

Not being scared by a flare-up of symptoms.

In my journey, I had many symptom flare-ups. I would have periods of time during which I was pain-free for days or weeks. Then, something would happen and my symptoms would flare up as badly as they ever were. When my symptoms disappeared I thought my recovery was a done deal, and when they flared up, I sank down into despondency. When I went through this cycle of symptom improvement and then flare-up many times, I became less and less afraid of the symptoms flaring up because I knew I could resolve them with my own self-treatment.

Ending flare-ups through skilled self-treatment.

The majority of our patients who do our protocol consistently do get better. We have patients who were in chronic pain for many years who are now pain-free for the most part. Most have learned not to be afraid of symptom flare-ups, as they are more able to effectively resolve them. For this reason, we ask our patients to do a 52 week recorded course in Paradoxical Relaxation to begin to take the edge off emotional agitation that’s gone on for many years.

An emotional release often accompanies the physical.

The phenomenon of somato-emotional release is common when a certain group of pelvic pain patients who do myofascial trigger point release, especially inside the pelvis. For example, a woman we treated with pelvic pain who was repeatedly sexually abused, wept regularly both when we instructed her on internal trigger point release and when she began doing it herself. Constricted tissue and pain is often connected to the emotional environment in which it began. Understanding and allowing emotional expression of grief, fear, or anger during treatment and giving it space to emerge and be released is essential in pelvic healing.

Controlling the tendency to be ‘anal’.

Those who get pelvic pain tend to be what, in the vernacular, would be called ‘anal.’ The colloquial use of ‘anal’ means to be obsessive, devoted to detail and perfectionistic and also to have obsessive thinking. It’s associated with a tightening of the anus, and in fact, there is some truth in this pejorative colloquialism.

Managing the pelvic pain patient’s tendency toward perfectionism, obsessive-compulsive behavior, and compulsive working is a lifestyle and psychological change that needs to be modified.

Paradoxical Relaxation helps to stop compulsive doing.

Paradoxical Relaxation is the behavioral method we use to help our patients learn to, “stop compulsively doing.” The pelvic pain patient tends to rarely, if ever, relax. In the moment of relaxation, it’s necessary that you stop all doing; this means you stop trying to achieve, get somewhere, or accomplish something. In the state of not doing, the pelvic muscles can relax.

In my book Paradoxical Relaxation, I’ve discussed extensively the importance of training attention to rest in sensation outside of thinking because resting attention is what can help someone who is a compulsive doer to relax.

After patients do a full session of internal and external physical therapy, we encourage them to do half an hour to an hour of Paradoxical Relaxation. The reason I ask people to do this is that I see the importance in disengaging the muscles of the pelvis from activity after they’ve been lengthened in order to allow the sore, tightened, painful tissue to get used to being at a normal length.

Moving from doing to being.

I learned in my own recovery that I had to regularly stop and call a timeout in my life. I had to be able to profoundly relax to calm down my over active nervous system. In a large sense, I have learned that one of the essential components in healing pelvic pain is learning to, at some time during the day, move out of the doing mode and into the being mode.

The mantra that self-treatment is the way.

When I was symptomatic, the most important element of my suffering was the fact that I felt helpless about doing anything about my pain. As I recovered from my own symptoms and felt confidence in helping myself, everything got better. I have come to believe that the most important part of treating pelvic pain is giving patients the ability to reduce or stop their own pain and symptoms both physically and mentally. Doing this dispels anxiety and helplessness which in my view are the most debilitating symptoms among all the symptoms of chronic prostatitis. Chronic prostatitis or chronic pelvic pain syndrome tends to recur under stress, and the most important thing I believe we can do for a patient with symptoms diagnosed as prostatitis is to help him reduce or stop his symptoms by his own efforts.

Summary

In summary, here is what I have learned:

  • When men come to see us with symptoms diagnosed as chronic prostatitis, drug and surgical treatment has failed to help them
  • Men we see who have symptoms diagnosed as chronic prostatitis almost always have painful pelvic muscles and trigger points can be found related to symptoms. Anxiety and stress generally tends to makes them hurt more
  • Symptoms of what is diagnosed as chronic prostatitis occur as the result of chronic tightening of the pelvic muscles over many years, even though symptoms may appear to begin suddenly. The phrase “the fruit falls suddenly but the ripening takes time” reflects this phenomenon
  • When you are suffering from pain with no foreseeable end in sight, it is easy to get lost and caught up in negativity, catastrophic thinking and the anxiety and depression related to it. Anxiety and worry about symptoms makes them worse
  • These emotions can be exacerbated by feelings of helplessness when doctors are unable to successfully treat symptoms
  • We have been dismayed that most doctors who provide chronic pelvic pain treatment do not appear interested in looking beyond the assumed causes of chronic prostatitis because these symptoms are not responsive to drugs or surgery, the main tools of conventional medicine
  • It is possible for most men with symptoms diagnosed as nonbacterial chronic prostatitis to significantly reduce their pain or stop it through their own efforts when they are properly instructed
  • Resolving symptoms diagnosed as nonbacterial chronic prostatitis means relaxing the core physical part of us. While there are methods for strengthening the core, relaxing and loosening our core is harder and more complicated to do—but it is doable
  • Patients who take ownership of their own problem and ultimately use their own intuition to determine what to do seem to do best
  • I am convinced that patients who learn to treat all of their symptoms themselves do best; self-treatment is the way

At this time in history, someone who has pelvic pain is best served by taking responsibility for his or her own welfare and seeking out treatment that makes most intuitive sense to them.

Effective Prostatitis Treatment and its Impact on the Quality of Life: Assessing a New Study

Effective Prostatitis Treatment and its Impact on the Quality of Life

Assessing a New Study

First, it should be noted that it is not the symptoms of chronic prostatitis that can destroy one’s quality of life, but the thought that the symptoms will never go away. A group of European urologists reported in a recent international study of 1563 patients* that the pain associated with chronic prostatitis or chronic pelvic pain syndrome (CCPS) impacted the quality of life of those suffering from this disorder more than the impact of urinary frequency/urgency or other common symptoms. The study reported that pain in the perineum was the most common symptom. Almost ½ of men reported discomfort after ejaculation. Discomfort in the testicles and area above the public bone were common symptoms. About 1/3 of men complained of pain in the penis.

[embed]https://www.youtube.com/watch?v=82OmQa_KrWg[/embed]

Men suffering from chronic prostatitis know only too well that the pain can play havoc with one’s quality of life.

This report is old news to anyone treating or suffering from chronic prostatitis. While the source of the pain and symptoms of chronic prostatitis are not visible to anyone, nor are symptoms seen by any visualizing technology or detectable by conventional medical testing, the pain and symptoms diagnosed as chronic prostatitis/chronic pelvic pain syndrome can at best put your life on hold and at worst make you feel like you will never be happy again (see details of symptoms of chronic prostatitis). The intensity and intimacy of pelvic pain is a perfect storm for inciting the catastrophic thinking so common in men with this disorder. Once someone has pelvic pain diagnosed as chronic prostatitis and there is no solution in sight, quality of life tends to evaporate.

It is not the pain but the meaning given to the pain that is the real suffering.

The new article did not delve deeply into why the pain of chronic prostatitis impacted quality of life so deeply. What is called chronic prostatitis is pelvic pain and a related group of symptoms that are very disturbing. Most important, chronic prostatitis symptoms can make normal functioning of life painful and difficult. The pain and dysfunction of the symptoms regularly intrude on living life moment to moment.

Our patients often say that they could handle their pain if they knew they would go away.

The actual pain of chronic prostatitis per se is not the reason why the quality of life is so profoundly impacted. In fact, most people we have seen have said that if they knew their pain would go away, they would be able to handle it. The source of the impact on quality of life is the catastrophic fear that the pain will never go away. They struggle to imagine living a normal and happy life again. It is this catastrophic meaning about the pain never going away that impacts their quality of life so strongly.

In the last review of hundreds of our patients we found that a large majority of them who did the Wise-Anderson Protocol for 6 months reported their level of emotional distress significantly dropped in conjunction with their ability to reduce the sensitivity/pain in their pelvic muscles. In other words, when our patients were empowered to reduce or stop their symptoms by themselves, they reported that their emotional distress significantly improved.

Treating chronic prostatitis pain using effective prostatitis treatment can reduce pelvic pain and the feeling of hopelessness.

Fear, helplessness, and hopelessness that the pain and symptoms will never go away fuel the hallmark catastrophic thinking of most patients diagnosed with chronic prostatitis. When a man can reduce his pain through his own efforts, his emotional distress improves. Effective prostatitis treatment gives patients a real sense of control over their pain, making them no longer fell like helpless victims of their pain.

 

[i]In this article, chronic prostatitis refers specifically to nonbacterial chronic prostatitis

*Wagenlehner, Florian, et al. “1082 NATIONAL INSTITUTE OF HEALTH CHRONIC PROSTATITIS SYMPTOM INDEX (CPSI) SYMPTOM EVALUATION IN PATIENTS WITH CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME–A MULTINATIONAL STUDY IN 1,563 PATIENTS.” The Journal of Urology 187.4 (2012): e439.

Is There a Cure for Chronic Prostatitis?

[embed]https://www.youtube.com/watch?v=IlWfAj7v5S8[/embed]

Is There a Cure for Chronic Prostatitis?

The question as to whether there is a cure for chronic prostatitis does not offer a simple answer. When prostatitis is bacterial, antibiotics can cure the problem and eradicate the bacteria. However, in most cases of men diagnosed with prostatitis, the prostate is not the source of the symptoms.

Antibiotics, alpha blockers, or anti-inflammatories typically do not cure nonbacterial prostatitis. It has been our experience that the symptoms of the majority of men we have seen diagnosed with chronic prostatitis are associated with chronic muscle tension in the pelvis. Almost none of the men we have seen clinically ever had prostate infections nor have antibiotics helped them. That is to say, it is our view, based on our clinical experience, that most cases of chronic prostatitis we have seen are caused by a self-feeding cycle of tension, anxiety pain, and protective guarding within the pelvic basin. This is the new emergent understanding of chronic prostatitis that is often ignored by conventional medical treatment. Our book, A Headache in the Pelvis, goes into this in detail.

That being said, it is possible for the symptom of muscle based prostatitis to significantly reduce or resolve, and a normal, happy life can begin again. Even when this occurs, under periods of stress the symptoms can flare up. This flare up of symptoms can typically be resolved using the Wise-Anderson Protocol.

For this reason, we do not say that this is a cure for chronic prostatitis per se because the symptom of muscle based prostatitis can recur under periods of stress. The tendency for anxiety, pain tension, and protective guarding often reasserts themselves. We do not say that our protocol is a ‘cure’ but instead, we say it is a method that allows a majority of men, for whom all other treatments have failed, to learn a method to help themselves throughout their lives. If you are showing  prostatitis symptoms and you’re looking for help, you can read about our protocol and the research we have done demonstrating the efficacy of our protocol.

NOTE: While it is our hope that these facts about chronic prostatitis are helpful, this information is not to be misconstrued as medical advice. This should be presented as general information about the disorder.

What to Know About Antibiotics and Alpha Blockers for Prostatitis

[embed]https://www.youtube.com/watch?v=ZunAO_cCd8Y[/embed]

What to Know About Antibiotics and Alpha Blockers for Prostatitis

Despite the almost universal use of antibiotics for prostatitis symptoms diagnosed as chronic prostatitis, credible and highly regarded studies over the past years have shown that antibiotics, alpha blockers, and anti-inflammatory drugs are usually no better than placebos.

Traditionally, those suffering from prostatitis experience one or more of the following symptoms:

  • Urinary Frequency / Urgency / Hesitancy
  • Discomfort with Sitting
  • Rectal / Perineum / Genital Discomfort
  • Discomfort During or After Sex
  • Pain or Relief After Bowel Movement
  • Lower Abdominal Discomfort
  • Tailbone / Low Back Discomfort / Pain
  • Stress Can Increase Symptoms
  • Hot Baths, Heat, Benzodiazepines Can Help Temporarily
  • Medications, Procedures, and Surgery Rarely Help
  • Medical Tests Find No Disease
  • Depression / Anxiety / Reduced Quality of Life

What the community must realize is that prostatitis is a local and systemic disorder. Conventional medical professionals tend to help relief through the use of antibiotics and alpha blockers for prostatitis. Yet, many of these short-term solutions only work to exacerbate the problem. Instead, this should be seen a local problem. Chronic anxiety and worry in certain individuals result in pain and dysfunction of the pelvic muscles. Without effectively treating this root of the problem, symptoms are unfortunately very likely to continue.

Our 6-day clinic seeks to resolve the symptoms of prostatitis by training our patients in self-treatment (local treatment) and practicing our protocol, Extended Paradoxical Relaxation. The ultimate aim is to reduce nervous system arousal daily. For more information about prostatitis, feel free to view recently published research.

NOTE: While it is our hope that these facts about chronic prostatitis, antibiotics, and alpha blockers are helpful, this information is not to be misconstrued as medical advice. This should be presented as general information about the disorder.

Chronic Prostatitis and Surgery: Is There a Better Way?

 

[embed]https://www.youtube.com/watch?v=J8D_M2b9CZc[/embed]

About Chronic Prostatitis and Surgery

To begin, there is no credible evidence to show that surgery helps prostatitis. While there is sporadic experimentation with prostate surgery and pelvic surgery, it has been our clinical experience that surgery typically complicates or worsens someone’s situation. We never recommend surgery for prostatitis or chronic pelvic pain syndrome.

Are Surgical Solutions Worth It?

Drugs, surgeries, and procedures have not been effective for those who are suffering from chronic prostatitis. In fact, we have concluded that surgery tends to complicate symptoms or make them worse than they were before. To our dismay, we have seen patients who have had their testicles and prostate glands removed, their anal sphincters cut, and colostomies put into place in the hopes that the lack of bowel movements would lessen the pain they feel. In addition, Botox, electrical stimulation, and acupuncture have all been ineffective treatments as well. More than that, we have seen patients become addicted to narcotics and other medications that did little good for them.

Unfortunately, many conventional doctors do not understand that pelvic pain is not typically related to infection or inflammation. It’s a muscle-based issue. The root of the problem cannot be solved if the spasticity of the muscles and the arousal of the nervous system are not addressed.

Paradoxical Relaxation is a method we use to help patients with chronic prostatitis. This method trains pelvic muscles to relax in the presence of stress. This means that instead of “trying” to feel better, thus causing more anxiety and in turn, pain, we disengage the muscles of the pelvis from activity to allow tightened tissue to get used to being at a more normal length.

NOTE: While it is our hope that these facts about chronic prostatitis and surgery are helpful, this information is not to be misconstrued as medical advice. This should be presented as general information about the disorder.

Quick Facts about Chronic Prostatitis and Diet

[embed]https://www.youtube.com/watch?v=DD9w1wdGcSQ[/embed]

About Chronic Prostatitis and Diet

Many men we have seen diagnosed with symptoms of chronic prostatitis report no benefit from diet modification. In fact, some men report that their symptoms temporarily improve with alcohol.

When it comes to pelvic pain syndromes and chronic prostatitis, when the pain or discomfort does not go away, there is a feeling that the pain may never go away, and this can be despairing. What Pelvic Pain Help hopes to achieve is the daily practice of relief. Relaxing the pelvic floor, quieting down anxiety, and calming down the tendency to tighten up the pelvic muscles under stress. Individuals can themselves release their own trigger points and areas of physical restriction.

This tension – anxiety – pain cycle can cause individuals to wonder if there is any hope of relieving their condition and symptoms. For a person under this type of duress, knowing they can do something about it is everything.

For more information about chronic prostatitis and diet, as well as how they relate to each other, watch the above video by Pelvic Pain Help.

NOTE: While it is our hope that these facts about chronic prostatitis and diet are helpful, this information is not to be misconstrued as medical advice. This should be presented as general information about the disorder.

Discomfort During or After Ejaculation – Symptoms of Chronic Prostatitis

About Ejaculation Discomfort in Chronic Prostatitis

  • Many men who see a urologist for chronic prostatitis will be given the advice to increase ejaculation. In fact, it is very common for men with prostatitis/ chronic pelvic pain syndrome to experience discomfort during and/ or after ejaculation.
  • There is often an increase in discomfort during or after sexual activity in men with prostatitis/ chronic pelvic pain syndrome because orgasm causes strong contractions of the pelvic, prostate, and seminal vesicle muscles that last about once a second during orgasm. Dr. Jeannette Potts observed that orgasm is a ‘pleasure spasm’. There is a significant increase in nervous system arousal during sexual intercourse or activity.
  • The ‘pleasure spasm’ of an orgasm will tighten the pelvic muscles further. This increased tightening temporarily contracts an already contracted area which doesn’t relax well and tends to throw the patient further above the symptom threshold. After a while, the muscles relax and return to their baseline level, the normal state of the pelvic floor reasserts itself (which is back to some degree of pain or discomfort when a person has chronic pelvic pain syndrome). For this reason, we do not recommend increasing sexual activity when a person has a pronounced increase in symptoms after sex.

NOTE: While it is our hope that these facts about ejaculation discomfort in chronic prostatitis are helpful, this information is not to be misconstrued as medical advice. This should be presented as general information about the disorder.