The Latest CPPS and Wise-Anderson Protocol Research

The Latest CPPS and Wise-Anderson Protocol Research

 

The following are excerpts and abstracts of publications regarding the latest CPPS and Wise-Anderson Protocol research:

The following is an abridged version. For the full version, see the link at the bottom.

CPPS

Department of Urology, School of Medicine, Stanford University, Stanford, California.

PURPOSE: A combination of manual physiotherapy and specific relaxation training effectively treats patients. However, little information exists on myofascial trigger points and specific chronic pelvic pain symptoms. We documented relationships between trigger point sites and pain symptoms in men with chronic prostatitis/chronic pelvic pain syndrome.

MATERIALS AND METHODS: We randomly selected a cohort of 72 men who underwent treatment with physiotherapy and relaxation training from 2005 to 2008. Patients self-reported up to 7 pelvic pain sites before treatment and whether palpation of internal and external muscle trigger points reproduced the pain. Fisher’s exact test was used to compare palpation responses, i.e., referral pain, stratified by the reported pain site.

RESULTS: Pain sensation at each anatomical site was reproduced by palpating at least 2 of 10 designated trigger points. Furthermore, 5 of 7 painful sites could be reproduced at least 50% of the time (p <0.05). The most prevalent pain sites were the penis in 90.3% of men, the perineum in 77.8% and the rectum in 70.8%.

Puborectalis/pubococcygeus and rectus abdominis trigger points reproduced penile pain more than 75% of the time (p <0.01). External oblique muscle palpation elicited suprapubic, testicular and groin pain in at least 80% of the patients at the respective pain sites (p <0.01).

CONCLUSIONS: This report shows relationships between myofascial trigger points and reported painful sites in men with chronic prostatitis/chronic pelvic pain syndrome. Identifying the site of clusters of trigger points inside and outside the pelvic floor may assist in understanding the role of muscles in this disorder and provide focused therapeutic approaches.

PMID: 19837420 [PubMed – indexed for MEDLINE]

Chronic prostatitis chronic pelvic pain syndrome

Department of Urology, Stanford University Schoolof Medicine, Stanford, California.

PURPOSE: Chronic pelvic pain in men has a strong relationship with biopsychosocial stress and central nervous system sensitization may incite or perpetuate the pain syndrome. We evaluated patients and asymptomatic controls for psychological factors and neuroendocrine reactivity under provoked acute stress conditions.

MATERIALS AND METHODS: Men with pain (60) and asymptomatic controls (30) completed psychological questionnaires including the Perceived Stress, Beck Anxiety, Type A behavior and Brief Symptom Inventory for distress from symptoms. Hypothalamic-pituitary-adrenal axis function was measured during the Trier Social Stress Test with serum adrenocorticotropin hormone and cortisol reactivity at precise times, before and during acute stress, which consisted of a speech and mental arithmetic task in front of an audience. The Positive and Negative Affective Scale measured the state of emotions.

RESULTS: Patients with chronic pelvic pain had significantly more anxiety, perceived stress and a higher profile of global distress in all Brief Symptom Inventory domains (p <0.001), scoring in the 94th vs. the 49th percentile for controls (normal population). Patients showed a significantly blunted plasma adrenocorticotropin hormone response curve with a mean total response approximately 30% less vs. controls (p = 0.038) but no differences in any cortisol responses. Patients with pelvic pain had less emotional negativity after the test than controls, suggesting differences in cognitive appraisal.

CONCLUSIONS: Men with pelvic pain have significant disturbances in psychological profiles compared to healthy controls and evidence of altered hypothalamic-pituitary adrenal axis function in response to acute stress. These central nervous system observations may be a consequence of neuropsychological adjustments to chronic pain and modulated by personality.

Chronic prostatitis

Department of Urology, Stanford University School of Medicine, Stanford, California

PURPOSE: The impact of chronic pelvic syndrome on sexual function in men is underestimated. We quantified sexual dysfunction (ejaculatory pain, decreased libido, erectile dysfunction, and ejaculatory difficulties) in men with chronic pelvic pain syndrome assessed the effects of pelvic muscle Trigger Point Release concomitant with paradoxical relaxation training.

MATERIALS AND METHODS: We treated 146 men with a mean age of 42 years who had had refractory chronic pelvic pain syndrome for at least 1 month with Trigger Point Release/paradoxical relaxation training to release trigger points in the pelvic floor musculature. The Pelvic Pain Symptom Survey and National Institutes of Health –Chronic Prostatitis Symptom Index were used to document the severity/ frequency of pain, urinary and sexual symptoms. A global response assessment was done to record patient perceptions of overall therapeutic effects at an average 5-month follow-up.

RESULTS: At baseline 133 men (92%) had sexual dysfunction, including ejaculatory pain in 56%, decreased libido in 66%, and erectile ejaculatory dysfunction in 31%. After Trigger Point Release/paradoxical relaxation training specific Pelvic Pain Symptom survey sexual symptoms improved an average of 77% to 87% in responders that are greater than 50% improvement. Overall a global response assessment of markedly or moderately improved, indicating clinical success, was reported by 70% of patients who had a significant decrease of 9(35%) and 7 points (26%) on the National Institutes of Health- Chronic Prostatitis Symptom Index (p<0.001). Pelvic Pain Symptom Survey sexual scores improved 43% with a markedly improved global response assessment (p<0.001) but only 10% with moderate improvement (p=0.96).

CONCLUSIONS: Sexual dysfunction is common in men with refractory chronic pelvic pain syndrome but it is expected in the mid fifth decade of life. Application of the Trigger Point Release/paradoxical relaxation training protocol was associated with significant improvement in pelvic pain, urinary symptoms, libido, ejaculatory pain and erectile and ejaculatory dysfunction.

PubMed – U.S. National Library of Medicine

Journal of Urology

Abstract
J Urol. 2005 Jul;174(1):155-60.

Integration of myofascial trigger point release and Paradoxical Relaxation training treatment of chronic pelvic pain in men.

Anderson RU, Wise D, Sawyer T, Chan C.

Department of Urology, Stanford University School of Medicine, Stanford, California, USA. rua@stanford.edu

From the Department of Urology (RUA, CC), Stanford University school of Medicine, Stanford, Sebastopol (DW) and Los Gatos (TS), California.

PURPOSE: A perspective on the neurobehavioral component of the etiology of chronic prostatitis (CP) and chronic pelvic pain syndrome (CPPS) is emerging. We evaluated a new approach to the treatment of CP/CPPS with the Stanford developed protocol using myofascial trigger point assessment and release therapy (MFRT) in conjunction with paradoxical relaxation therapy (PRT).

MATERIALS AND METHODS: A total of 138 men with CP/CPPS refractory to traditional therapy were treated for at least 1 month with the MFRT/PRT protocol by a team comprising a urologist, physiotherapist and psychologist. Symptoms were assessed with pelvic pain symptom survey (PPSS) and National Institutes of Health-CP Symptom index. Patient response assessment perceptions of overall effects of therapy were documented on a global response assessment questionnaire.

RESULTS: Global response assessments of moderately improved or markedly improved, considered clinical successes, were reported by 72% of patients. More than half of patients treated with the MFRT/PRT protocol had a 25% or greater decrease in pain and urinary symptoms, respectively. The 2 scores decreased significantly by a median of 8 points when the 25% or greater improvement was first observed, that is after a median of 5 therapy sessions. PPSS and National Institutes of Health-CP Symptom Index showed similar levels of improvement after MFRT/PRT protocol therapy.

CONCLUSIONS: This case study analysis indicates that MFRT combined with PRT represents an effective therapeutic approach for the management of CP/CPPS, providing pain and urinary symptom relief superior to that of traditional therapy.

chronic pelvic pain syndrome

PURPOSE: Abnormal regulation of the hypothalamic-pituitary-adrenal-axis and diurnal cortisol rhythms are associated with several pain and chronic inflammatory conditions. Chronic stress may have a role in the disorder of chronic prostatitis/chronic pelvic pain syndrome related to initiation or exacerbation of the syndrome. We tested the hypothesis that men with chronic pelvic pain syndrome have associated disturbances in psychosocial profiles and hypothalamic-pituitary-adrenal-axis function.

MATERIALS AND METHODS: A total of 45 men with CPPS and 20 age-matched, asymptomatic controls completed psychometric self-report questionnaires including the Type A personality test, Perceived Stress Scale, Beck Anxiety Inventory and Brief Symptom Inventory for distress from physical symptoms. Saliva samples were collected on 2 consecutive days at 9 specific times with strict reference to time of morning awakening for evaluation of free cortisol variations, reflecting secretory activity of the hypothalamic-pituitary-adrenal-axis. We quantified cortisol variations as the 2-dat average slope of the awakening cortisol response and the subsequent diurnal levels.

RESULTS: Men with CPPS had more perceived stress and anxiety than controls (p<0.001). Brief Symptom Index scores were significantly increased in all scales (somatization, obsessive/compulsive behavior, depression, anxiety, hostility, interpersonal sensitivity, phobic anxiety, paranoid ideation, psychoticism) for chronic pelvic pain syndrome, and Global Severity Index rank for CPPS was 93rd vs. 48th percentile for controls (p<0.0001). Men with chronic pelvic pain syndrome had significantly increased awakening cortisol responses, mean slope of 0.85 vs. 0.59 for controls (p<0.05).

CONCLUSIONS: Men with CPPS scored exceedingly high on all psychosocial variables and showed evidence of dysfunctional hypothalamic-pituitary-adrenal-axis function reflected in augmented awakening cortisol responses. Observations suggest variables in biopsychosocial interaction that suggest opportunities for neurophysiological study of relationships of stress and chronic pelvic pain syndrome.

pelvic pain syndrome

Below is a summary of the latest research findings about the Stanford Protocol presented at the American Urological Association in San Antonio, Texas, May, 2005

RESULTS: 138 men with refractory CPPS enrolled and treated; average age 40.5 years (range 16-79). Disease duration: median 31 months (range 1-354) 59% (81/138) of patients had clinically meaningful improvements (“>25-100% decreased symptom core) in total pain as reported on Stanford PPSS(table 1)

Of these, 39% of patients achieved “>50%

Symptom improvement Total pain score 69% Urinary sc80%

After a median of five myofascial TrP release treatments , median baseline total pain scores of 13 decreased significantly by 8 points (p<0.001), Stanford PPSS (Table 2)

72% of patients reported GRAs indicating marked (46%) or moderate (26%) improvements in their symptoms.

Both symptom surveys, the NIH-CPSI and the Stanford PPSS, reflected similar levels of symptoms improvement after treatment (fig. 2)

CONCLUSION:

MFRT combined with PRT (treating these patients with the Wise-Anderson Protocol) resulted in moderate to marked improvements in symptoms in 72% of patients.

Treatment is based on the new understanding that certain chronic pelvic pain reflects a self-feeding state of tension in the sore pelvic floor perpetuated by cycles of tension, anxiety and pain. Our premise is that in addition to releasing painful myofascial trigger points, the patient needs to supply the central nervous system with information or awareness to progressively quiet the pelvic floor. The patient moves from being a passive, helpless victim to an active participant/partner in healing.

Contact us for a PDF of the Full Research.

Pelvic Pain Syndrome: An Address to the National Institute of Health

The following is an address by Dr. Wise to the National Institutes of Health

(NOTE: Portions of this transcript have been edited for clarification.) 

The goal of the Wise-Anderson Protocol is to enable the patients to reduce and/or resolve symptoms without dependency on drugs or others to do so for them.

David Wise, PhD
Plenary address to the
National Institutes of Health (NIH)
Scientific Workshop on Prostatitis/Chronic Pelvic Pain Syndromes
Baltimore, Maryland
October 21, 2005

Introduction

Thank you for giving me the opportunity to discuss the Wise-Anderson Protocol at this National Institutes of the Health-sponsored scientific meeting on Prostatitis/Chronic Pelvic Pain Syndrome.

How I became involved in treating chronic pelvic pain syndrome.

I happened to have had the unusual experience of the slow motion nightmare of chronic pelvic pain syndrome for a period of over twenty years. At one time or another I had almost all of the symptoms you typically hear from patients, and then unrelieved, unrelenting pain 24 hours a day 7 days a week. I had no one to talk to and no one to help me — and then around ten years ago, I had the fortune of experiencing the resolution of my own symptoms by finding and implementing the elements of what is now called the Wise-Anderson Protocol. I gratefully remain pain and symptom-free. So I speak to you both as a clinician who has seen many, many patients with pelvic pain over the past years, and as someone who has had the direct experience of the pelvic pain syndrome with the experience of resolution.

The development of the Wise-Anderson Protocol.

I also have the unusual fortune of meeting and collaborating with Rodney Anderson at Stanford University, director of the Stanford Pelvic Pain Clinic. He is a remarkable physician to whom I have great gratitude for his big mind and willingness to think outside of the box. I have also collaborated with Tim Sawyer, an extraordinary physical therapist. My purpose in the few minutes is to, as clearly as I can, explain the methodology we developed at Stanford over an eight-year period and which we continue to study and refine.

Paradigm shift: chronic pelvic pain is not an infection, but a tension disorder.

I am aware that the Wise-Anderson Protocol represents a significant paradigm shift. We don’t believe the vast majority of those diagnosed with prostatitis/chronic pelvic pain syndrome suffer from a prostate infection or occult bacteria, an autoimmune disorder or compressed pelvic nerves.

We see the overwhelming majority of cases diagnosed as the result of the overuse of the human reflex to tighten the genitals, rectum, and contents of the pelvis in response to anxiety, pain, or trauma by chronically contracting the pelvic muscles. This tendency becomes exaggerated in predisposed individuals, particularly those with a tendency toward anxiety who respond to stress by habitually and unconsciously tightening their pelvic floor. Such a tendency is invisible. No one can see it. Usually, the person who has such a tendency is unaware of it. And the consequences of this tendency are also invisible except for the complaints of discomfort, pain and urinary dysfunction that the sufferer eventually expresses.

This state of chronic constriction creates pain-referring trigger points in and around the pelvis, which in turn, creates an inhospitable environment for the nerves, muscles, blood vessels, and structures within the pelvic basin. This results in a self-feeding cycle of tension, anxiety, and pain, which has been previously unrecognized and untreated. It is a kind of short circuit. Patients with pelvic pain often wind up in the emergency room when this short circuit gets out of control.

The havoc of chronic tension in the pelvis and the tension-anxiety-pain cycle.

Most people neither appreciate nor understand the havoc that chronic tension plays in the pelvic floor. It is the same havoc that chronic neck and shoulder tension plays in a headache, chronic back tension plays in low back pain, or chronic jaw clenching plays in temperomandibular disorder.

There can be psychological, physical, or social triggers to the chronic tightening of the pelvic floor. Once this cycle begins, it tends to have a life of its own and carries on even when the initiating triggers have passed.

The purpose of the Wise-Anderson Protocol is to break this cycle and to help patients prevent its reoccurrence. The methodology is low tech. The aim is to get patients off of all drugs and to end patient dependency on professional help. The responsibility for the success of the treatment is largely up to the patient’s compliance with the protocol. Patients who look for a quick external fix to their condition tend to lack the motivation that the Wise-Anderson Protocol demands. Such individuals tend not to be good candidates.

The problem in the great quest to restore the pelvis to a relaxed and symptom-free state is that pain, tension, and trigger point activity in the pelvis is intimately tied to emotional reactivity and autonomic arousal. They feed each other. Anxiety is the gasoline on the fire of pelvic pain. This is also why placebo is so influential in this condition. This tie-up with autonomic arousal and pelvic pain has never been addressed and is essential to any effective treatment.

How to understand pelvic pain if you don’t have it.

I want to take a moment to help those of you who have never had pelvic pain syndrome to experientially understand it from my viewpoint. In this way, you have more of an intuitive sense of what we do. If I were to ask you to tighten your pelvic muscles for the next ten seconds as though you were stopping yourself from urinating, most of you could do this. If I ask you to tighten your pelvic muscles for one minute, probably fewer of you would be willing.

Now imagine you were to continually tighten up your pelvic muscles for a half an hour, one hour, twelve hours, twenty-four hours, one month, six months, one year, two years, five years, ten years. Most people consider it inconceivable to be stuck in an activity of such self-abuse and self-inflicted pain. No one here would dare venture voluntarily. I suggest that the consequences of this kind of chronic tension lead to the symptoms of which most patients diagnosed with prostatitis/cpps suffer.

I want to talk about the relationship between anxiety and trigger point activity.

Anxiety makes trigger points hurt more.

Here are pictures of electrical activity in trigger points at baseline, during relaxation and under stress, in a study done by Gevirtz and Hubbard in San Diego. On the left, we see trigger point activity at baseline… notice that the electrical activity in the trigger point is significantly elevated from the electrical activity of the non-tender tissue just 1/4 inch away. Notice now the center reading after the subject has begun relaxation. The electrical activity of the trigger point normalizes. Notice now the electrical activity of the trigger point during a stressor. The electrical activity is significantly activated well beyond baseline readings. These studies have been duplicated hundreds of times and clearly show the strong impact of autonomic arousal on trigger point activity.

The Wise-Anderson Protocol represents an effective and safe non-drug, non-surgical treatment for pelvic pain syndrome. It provides far better outcomes than conventional therapies for most patients with no long term side effects. I will briefly summarize the results of our study published this year in the July issue of Journal of Urology. At Stanford, we studied 138 patients who were referred to us, usually by physicians who could no longer help these patients because they had failed all conventional therapy. We were the court of last resort. After treatment, using the Wise-Anderson Protocol, 72% of these refractory patients reported that they marked moderate improvements in their symptoms as reported on the Global Response Assessment. These responses reported as marked and moderate improvements by patients were commensurate with appreciable (10.5% decrease in marked and a 6.5 % decrease) decreases in the NIH-CPSI scores.

Although we have not systematically studied the numbers, it is my observation that positive results from our protocol improve with the increased competence of the patient in our methodology over time. In other words, in my experience, patients’ symptoms appear to improve the longer they follow our protocol.

The two essential elements: Paradoxical Relaxation and pelvic floor Trigger Point Release.

Let me touch on the Wise-Anderson Protocol Trigger Point Release. Time does not permit any detailed discussion of the Trigger Point Release we use and have developed. Suffice it to say that we work with approximately 40 trigger points related to pelvic pain syndrome. We apply the same principles of Trigger Point Release pioneered by Travell and Simons for external muscles, to the release of the internal muscles. A comprehensive list and detailed illustrations of trigger points related to male pelvic pain syndrome and a detailed description of our method are found in the 3rd edition of our book, A Headache in the Pelvis: A New Understanding and Treatment for Prostatitis and Chronic Pelvic Pain Syndromes.

Wise-Anderson Protocol Trigger Point Release.

Here are some notable aspects of the Trigger Point Release protocol we use.

  • We use primarily Trigger Point Release oriented therapy and not myofascial release therapy. They are not the same.
  • Trigger points that refer pelvic pain exist both inside and outside the pelvic floor.
  • The most common trigger points in male pelvic pain are found in the anterior levator ani, the obturator internus, adductors and surprisingly, in the quadratus lumborum and the psoas. I don’t expect you to take in this list but only to know that we have found there are specific trigger points related to specific pelvic pain symptoms.
  • Trigger points tend to be found anteriorly in patients with more urinary symptoms and posteriorly in patients complaining more of rectal pain.
  • We use a method called pressure release on a trigger point, holding it for 60-90 seconds– this length of time, which is usually difficult for many therapists to routinely hold, is critical to the release of the trigger point.
  • We rarely do trigger point injection, only with stubborn external trigger points. Even then, we never advise the use of botox in such injections. We never do or advise internal injections.
  • The number of treatments varies between 5-40 sessions.
  • We generally discourage kegel exercises and do not use pelvic floor biofeedback or electrical stimulation.
  • Patients are taught external and internal trigger point self-treatment. We have found that patients can do the majority of the Wise-Anderson Protocol physiotherapy themselves once they are shown how to do it.
  • We continue to develop an internal wand which we sometimes prescribe for patients when they have no partner or other resources to work with the internal trigger points at home. This has to be used carefully and only after the patient has been thoroughly instructed in its use.
  • In the Wise-Anderson Protocol, Trigger Point Release is done concomitantly with Paradoxical Relaxation.

A word about using only physiotherapy or Paradoxical Relaxation in treating pelvic pain syndrome.

Both Paradoxical Relaxation and Wise-Anderson Protocol physiotherapy aim to rehabilitate the patient’s pelvic floor and to stop the habit of chronically tightening the pelvic muscles under stress. For most patients, each method is necessary but not sufficient in restoring the pelvis to a symptom-free state. The intrapelvic Trigger Point Release we use rehabilitates the pelvic muscles and allows them to relax. The focus of Paradoxical Relaxation is to allow a rehabilitated pelvis to profoundly relax and to support the healing mechanism of the body with respect to a chronically sore and contracted pelvic floor. Importantly, a central purpose of Paradoxical Relaxation is to modify the habit to unconsciously and habitually tighten the pelvis.

It is tempting to look for a quick fix to the problem of Prostatitis/CPPS. As we know, there are no drugs or surgical procedures that satisfactorily help the pain and dysfunction of Prostatitis/CPPS. There is no quick fix. While physiotherapy is essential to our protocol, it is insufficient to resolve the problem. Most patients who have suffered from this problem and simply do physiotherapy discover this.

Generally, if patients do not learn to voluntarily and regularly relax the pelvic floor and reduce their own nervous system arousal, in the long term, manual physiotherapy efforts at rehabilitating the pelvic floor tend to be short lived. Patients easily go back to the old habits that brought about the condition in the first place. A stressful hour in traffic or a fight with one’s partner after the best of physiotherapy session can easily reactivate the trigger points that the therapist has just deactivated. I have seen this with many patients and know it personally.

Paradoxical Relaxation in the Wise-Anderson Protocol.

Few would disagree with the value of profoundly relaxing a painful pelvis. The question is: how is it done? Consider how difficult it is to relax even you neck muscles in the middle of an ordinary upset in your life. Relaxing tension associated with pelvic pain syndrome and anxiety is more difficult.

Tightening against pelvic pain worsens it.

Paradoxical Relaxation seeks to reverse the dysfunctional reflex to tighten against pelvic pain syndrome and the fear associated with it. We can call this chronic tension dysfunctional protective guarding. This reflexive tightening is dysfunctional because it exacerbates rather than protects against pain and anxiety.

The reaction to tighten the pelvis in response to pain paradoxically exacerbates it. Pain is a stimulus that triggers fight or flight. Pain does not reflexively trigger repose and rest, which is in fact what we ask patients to do. Accepting tension as a way to relax it is counter- intuitive. It is this strategy that can reduce the pain or take it away, and thus, we name our method Paradoxical Relaxation.

Dysfunctional protective guarding is at the heart of other functional disorders.

Dysfunctional protective guarding exists in a number of other functional somatic disorders. They include tension headache, temperomandibular disorder, lower back pain, non-cardiac chest pain, and idiopathic dyspepsia among others.

I think a modified Wise-Anderson Protocol may be useful in some of these disorders as well. The central strategy of Paradoxical Relaxation comes from the insight that accepting tension relaxes it. In Paradoxical Relaxation, the emphasis is on tension and not on pain even though pain is usually perceived peripherally during the relaxation training.

Paradoxical Relaxation is not new. The major insights of this therapeutic strategy derive from the world’s oldest wisdom traditions and practices that focus on quieting the mind and body, and from the methodology of my teacher Edmund Jacobson who developed the technique of progressive relaxation.

The paradox of Paradoxical Relaxation can be expressed in the following ways:

  • That accepting tension relaxes it
  • That accepting what is, is the fastest way to change it
  • That what we resist persists
  • That the requisite for changing something is first accepting it as it is, on its own terms

This happens to apply to stubborn pelvic muscle tension. Remarkably, this insight has the potential to allow patients to dissolve pelvic pain syndrome.

Accepting tension is both counter-intuitive and functional in terms of relaxing stubborn tension associated with functional somatic disorders I have mentioned above. Paradoxical Relaxation is a modern day method to implement this perennial wisdom for ordinary people who have pelvic pain syndrome.

In Paradoxical Relaxation, we ask patients to do an extraordinary thing: to focus on, and then rest with their tension when they are anxious and in pain. Learning to do this requires many hours of practice. For the first 3 months, patients are asked to do 1- 1 1/2 hours of relaxation guided by 1 of a 38 lesson sequenced recorded course. The course consists of over a year of 1-2 daily sessions of relaxation training. This can’t be learned from stand-alone relaxation tapes. Patients must receive many hours of instruction by a teacher competent in the method. The Wise-Anderson Protocol is the slow fix.

Pelvic Pain syndrome is almost always accompanied by a constant level of fear.

Paradoxical Relaxation asks patients to relax while they feel pain and fear. Patients have to be reassured that it won’t hurt them to relax while they experience their fear. It is common for patients to feel that if they accept their tension and fear and pain, that they have given up and that they will never get rid of their condition. These notions are obstructions to learning and must be addressed directly. Here is the paradox again–relaxing with and accepting fear is most likely to dissolve it.

To the novice, relaxing with pelvic pain syndrome, chronic tension, and chronic anxiety is scary.

And so it is, in this context, that we ask people to sit still with it all. Relax with the pain, fear, helplessness, desire for distraction, fear of the method failing, fear that their life is over and that they will have to live in chronic pain until they die, and fear of getting their hopes up. This is scary territory. Teaching patients this relaxation protocol addresses all of these concerns and takes time and many repetitions to gain some degree of competence.

The Wise-Anderson Protocol is done in a 6-day intensive immersion clinic.

The format of the Wise-Anderson Protocol is unusual as it is done in a six-day intensive immersion clinic involving some 30 hours of treatment. At this clinic, patients are trained in Paradoxical Relaxation, receive daily physiotherapy, are trained in self-administered Wise-Anderson Protocol Trigger Point Release, specific stretches, and related physiotherapy techniques. It is the goal of this clinic for the patient to be able to self-administer most of the protocol without reliance on additional treatment.

The goal of the Wise-Anderson Protocol is to enable patients to resolve symptoms without drug dependency.

The Wise-Anderson Protocol represents a very different paradigm from one in which a patient who feels he has no control over his symptoms comes to the doctor to be cured and submits himself passively for the remedy. Our aim is to make patients independent. It is our goal that patients trained in our protocol find themselves in a position to take care of and possibly resolve this condition themselves without dependency on drugs or others to do so for them.

Paradoxical Relaxation: Relieving a Painful Pelvic Floor

 

https://www.youtube.com/watch?v=kBnu9Hl0B1A

Paradoxical Relaxation relaxes the tension and shortened muscles within a painful pelvic floor.

This involves a daily practice of the cultivation of effortlessness in the presence of pain, anxiety, and tension.

Paradoxical Relaxation has two components: The first is a breathing technique used at the beginning of relaxation, a coordination of heart rate and breathing. This reduces respiration to approximately 6 breaths per minute. The second component is the instruction given for the remainder of the session. These direct the patient to focus attention on the effortless letting go of tension in a specified area of the body, accepting residual tension that does not easily release.

b. Patients are asked to listen to approximately 1 hour of recorded relaxation instruction daily. These allow the focus of individual predetermined sites, including frontalis, jaw, neck, shoulders, arms, hands, upper back, chest, stomach pelvis, legs, and feet. Each site is the focus of practice for approximately 2 weeks, and the entire course lasts for approximately a year and two months. Home practice is done daily and includes the use of 46-recorded lessons varying in length from 7 minutes to 45 minutes. The focus on the relaxation of a painful pelvic floor is generally avoided for the first several months of relaxation training. This is because such a focus can exacerbate symptoms until competence in relaxation is gained in neutral, non-painful areas.

c. Relaxation instruction guides the patient to redirect attention away from discursive thinking and daydreaming. The target range of brain wave activity is low-frequency alpha.

d. Catastrophic thoughts that increase sympathetic arousal arising during relaxation are identified. A cognitive therapy protocol is used to help the patient reduce the impact of such thinking.

The process of Paradoxical Relaxation is a slow one.

Respect for and cooperation with this very slow process is essential to success. When the desire of the patient aims to hurry the body’s slow letting go of deeply ingrained tension, they usually fail to relax a painful pelvic floor. In Paradoxical Relaxation, the instruction is given to let go of tension. This effortless relaxation usually occurs in small and unremarkable steps. Recognizing and working with these small gradations of relaxation is essential.

Edmund Jacobson described residual tension in detail in his long career in the development of relaxation therapy, which began in 1908. The patient is instructed to keep attention focused on residual tension without trying to change it. When attention is distracted by visual or conceptual thinking throughout the protocol, the patient is instructed to refocus attention on the remaining tension without aiming to achieve any result. It is essential that the patient understands that deep relaxation occurs when attention rests in sensation and not in thinking.

Instructions alternate between letting go of the tension that easily lets go and effortlessly feeling the remaining tension. The tension that is being focused upon without effort usually abates during this process. The patient is instructed to permit this abatement to occur. Sometimes the tension does not abate or even increases, and the patient is instructed to remain softly focused on the remaining sensation without an intention to change it. The concept underlying this protocol is that one does not relax stubborn, residual tension directly but instead is effortless in remaining continually aware. Relaxation occurs without any effort on the part of the patient. Exerting any effort increases tension. This is because relaxation is identical to effortlessness.

We specifically discourage patients from focusing on the relaxation of a painful pelvic floor for the first 4 months of treatment, as the patient’s attachment to the relief of symptoms tends to interfere with the conscious and simultaneous effortless attention on tension. The focus on the relaxation of the upper body is most easily accomplished and usually results in a reduction of pelvic tone. The focus on the relaxation of the pelvic musculature requires that the patient makes the distinction between pain and tension. The aim of the protocol then becomes directed to the tension and not the pain in the area of a painful pelvis.

https://www.youtube.com/watch?v=ToZQDIq90rs

Learn to profoundly relax pelvic tension in the presence of pain and anxiety.

Pain and anxiety stimulate additional tension and aversion. Without instruction, most patients who are not properly instructed are loathe to sit still in the presence of unresolved pain. The instructions of Paradoxical Relaxation train patients to stop the tension-anxiety-pain cycle by focusing on tiny residual tensions that they can easily relax. At the same time, they can accept the tension and pain that remains. Attention is redirected from negative cognitions and focuses on letting go of tiny and often ignored tensions in the body unconsciously aimed stopping the pain and tension – efforts that only exacerbate symptoms. In the paradoxical acceptance of pain and tension that does not easily relax, the patient learns how to ride the tension down in small steps that require acceptance of what formerly has been unacceptable and frightening.

Chronic pelvic pain syndromes tend to be self-perpetuating disorders in which a patient’s pain causes a reflexive tightening of the pelvic floor, which in most patients, often prompting a flurry of negative thinking. The reflex to contract against pain actually increases pain. Negative and catastrophic thinking fan the fire of the pain by igniting the electrical activity in the trigger points referring pain in the pelvis. The tension-anxiety-pain cycle is a major obstacle to the reduction of a painful pelvic floor. It feeds itself in the moment that a patient is asked to relax the pelvic tension. The disruption of the self-feeding cycle of tension, anxiety, and pain can be accomplished by a select group of patients who become competent in Paradoxical Relaxation.

While we utilize an extensive set of recorded tapes in the Wise-Anderson Protocol relaxation method, instruction is necessary to train patients in the method. Below we discuss the issue of stand-alone relaxation tapes.

Why Paradoxical Relaxation cannot be learned from recorded tapes in the absence of instruction.

(This is part of a response sent to the webmaster of the chronicprostatitis.com website on the issue of stand-alone relaxation tapes.)

As we have discussed, I do not sell the audio Paradoxical Relaxation course on a stand-alone basis. There are numerous relaxation tapes that can be bought from many different sources and people are free to buy them. I could sell the recorded lessons I use on a stand-alone basis – I have certainly had enough requests – but choosing not to do this is neither a casual nor a self-serving decision on my part. I have a short answer and a long answer to explain.

Here is the short answer why.

I have no confidence that someone can learn to relax a painful pelvic floor from a relaxation tape without instruction from someone who is competent in the method and without intrapelvic Trigger Point Release. I do not want to associate myself with making available a half measure that appears to offer something substantial but does not.

When I was symptomatic, I tried many remedies that all seemed reasonable but ultimately failed to help me. They left me hopeful at first, then disappointed, and disheartened. A stand-alone relaxation tape, in my opinion, is a half measure. Half measures give little chance of offering real recovery from chronic pelvic pain syndromes. I have decided that if I am to err, I will err in the direction of not offering anything instead of offering a half measure in which I have no confidence.

Here is the long answer why.

Learning to relax the pelvic muscles and muscle tenstion from a relaxation tape is like learning to play the violin by listening to recorded instructions. In my experience, such an endeavor usually fails; the person gets discouraged and usually gives up. To learn the violin, you need instruction from someone who plays the violin. The more accomplished the player, the better. You want to learn the violin from someone who plays it every day, who is excited about it, and whose expertise is obvious. Imagine learning the violin from someone who does not play it. The obstacles to learning to play the violin and learning to relax deeply are very similar — except learning to deeply relax a painful pelvic floor is harder than playing the violin.

Our instinct is to tighten against pain, not relax. Yet, I found that relaxing with the tension of certain kinds of pelvic pain can dissolve it. Learning to do this is a major event in someone’s life because it is from this place that it can become possible to break the cycle of pain, anxiety, and tension and allow the sore and irritated tissue in the pelvic floor to heal.

There may be some unusual individuals who can deeply relax on a consistent basis by simply using recorded instructions and I applaud them and wish them well. The reason I do not have any faith in this is that to relax a painful pelvic floor and maintain a relaxed pelvic floor over time, (and not everybody can learn how to do this) requires guidance with regard to many issues. Examples of the issues that must be addressed are:

  • What to do with the pain during relaxation
  • How to not add tension the tension of ‘trying’ to relax tension
  • When to use breathing to focus distracted mind and when to cease the breathing technique
  • What to do when emotions arise that the tension in the pelvic floor is suppressing
  • How to accept the resistance to accepting the tension
  • What it means to rest while there is discomfort
  • What to do when a plateau is reached and tension doesn’t reduce
  • What to do when symptoms abate during relaxation and then resume quickly afterward
  • How to relax in the office or on the bus

I have seen many patients distort instructions and become frustrated in their practice of relaxation. A relaxation tape usually addresses none of this and the successful resolution of these issues makes the difference between success and failure.

To learn to relax a painful pelvic floor, especially in the presence of pain, is an enigma and the method to do this is anti-intuitive. It is often frightening for someone with pelvic pain to sit still with their pain and their thoughts without guidance. In my experience, people avoid the kind of relaxation required to relax a tight and painful pelvis if there is no support and the recorded tapes wind up on the shelf.

Few professionals whom I have offered to train in teaching this method have been interested. I think that the reason is that they were not motivated, like my pain motivated me, to spend the time learning to do the relaxation themselves. The best teachers of this method are turning out to be the patients I have trained who are doing well and use it on a daily basis.

The History of the Stanford Protocol and Wise-Anderson Protocol

https://www.youtube.com/watch?v=DCw9LCHKsys

The History of the Wise-Anderson Protocol & Prostatitis Symptoms 

The Wise-Anderson Protocol began with David Wise, PhD, a psychologist in California who had suffered from Chronic Pelvic Pain Syndrome for many years. He contacted several urologists, including Dr. Rodney Anderson, a professor of Urology at Stanford University School of Medicine and leading practitioner and expert in the field of pelvic pain. Dr. Anderson was considered to be the court of last resort for patients with pelvic pain and prostatitis who had not been helped by any other treatment.

Through many years of suffering, David Wise, PhD discovered a way to become free of symptoms.

He reported the method he used to Dr. Anderson, who headed the chronic pelvic pain clinic in the Department of Urology at Stanford University Medical Center. Dr. Wise then began working as a Visiting Research Scholar at Stanford’s Department of Urology alongside Dr. Anderson, treating men and women with a variety of diagnoses. This included chronic pelvic pain, prostatitis, levator ani syndrome, pelvic floor dysfunction, pelvic floor myalgia, interstitial cystitis, and other chronic pelvic pain syndromes. Dr. Wise and Dr. Anderson worked together for eight years at Stanford, treating patients with the protocol that Dr. Wise used in his own recovery. At Stanford, the protocol was administered to patients on an individual basis in a conventional medical format.

During these early years, the results of the Wise-Anderson Protocol were presented at meetings for pelvic pain and to prostatitis researchers at the National Institutes of Health and other scientific meetings. In 2003, Dr. Wise and Dr. Anderson published the first edition of A Headache in the Pelvis, a book that described the new protocol in detail. In the first edition of A Headache in the Pelvis, this protocol was called the Wise-Anderson Protocol. As the protocol became more widely disseminated, those on the internet dubbed it the Stanford Protocol. The term Wise-Anderson Protocol is now again used, although it was popularly called the Stanford Protocol for many years. The Wise-Anderson Protocol is identical in form and substance to what has been called the Stanford Protocol in the public arena.

When Dr. Wise left Stanford he began treating patients using the Wise-Anderson Protocol in a six-day comprehensive clinic in Sonoma County, California. The immersion clinics have been offered in Sonoma County since 2003. Patients come from all around the world to learn the Wise-Anderson Protocol and prostatitis causes.

Competence in self-treatment has produced the best results in patients who have learned the Wise-Anderson Protocol.

The focus of the Wise-Anderson Protocol has evolved over the years to train patients to do the protocol without the assistance of professionals. While the immersion clinics in Sonoma County are not affiliated with Stanford, Dr. Anderson continues to evaluate patients with pelvic pain at Stanford and refer patients to the immersion clinic. Additionally, Dr. Anderson continues conducting and publishing research on the Wise-Anderson Protocol, as well as other medical research on a variety of subjects. From 2003 to the present, Dr. Rodney Anderson, Dr. David Wise and Tim Sawyer (Physical Therapist) have actively and enthusiastically collaborated on research involving patients seen at both clinics.

Since 2003, Anderson, Wise and Sawyer have published a number of articles in the Journal of Urology on data from patients they have collaboratively seen and treated. Abstracts of these articles can be found in the “Latest Published Research” post on this blog. In 2005, Dr. Wise was a plenary speaker at a National Institutes of Health conference on pelvic pain. There he presented research results on the Wise-Anderson Protocol. Dr. Wise presented the protocol to scientific meetings, including those of the International Continence Society. Both Dr. Wise and Dr. Anderson have written chapters in medical textbooks describing the Wise-Anderson Protocol. At the time of writing this section, Dr. Anderson presented a clinical poster at the American Urological Association. A report of Dr. Anderson’s presentation at the American Urological Association was published in Medscape Medical News. It was titled Intensive Therapy Regimen Helps Men With Chronic Pelvic Pain Syndrome.

Tim Sawyer, who is the architect of the physiotherapy program, was chosen to write the pelvic floor section for the new edition of Travell and Simons. It was called Myofascial Pain and Dysfunction: The Trigger Point Manual. This is the authoritative medical textbook on myofascial trigger point therapy. Tim Sawyer trained and treated patients with Dr. Janet Travell and Dr. David Simons, the physicians who introduced trigger point therapy to medicine. Dr. Travell was the White House physician to President John F. Kennedy, and Tim Sawyer is considered one of the top pelvic floor physical therapists in the world.

Recently, Anderson, Sawyer, and Wise published a pioneering article in the Journal of Urology. The article showed the relationship of trigger point location and symptoms in patients with pelvic pain, using the data from the immersion clinics held in Sonoma County. Another article updating these results has been completed and recently submitted for publication. Currently, Anderson, Wise and Sawyer have completed a study on the effectiveness of a new internal trigger point physiotherapy device for the self-treatment of trigger points. The study data on the physiotherapy device is being prepared for publication and will hopefully be published soon.

Excerpt From A Headache in the Pelvis

The following is an excerpt from “A Headache in the Pelvis

We have identified a group of chronic pelvic pain syndromes that we believe is caused by the overuse of the human instinct to protect the genitals, rectum, and contents of the pelvis from injury or pain by contracting the pelvic muscles. This tendency becomes exaggerated in predisposed individuals and over time results in chronic pelvic pain and dysfunction. The state of chronic constriction creates pain-referring trigger points, reduced blood flow, and an inhospitable environment for the nerves, blood vessels, and structures throughout the pelvic basin. This results in a cycle of tension, anxiety, and pain, which has previously been unrecognized and untreated.

Understanding this tension, anxiety, and pain cycle has allowed us to create an effective treatment. Our program breaks the cycle by rehabilitating the shortened pelvic muscles and connective tissue supporting the pelvic organs while simultaneously using a specific methodology to modify the tendency to tighten the muscles of the pelvic floor under stress.

The reason that chronic pain and dysfunction resist a simple mechanical fix is that they tend to come out of a background of a life-long habit of focusing tension in the pelvic muscles. It is necessary to rehabilitate the pelvic muscles in conjunction with changing the predisposition to pelvic tensing under conditions of stress.

An Allegory

It came to pass that the world went through a period of strife, and the citizens of the pelvic floor were required to work more and more. Night shifts became common place. In some parts of the land, citizens were required to work twenty four hours a day, seven days a week, with no rest.

Painful protests from the pelvic floor were made with demands for a return to the balance between rest and work. The world, however, did not seem to understand what the pelvic floor was trying to say.

The world became desperate and decided to hire a new consultant who saw the problem differently. The new consultant said, “If you want to solve this problem, you must go to the land of the pelvic floor and listen to its complaints.” The world replied: “We don’t know how to talk to or understand the pelvic floor. We have never had a conversation with it.” The consultant answered: “I know the language of the pelvic floor and will teach you how to understand what it is trying to tell you.”

After a while, the world said to the consultant: “Your method seems to be working much of the time but why is everything not completely back to normal?” The consultant replied: “Both you and the land of the pelvic floor are used to the unhappy state of affairs that has existed for many years. If you are not reminded, you will continue to force the citizens of the pelvic floor to work without rest.”

Therefore, a curriculum was set up for the pelvic floor as well. The people of the pelvic floor went to special clinics where they learned to stretch the contracted posture that they developed due to their constant work. This stretching and their lessons in learning not to fall back into the old habits enabled them to relearn how to relax and rest.

Pelvic pain and dysfunction result from overused and chronically tensed pelvic musculature.

The pelvic floor is your pelvis and the contents of your pelvis, including your genitals, rectum, and the muscles that hold up the contents of your abdomen. It also includes the structures that are involved in urination, defecation, sexual activity, and physical movement. These functions and their myriad of biochemical, nervous, and mechanical processes go on often without requiring your awareness, will, conscious effort, or attention.

The pelvic floor muscles are not meant to be chronically contracted. When muscles are chronically tensed, they tend to shorten and eventually accommodate so that the posture of a shortened state of the muscles feels normal. This chronic shortening impedes the ability of the tissues to have proper oxygenation, nutrition, management of wastes and rejuvenation of tissue.

The tendency to focus tension in the pelvic muscles is not an accident. Some have suggested that a person’s inclination to focus tension in the pelvic muscles begins with toilet training. The child is able to stop his parent’s reaction to soiling by tightening his pelvic muscles. Over time, tightening the pelvis becomes a conditioned reaction to any situation in which anxiety arises. Let us be clear that this idea of focusing tension in the pelvic muscles as a result of early toilet training is simply an idea and we do not propose that it should be taken as fact. It is however, a compelling explanation of how pelvic tension may well begin early in life.

In our allegory, we see that the constant demand made upon the pelvic floor leads to a disruption in its ability to function. It is our view that, over time, a constant demand on the pelvic floor to tense results in an environment that is inhospitable to the nerves, blood vessels, and structures within it. The pelvic floor is not made of steel and in certain individuals is quite disturbed by chronic tension.

The painful pelvis is like a continually contracted fist.

Now imagine you maintain this clenched fist for a day. Now imagine you maintain this fist for a week. Now imagine a month of tightening your fist constantly twenty-four hours a day. Now imagine doing it for a year. Now imagine doing it for several years. This is one way to understand the state of the pelvic floor in people with pelvic pain.

Imagine continually tensing your pelvis.

People who have never had pelvic pain are incredulous at being asked to contract their pelvic muscles for 30 minutes. The prospect of continual tightening of the pelvic muscles for a week, month, or year would be unthinkable and yet the research shows increased tone in the pelvic floor for people with pelvic pain. Dealing with such a condition is the focus of our protocol.

In our allegory, we make the point that ‘the world’ has lost communication with the pelvis. Most of our patients tend to be out of touch with what is going on in their pelvis. We offer a method to open communication with the pelvis to help bring about a healing of the sore.

Why Stress Triggers and Perpetuates Pelvic Pain Symptoms

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

Even slight amounts of stress can trigger pelvic pain symptoms.

Studies have shown that myofascial trigger points that are found in sore and painful muscles inside the pelvic floor are strongly affected by stress. Gevirtz and Hubbard did electromyographic monitored studies of the electrical activity of trigger points and their relationship to stress. Even the slightest increase in anxiety and nervous arousal caused a significant increase in the electrical activity of the trigger points. Individuals suffering from pelvic pain often report an increase in pelvic pain symptoms with stress and a decrease of pelvic pain symptoms with the reduction of stress and anxiety. For this reason, the Wise-Anderson Protocol trains patients with a relaxation method. This regularly reduces anxiety and nervous system arousal.

While individuals with pelvic pain often notice the relationship between stress and their symptoms, some people with pelvic pain are only rarely aware of the impact. The reason is that if you live, for instance, in a marriage where there is ongoing resentment, a work situation in which you deal with frustration regularly, or live with a sense of dread because of a general tendency to jump to catastrophic conclusions, you get used to these emotional currents and think they are just a part of life. You may not connect the dots in seeing their relationship to your symptoms. When you live in water, you don’t notice that you’re wet.

Many of our patients tend to live in a world of constant worry.

We know that when you have pelvic pain symptoms, you usually live with some level of anxiety and/or depression. Our recent study at Stanford shows a greater early morning rise in salivary cortisol in pelvic pain patients as opposed to normal, non-symptomatic control subjects. These findings which suggest heightened anxiety in individuals who suffer from pelvic pain syndromes. We have discussed in our book A Headache in the A Pelvis that an increased level of psychological distress in patients dealing with pelvic pain symptoms is equivalent to dealing with the same kind of stress people deal with who have heart disease or Crohn’s disease. Absent are studies of levels of dread, resentment, and anger in those who deal with pelvic pain, though it is our anecdotal experience that such emotions often punctuate the lives of many of our patients.

https://www.youtube.com/watch?v=SndMj85EV8Y

Many patients do not recognize the relationship between their emotional states and their pelvic pain symptoms.

Most people dealing with pelvic pain symptoms are not aware of the significance of their condition. When you are able to relax and let go of a level of anxiety you normally live with, and you witness a dramatic improvement in your symptoms, you usually find the wherewithal to earnestly do something about anxiety. It’s all about seeing the relationship between cause and effect.

To stop catastrophic thinking, you first have to recognize it. Pelvic pain can provide the impetus to decide to see things differently. This is because seeing things differently can reduce your symptoms. It is part of our language to distinguish between optimistic and pessimistic viewpoints by using the analogy of ‘seeing the glass half full or half empty.’ It is not a lie to say the glass is half full or half empty; they are both equally true. But for someone who knows the glass as half empty, and suffers from such a viewpoint, it takes an effort to choose the ‘half full’ perspective, because the perspective is so strongly ingrained.

Chronic states of anxiety, fear, dread, sorrow, resentment or anger must be addressed for any real resolution. Unfortunately, at this time, contemporary medicine has not been interested in the profound relationship between pelvic pain symptoms and ongoing dysfunctional emotional states. This is the reason why, in our view, conventional treatments have failed. The rehabilitation of attitudes that promote chronic states of anxiety, fear, dread, sorrow, resentment or anger is essential for anyone who is serious about stopping their pelvic pain.

The paradigm implied in the treatment protocol for pelvic pain developed at Stanford University.

It is a new paradigm to think you can voluntarily relax your habitually tight core which includes the anorectal area. When you call someone a “tight ass,” the implication is that such a person is characteristically in a chronic state—someone who is “tight-assed” or “anal” is considered a kind of person whose tendency is to be perfectionistic and cannot be reformed. Our protocol is based on the understanding that voluntary efforts to behaviorally change the default tone of the pelvic floor can change to one that is relaxed and at ease. This new understanding asserts that “tight asses” can become “relaxed asses.”

Like the insights of the new paradigm of neuroscience regarding the plasticity of the brain, we propose that the chronically tensed core, including the intestines and pelvic floor muscles, can be trained to be relaxed. We propose that the tendency to brace the viscera under stress can be changed without surgery or drugs. This is done through training in calming a chronically vigilant nervous system. In other words, the chronic tension associated with nervous system arousal can be brought under our voluntary control.

Changing this habitual inner posture is not brought about by drugs or surgery. It can be brought under the control of the patients’ disciplined consciousness. For patients who come to our clinic, the suffering with pelvic pain is what we believe provides the motivation for someone to learn to control catastrophic thinking, an upset nervous system, and the pelvic pain related to them. We are proposing that resolving chronically tight insides can’t be done by anyone else except by the person who is suffering. Over a lifetime, we believe that teaching people to calm down their insides under their own volition is the most cost effective method of dealing with pelvic pain, despite the fact that initially training people to do this has its costs. In our view, the psychophysical treatment of the Wise-Anderson Protocol represents the best framework within which someone can modify a contracted core.

A gentle approach to breaking the cycle.

The Wise-Anderson Protocol intervenes in all aspects of the tension-anxiety-pain cycle. Paradoxical Relaxation lowers pelvic tension and anxiety by lowering autonomic nervous system arousal and habitual pelvic tension. Trigger Point Release and certain myofascial release methods, including what we describe as skin rolling and pelvic floor yoga, deactivates trigger point pain, lengthens chronically contracted muscles, and makes the pelvic muscles more capable of relaxation.

Our understanding is a significant departure from the conventional view of prostatitis and chronic pelvic pain syndromes. We see pelvic pain as a physical expression of the way a person copes with life. We propose that pelvic pain is the result of a neuromuscular state perpetuated by anxiety and chronic bracing in both men and women. It is not the result of a foreign organism in the prostate gland in the case of prostatitis, an autoimmune disorder, or other contemporary explanations.

When certain predisposed individuals focus tension in the pelvic muscles, this chronic tension, over time, creates an inhospitable environment in the pelvic floor that gives rise to a cycle of tension, anxiety, and pain. Once this cycle is set into motion, it takes on a life of its own. Our treatment aims to restore the capacity of the pelvic tissue to relax, to perform its normal functions, and to return to a pain-free and dysfunction-free state.

Why is there Confusion about Prostatitis Symptoms?

[embed]https://www.youtube.com/watch?v=Q5FGDhXyT9A[/embed]

Why is there Confusion about Prostatitis Symptoms?

Most cases diagnosed as prostatitis are actually problems of chronically tightened muscles of the pelvis – not problems of the prostate gland.

While Pelvic Pain Help treats both men and women with pelvic pain, a large majority of men are diagnosed with prostatitis. Unfortunately, most men with this diagnosis have mistakenly been told that their symptoms are caused by a problem with their prostate gland. In fact, the problem of genital, rectal, perineal pain, urinary symptoms, sitting discomfort, in most men has nothing to do with the prostate gland.

Approximately ninety-five percent (95%) of diagnosed cases are not prostatitis.

Approximately 95% of men with this diagnosis do not have symptoms caused by some pathology of their prostate gland. Most men do not understand the confusion among doctors about what is and isn’t prostatitis. In fact, many doctors do not understand this confusion either. Pelvic Pain Help hopes to clarify this confusion in this blog and on this website.

Most symptoms are not caused by an ‘itis’ of the prostate.

The overwhelming majority of cases do not appear to be caused by any known problem of the prostate gland. Nevertheless, most doctors currently have continued to use the term prostatitis and treat complaints of pelvic pain and urinary dysfunction as if they were caused by an infection or inflammation of the prostate. In careful studies, in past decades of treating the prostate in such men, the overwhelming majority derive no lasting relief from antibiotics or anti-inflammatory drugs.

Unfortunately, many doctors make a diagnosis of prostatitis symptoms and prescribe antibiotics without verifying that there is any infection present in the prostate.

Prostatitis, which means an infection or inflammation of the prostate gland, is often diagnosed without the doctor doing any definitive testing. As we have seen in a study of physicians in Wisconsin, a large majority of doctors view prostatitis symptoms as an inflammation or bacterial infection. More than that, almost all prescribe antibiotics as a treatment. Most urologists know from their own experience that antibiotic treatment without evidence of infection routinely fails to help symptoms. Yet, almost 100% of the cases of this kind receive antibiotics. We are always troubled to hear this experience in patients who come to see us, especially when the doctor made no attempt to establish the presence of infection.

https://www.youtube.com/watch?v=N-BSDxgNl6M

Antibiotics are the best treatment for bacterial prostatitis but rarely help men with no prostate infection.

Pelvic Pain Help wants to emphasize that the antibiotic treatment of bacterial prostatitis has been an achievement of modern medicine. If you have bacterial prostatitis, antibiotics are a very good treatment—certainly the only treatment. Viewing all conditions of pelvic pain and dysfunction in men, however, is an error in judgment.

That being said, prostatitis as a tension/muscle disorder. The contribution of our website is to make it known in the large majority of cases of this diagnosis, it is the muscles of the pelvis, not the organs, that are the source of the problem. The protocol of 6-day clinic that we developed at Stanford, the Wise-Anderson Protocol, focuses on rehabilitating the muscles of the pelvis through Internal Trigger Point Release and Paradoxical Relaxation. The success of our protocol has been confirmed in a number of published scientific studies.

For more information, a video discussion of this is found here. Pelvic Pain Help hopes to be a valuable resource to you in discovering true prostatitis symptoms.