• In this blog, I will explain the Wise-Anderson Protocol and why it helps significantly reduce pain and symptoms, of chronic pelvic floor related pain in majority of men and women who are trained in it.
• I suffered from pelvic floor related pain and symptoms for over 20 years before I had the great fortune, unlike many who suffer from chronic pelvic pain, of resolving it.
• The way that I became symptom free became the basis of what is now called the Wise-Anderson Protocol, a protocol named after myself and Dr. Rodney Anderson, professor of Urology at Stanford University School of Medicine with whom I developed the program.
• I sometimes muse that if the Wise-Anderson Protocol in its current form, had been available when I first started having symptoms when I was 18, back in 1963, many years of my life would have been very different
In a study our team conducted and published in the Journal of Urology, the method we call the Wise-Anderson Protocol used for almost 30 years now, was show to reduce pelvic pain symptoms in a majority of patients who had been trained in it and practiced it. It has given their lives back to many of our patients.
• In a published article in the major urology journal, the Journal of Urology after 6 months, there was a 59% marked to moderate reduction in pain and symptoms.
• In another published article in the Clinical Journal of Pain there was a dramatic reduction in trigger point sensitivity — how much it hurt inside when trigger points were palpated – a drop from 7.5 to 4 after 6 months.
• This occurred when patients who failed at all other treatments who then used our Internal Trigger Point Wand in conjunction with our entire protocol – almost cutting the internal pain/sensitively level in half.
• It has been my observation that the pain level continues to reduce among many of our patients as they continue our protocol after a period of 6 months.
• In the journal of Applied Psychophysiology and Biofeedback, 1/3rd of patients after 6 months voluntarily gave up all medications they were taking in relationship to their symptoms.
• Medication reduction was unsurprisingly associated with a decrease in pain and symptoms
The Wise-Anderson Protocol is now offered to eligible people in a 4 day immersion in-person immersion clinic and home program
The Wise-Anderson Protocol is a protocol we began to develop almost 30 years ago at Stanford University Medical Center in the Department of Urology and since 2003 has been taught to patients in a private multi-day in-person clinic, and more recently is available in a comprehensive home program that can be done without in-person attendance.
How you understand a problem determines how you treat it
In our book, A Headache in the Pelvis, we use the example saying that it isn’t a good idea to treat chest pain with open heart surgery if the problem is heartburn. You don’t want to do exploratory brain surgery when headache is simply caused by stress. Correctly understanding a problem is the key to solving it. This is especially important for pelvic floor pain that you can’t see or detect with any conventional testing.
Here is our understanding as to why pelvic floor related pain becomes chronic and how to resolve it
• Pelvic floor-related pain is invisible to the eye and to conventional medical testing. A person with chronic pelvic pain complains of a variety of peculiar and varied symptoms and yet the doctor or anyone else can’t see evidence of the problem other that the person’s complaints of pain and symptoms.
• Conventional tests and treatment –… conventional tests like CT scans MRI’s Xrays, blood tests etc. can’t detect chronic pelvic pain syndromes. Similarly the conventional treatments of drugs surgery procedures, injections are of little help.
• It turns out that to know what to do with a patient whose symptoms you can’t see or test for, you have to project a concept of the problem on the patient
• If the concept you project on the pelvic pain patient is wrong, your treatment won’t help. This is the case in the current treatment of pelvic pain.
The confusion about how to effectively treat pelvic pain comes from the strange and seemingly unrelated symptoms. Pelvic pain patients have 3 or more of the following symptoms.
• Perineal, anal, rectal pain, genital pain/discomfort/tightness/burning that can be on one side or another, on both sides or in the middle.
• Symptoms can be continual, episodic, at different levels of intensity during the day, can remain in the same place or shift to different places
• Pain or discomfort can worsen with sitting (sometimes feels like a golf ball stuck up inside)
• Pain or discomfort can be relieved or worsened during or after bowel movements (or bowel movements can have no effect on symptoms)
• Pain or discomfort and be felt in the perineum, lower abdomen (on one side or another or in the middle), tailbone, low back, above the pubic bone as well as up inside the pelvis
• Pain or discomfort if often exacerbated during/after sex, sitting or with stress, after a long day at work,
• Urinary urgency, frequency, or discomfort, constipation are common
• Temporary relief sometimes occur with hot baths or valium type drugs
• Symptoms can be constant or wax and wane, often (not always) better in the morning and worsens as day unfolds
• Typically, symptoms flare ups occur (varies from person to person) with stress, sitting, sex, bowel movements
• Occasional anal fissures
• Pelvic pain is accompanied by anxiety, depression, reduction in self esteem
• Significant reduction in quality of life
How can you make sense of these symptoms?
• Pelvic floor pain is typically a quiet and ongoing inner crisis of being in pain, having often chronic weird symptoms, feeling alone, misunderstood and having little help. Even when some things like physical therapy help, symptom relief is typically short-lived. I know this well from my personal experience.
So what is pelvic floor pain. I want to refer to a study we published an article in the Gold Journal of Urology in 2018 called Prostatitis/chronic pelvic pain syndrome as a psychoneuromuscular disorder—a problem of chronically painful, tight pelvic and related muscles that make the pelvis tissue sore – pelvic tissue that has developed painful trigger points occurring as the result of chronic pelvic tension which feed more pelvic tightening, anxiety, and pain … all in an self-feeding cycle.
• This symptoms of a male pelvic floor pain, often confusingly diagnosed as prostatitis/cpps also occur in women. In a study we published in the Journal of Psychophysiology and Biofeedback, we found that our protocol helps women with pelvic floor pain and symptoms to the same degree that it helps men.
• While a small minority of pelvic pain we treat appears to be the result of an insult or injury to the pelvis, most cases of pelvic pain occur as the result of the reaction of the pelvis to chronic, worry that is that prompts an often unconscious habit of protective pelvic muscle tightening.
• Like a dog that pulls in its tail when frightened, pelvic floor pain can be thought of as the human equivalent of a dog pulling its tail in. When upset, the pelvis of the dog contracts to pull in the tail. Chronic worrying in a certain group of people produces chronic pelvic tightening. Not infrequently the tailbone is actually pulled in.
- You can think of pelvic floor pain as the center of the body, the core of the body that is chronically hurting, tensed, triggering anxiety, pain, protective guarding — resulting in ongoing sore pelvic tissue – all part of a self-feeding cycle that has been out of reach of all medical interventions.
So what to do about this peculiar and distressing picture? The Wise-Anderson Protocol addresses this condition directly.
- The aim of the Wise-Anderson Protocol is to stop the cycle of tension, anxiety, pain and chronic tightening of the pelvic and related muscles on a daily basis.
- In the Wise-Anderson Protocol we ask patients to follow a physical and ongoing behavioral program that has to be practiced for an extended period of time to restore the pelvic muscles to a state of not being contracted or in pain.
- I learned that resolving pelvic pain is an inside job. No one could do it for me. Having been through it, I see that stopping the pain and symptoms of chronic pelvic floor pain requires that the person with pelvic pain release the chronic painful guarding in the pelvis, release the painful internal and external trigger points, daily stop anxiety – all in order to help the sore pelvic tissue to heal
- Ultimately no one can stop you from chronically tightening up your pelvic muscles except you
- And here is a key issue that is missed in most attempts to deal with pelvic pain: if the sore pelvic tissue doesn’t heal from its long time of being squeezed, this sore, painful tissue itself triggers a reflex guarding/tightening. Unresolved painful trigger points, chronic muscle guarding, and sore painful tissue all forming a self feeding cycle is what keeps pelvic floor pain chronic.
- Extended Paradoxical Relaxation is based on the pioneering work of my teacher, Edmund Jacobson, considered the father of relaxation therapy in the United States who developed Progressive Relaxation at the turn of the 20th This method puts the pelvic floor and nervous system into a quiet chamber every day which is not unlike the quiet necessary for someone in a hospital room to heal.
- Extended Paradoxical Relaxation uses the principles of Jacobson’s Progressive Relaxation and has been adapted to be used by the pelvic pain patient who must deal with pain and anxiety. It requires proper instruction and daily practice of at least an hour a day for an extended period of time.
- At this time, conventional medicine has little to offer to release the chronically tightened pelvic floor muscles and to reduce the anxiety of an aroused nervous.
- You would think that a pill could calm down the nervous system. In fact there are no such pills that don’t have serious side effects and the problem of addiction. You would think that someone could simply do physical therapy on you and that would solve the problem of the chronically tightened pelvis.
- Pelvic floor physical therapy, which we pioneered in men 30 years ago and are experts at teach patients, is a necessary but temporary intervention that doesn’t stop the habit of tightening the pelvis under stress that reinvigorates pelvic trigger points.
- Pelvic floor physical therapy that you learn to do yourself can release the chronic guarding that keeps the pelvis too tightened. It must be carefully taught and a effective tool needs to be used and its use taught to the patient. Our FDA approve/cleared Internal Trigger Point Wand for internal trigger point release and our FDA registered Trigger Point Genie are the medical devices we have designed and carefully teach our patients to use.
- Resolving pelvic pain is an inside job. Pills, surgery or procedures don’t work for it. As most of our successful patients have found, no one can do this for yourself except you.
- When our program is successful, it is typically practiced daily for 3 months to a year or more until symptoms abate.
- In summary, the Wise-Anderson Protocol takes on the major task of helping to heal a sore and irritated inner core of the body called the pelvic floor.
- It is a practice that we teach our patients to do using our specialized devices for releasing the chronically painful and tightened pelvic floor and related muscles. This, in combination with Extended Paradoxical Relaxation have the goal of helping to heal the pelvic tissue that became sore from chronic protective guarding
- The Wise-Anderson is not a quick fix. In our experience there are no quick fixes.
It is possible however to skillfully practice a physical and behavioral set of methods that can help to heal the sore and painful pelvis.