You are the environment in which your pelvic pain heals or does not heal

In the original version of our book A Headache in the Pelvis, we described pelvic floor pain as a condition in which the tissue of the pelvic floor is caught in an inhospitable environment of chronic contraction, pain, and tension. We stated simply that our therapeutic approach – called the Stanford Protocol by some, and we call the Wise-Anderson Protocol – aims to turn this unhealthy environment into a hospitable one to permit the healing of sore, tightened tissue.

Many years after we originally wrote that first edition, and after treating several thousand additional patients, many new observations and insights have emerged, and we’ve found different ways to describe the onset and perpetuation of this invisible condition.

If you have pelvic pain, and your pelvic floor muscles are locked in a self-feeding cycle of tension, anxiety, pain, sore tissue, and protective guarding, then it’s an important but often-overlooked observation that you are the environment in which this condition exists. You are the environment in which this sore, painful tissue can or cannot heal. As a result, you needn’t be a passive participant to resolving your condition.

I experienced pelvic pain for over 20 years. Every day, I was in pain, distracted, and living with an underlying feeling of dread that I would never recover my life. Inwardly, I felt like a mess. Doctors had nothing to offer me. They told me that my conditions was related to my prostate gland – something I later discovered was untrue – but they also seemed uninterested in my pain, and more than happy to see me leave their office. Knowing what I do know now, I think my sense about the doctors was correct: they weren’t interested in my situation, they didn’t understand it, and they could do nothing to help. In fact, they offered the faulty diagnosis that somehow this was a prostate-related problem for which there was no solution. When you’re a doctor and someone comes to see you with a condition you don’t understand and can’t help, you naturally withdraw. I still clearly remember the first time I went to see a doctor about my pelvic pain. He talked to me, examined me, and very quickly said to his nurse, “Next patient.”

I went to these doctors as an anxious and frustrated patient. I had the idea that my condition was mysterious and arbitrary – that it had nothing to do with the state I was in. I didn’t understand that my inner state had everything to do with my chronic symptoms. But, no doctor I saw understood this either.

What does it mean that my inner state led to my chronic condition? Consider a more straightforward example: if you tightened your hand into a fist for a year, the tissue of your hand would be sore, irritated, and painful. That’s just common sense. Further, if you kept maintaining a fist, this sore tissue would remain irritated and painful – that pain isn’t going to heal. This continually tightened fist is the environment that the sore, painful hand and fingers exist in.

The same situation exists with pelvic floor pain: the patient’s tightened, anxious, nervous state is the environment that interferes with the healing of the tissue. Furthermore, normal activities of life exacerbate the pain and irritation of sore pelvic tissue. Sitting, walking, lifting, and balancing are all potentially irritating to the already sore pelvic floor. Additionally, a subset of people with pelvic pain have post bowel movement pain, post urination pain, post orgasm pain, and even sitting pain – activities that are part of regular life and normally cause no pain or difficulty. With pelvic floor pain and dysfunction, these activities contribute to the inhospitable environment that interferes with the pelvic floor.

And, of course, there is also anxiety, sleep disturbance, and the deep psychological distress that most people with pelvic pain endure. Anxiety and nervous arousal are a huge exacerbator of pelvic floor pain. Gevirtz and Hubbard demonstrated in a watershed study that relaxation quiets electrical activity in trigger points, while anxiety hugely heightens electrical activity.

All of this is what I mean when I say that you are the environment in which your pelvic floor tissue can heal or remain irritated. Our approach asks a very big sacrifice – that patients devote at least two hours every day to applying competent, self-administered physical release and practicing relaxation.

When I had pelvic pain, I went to the doctor and hoped that the doctor would just fix it. I wanted to simply say, “Here it is doc. It’s your problem, now.” A doctor who understood pelvic floor pain would have replied, “You will have to create an environment inside yourself, every day, to allow the sore and painful tissue to heal.”

It’s true that pelvic floor pain can go away on its own without treatment. There are people who practice no self-treatment and just get better. It’s also true that some patients get better in a variety of ways – from doing physical therapy to changing jobs and other apparent interventions. In my experience, however, those people are a small minority of pelvic pain patients. For the majority of patients, no one else can ultimately fix the problem. It’s like brushing your teeth – yes, someone else can show you how to brush and floss, but ultimately there is no one who can do this for you in your life except you.

We are the environment in which our pelvic pain exists, and in my view this environment in which we exist day-to-day is the central factor that facilitates the healing of pelvic pain. Skillfully loosening the relevant tissue inside and outside physically and providing regular and significant daily time in which the body becomes quiet and relaxed is necessary for most cases of pelvic pain to significantly improve and resolve.

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.