While there are a number of causes of pelvic pain, we treat muscle based pelvic pain that can be called pelvic floor dysfunction. Sometimes this condition is given the name ‘prostatitis/chronic pelvic pain syndrome (where there is no infection present) in men. In men and women is sometimes called, pudendal neuralgia, rectal pain, levator ani syndrome, piriformis syndrome, pelvic floor myalgia. We consider all of these names simply other names for pelvic floor dysfunction Our work over the past 30 years has been in both a clinical practice where patients come to see us in California and in doing research on the pelvic pain we treat. You can see the research the outcomes of our protocol with pelvic pain patients in the next question below.

Understanding what causes pelvic floor dysfunction is critical for its resolution. There are a number of theories about this kind of pelvic pain that inform conventional treatment that we consider at best incomplete and at worst simply incorrect.

Our view of pelvic floor dysfunction is that it is a psychoneuromuscular condition (simply said, a problem involving body and mind) typically brought about by anxiety (and sometimes by an injury insult) in which the muscles the pelvic floor protectively tighten up and at a certain point do not untighten. The tissue inside the pelvic floor isn’t happy being chronically tightened and begin to hurt.

The pain of the chronically tightened muscles promote increased anxiety which makes the chronic muscle tension worse which forms itself into a self-feeding loop of tension-anxiety-pain-protective guarding-sore pelvic tissue. The Wise-Anderson Protocol trains the pelvic pain patient to physically loosen the chronically tightened muscle (that develop pain referring trigger points) with our FDA cleared Internal Trigger Point Wand for internal trigger point release and our Trigger Point Genie for release trigger points and chronically tightened external muscles feeding the pelvic pain cycle.

Yes, we have published a number of studies in peer-review high quality journals. Most studies have been published in the Journal of Urology as well as publications in the Gold Journal of Urology, the Clinical Journal of Pain and Applied psychophysiology and biofeedback. Here are the studies: (Joshua we may want to create a link to these research publications and articles—we may have a link that says ‘read the 18 studies/articles of/about the Wise-Anderson Protocol.)

PUBLISHED RESEARCH
PUBLICATIONS OF AND ARTICLES ABOUT THE WISE-ANDERSON PROTOCOL AND OTHER RELATED ARTICLES ABOUT PELVIC PAIN RELIEF

The following articles are published research articles about different conditions that are associated with pelvic pain, our research about pelvic pain relief, and the development of the Wise-Anderson Protocol and the Internal Trigger Point Wand.
Please click any of the articles below to read the full article:

Coccygodynia and Pain in the Superior Gluteal Region – October 1937, Jour. A.M.A., Volume 109, Number 16, George H. Thiele, MD, Kansas City, MO.

Coccygodynia was found to be accompanied by spasm of the levator ani and/or coccygeus muscles in sixty-four of sixty-nine patients seen by nine different observers. Spasms of the piriformis muscle was found in thirty-one of thirty-three patients with a pain in the supragluteal region or down the back of the thigh (Thiele’s and Wilson’s) There’s a sound anatomic basis for the causation of coccygodynia by spasm of the levator ani and coccygeus muscles and for the production of supragluteal pain and pain down the back of the thigh by spasm of the piriformis muscle. In the treatment of these complaints by massage of the pelvic muscles involved, the technic outlined should be carefully followed.

In a series of eighty patients with coccygodynia or pain in the supragluteal region or down the bac of the thigh who were treated by massage by eight different proctologists, 60 per cent were cured, 33.7 per cent were definitely improved and 6.3 per cent were unimproved.

Chronic Pelvic Pain Syndrome: Reduction of Medication Use After Pelvic Floor Physical Therapy with an Internal Myofascial Trigger Point Wand – R. U. Anderson Stanford University School of Medicine, Stanford, CA 94305, USA e-mail: rua@stanford.edu: R. H. Harvey Department of Health Education, San Francisco State University, San Francisco, CA, USA D. Wise _ T. Sawyer National Center for Pelvic Pain Research, Sebastopol, CA, USA; J. Nevin Smith Sonoma, CA, USA; B. H. Nathanson OptiStatim, LLC, Longmeadow, MA, USA.

This study documents the voluntary reduction in medication use in patients with refractory chronic pelvic pain syndrome utilizing a protocol of pelvic floor myofascial trigger point release with an FDA approved internal trigger point wand and paradoxical relaxation therapy. Self-referred patients were enrolled in a 6-day training clinic from October, 2008 to May, 2011 and followed the protocol for 6 months. Medication usage and symptom scores on a 1–10 scale (10 = most severe) were collected at baseline, and 1 and 6 months. All changes inmedication use were at the patient’s discretion. Changes in medication use were assessed by McNemar’s test in both complete case and modified intention to treat (mITT) analyses. 374 out of 396 patients met inclusion criteria; 79.7 % were male, median age of 43 years and median symptom duration of 5 years. In the complete case analysis, the percent of patients using medications at baseline was 63.6 %. After 6 months of treatment the percentage was 40.1 %, a 36.9 % reduction (p.001). In the mITT analysis, there was a 22.7 % overall reduction from baseline (p.001). Medication cessation at 6 months was significantly associated with a reduction in total symptoms (p = 0.03).

Success of 6 Day Intensive Program Wise-Anderson Protocol – Journal of Urology, 2011, Volume 185, Issue 4, p. 1294.

Patients with CP/CPPS with long-standing pain that is refractory to traditional treatment may benefit from focused myofascial TrP therapy and concomitant PRT. Education of patients in techniques for self-administered TrP massage and encouragement of continued pelvic muscle relaxation are assets in helping them to participate in the management of this chronic disorder. Refinement of clinical phenotyping and selection of patients with pelvic muscle tenderness should enhance the success rate with this treatment modality.

Award for Internal Trigger Point Wand – American Urological Association, 2011.

AUA chooses internal trigger point wand used and developed in the Wise-Anderson Protocol (Stanford Protocol) as an elite abstract presentation. Internal trigger point wand study abstract presented at the AUA chosen as 1 of 40 out of 2000 abstracts submitted for presentation at an AUA sponsored press conference.

The Scapegoat of the Prostate Gland and the Wise-Anderson Protocol – Bartlett’s Integrated Health Journal, 2011, Emilia Ripoll.

In the sixth edition of A Headache in the Pelvis: A New Understanding and Treatment for Chronic Pelvic Pain Syndromes, Drs. Rodney Anderson and David Wise state, “in 95% of prostatitis cases, the prostate is not the problem. In the case of men with prostatitis and chronic pelvic pain syndromes, 95% of patients who are diagnosed with prostatitis do not have an infection or inflammation that can account for their symptoms. In a word, in the overwhelming number of cases of men diagnosed with prostatitis, the prostate is not the issue.”

Report on the Success of Internal Trigger Point Wand and the Wise-Anderson Protocol – Medscape Medical News, 2011, Trigger Point Wand Eases Chronic Pelvic Pain, Jill Stein.

Report on success of trigger point wand used in the Wise-Anderson Protocol (Stanford Protocol). 87% completing 6 months of use report significant reduction in pelvic floor sensitivity/pain from 7.5 to 4 on a 0-10 scale. Patients used the wand two to three times per week for 5-10 minutes and were followed up at 1 and 6 months. Ninety-five percent (106/111) reported the therapy was very or moderately effective in relieving pain. Their average assessments of pelvic floor pain on a scale of 1 to 10 dropped from 7.5 at baseline to 4 at 6 months; 39% of patients reported a greater than 50% reduction in pelvic muscle sensitivity.

Report on Success of Internal Trigger Point Wand and the Wise-Anderson Protocol – Urology Times, 2011, Self-massage shows benefit in CP/CPPS patients with myofascial pain, Urology Times Daily Meeting Report.

Patients used the wand two to three times per week for 5 to 10 minutes and were followed up at 1 and 6 months. Ninety-five percent (106/111) reported the therapy was very or moderately effective in relieving pain. Their average assessments of pelvic floor pain on a scale of 1 to 10 dropped from 7.5 at baseline to 4 at 6 months; 39% of patients reported a greater than 50% reduction in pelvic muscle sensitivity.

Internal Trigger Point Wand in the Wise-Anderson Protocol – American Urological Association Poster, 2011, Abstract Presentation of Study of safety and efficacy of Internal Trigger Point Wand developed and used in the Wise-Anderson Protocol.

The personal therapeutic wand helped to achieve pain reduction or abatement in most patients thus ranking it very high amongst other multi-modal treatments. Patients required simple education regarding hygiene and adequate training in the careful application of the wand to prevent trauma to the anal or vaginal tissue. Self-treatment with an internal pelvic therapeutic wand appears to be a safe, viable treatment option in select refractory patients with pelvic pain.

Results of Internal Trigger Point Wand used in the Wise-Anderson Protocol – Clinical Journal of Pain, 2011, US National Library of Medicine National Institutes of Health, Clin J Pain. 2011 Nov;27(9):764-8.

Safety and effectiveness of an internal pelvic myofascial trigger point wand for urologic chronic pelvic pain syndrome., Anderson R, Wise D, Sawyer T, Nathanson BH. Source, Department of Urology, Stanford University, School of Medicine, Stanford, CA.
A multimodal protocol using an internal pelvic therapeutic wand seems to be a safe, viable treatment option in select refractory patients with pelvic pain.

The Failure of Conventional Drugs to Treat Prostatitis – Nature Reviews, Urology, 2011, Drug Therapies for CP/CPPS: help or hype, Anderson, R.U. & Nathanson, B.H., Nat.Rev.Urology 8, 236-237 (2011), Department of Urology, Stanford University School of Medicine, CA 94305-5118, OptiStatim LCC, P.O. Box 60844, Long Meadow, Mass 01116.

While the ineffectiveness of these drugs is old news to those of us who specialize in treating CP/CPPS, they are still routinely prescribed by most clinicians treating this condition—and patients continue to suffer from CP/CPPS. Underlining the failure of these conventional oral medications should have been the main conclusion of this article. The authors admit that “the reason for the benefit associated with antibiotics is not immediately clear.” Other non pharmacological therapies for CP/CPPS do exist, however, and the logical trend in the diagnostic evaluation of CP/CPPS is to utilize careful phenotyping in the initial work-up of the suffering patient. This phenotyping approach has recently been proposed and evaluated in a multimodal therapy setting, with excellent results.6 The differences in the management strategies used depend upon recognizing the heterogeneity of the condition and the specificity of symptoms, which are characterized by the six domains of the UPOINT phenotyping system (urinary, psychosocial, organ-specific, infection, neurologic/systemic, and tenderness of skeletal muscles) that are used for focusing treatment. Each of these domains should be treated with stateof-the-art therapy, which might sometimes require more than one treatment modality. Notably, pelvic tension and muscle tenderness make up the majority of the specific symptoms and physical findings in patients with CP/CPPS. In our personal experience of treating this condition, we have found alternatives to failed oral medications, such as multimodal physical therapy and cognitive behavioral therapy, and suggest that innovative treatment strategies be explored after patients have been carefully phenotyped and once traditional antibiotic or α-blocker therapy of CP/CPPS has been deemed inappropriate.

Report on Improvement in Symptoms of Men with Chronic Prostatitis / Pelvic Pain – Medscape Medical News, 2010, Intensive Therapy Regimen Helps Men with Chronic Pelvic Pain Syndrome, Jill Stein.

Report on Wise-Anderson Protocol showing sustained improvement in men with prostatitis/pelvic pain in 2010 study in the Journal of Urology

Report on the Success of the Wise-Anderson Protocol in the Journal of Urology – Doctor’s Channel, 2010, Journal of Urology, New Article Reports Wise-Anderson Protocol Helps 82% of Men Diagnosed With Prostatitis.
You can find the source video here on their website: http://www.thedoctorschannel.com/video/4146.html
Source: National Institute of Health and US National Library of Medicine at http://www.ncbi.nlm.nih.gov/pubmed/21334027

Men with chronic pelvic pain refractory to traditional treatment benefit from intensive myofascial trigger point therapy and concomitant paradoxical relaxation training. Education in techniques for self-administered trigger point release and continued pelvic muscle relaxation help patients reduce pain and dysfunction. Refinement of clinical phenotyping and selection of patients with pelvic muscle tenderness should enhance the success rate with this treatment modality.

Reports on Trigger Points and Prostatitis / CPPS – Journal of Urology, 2009, Oct 16 (Epub ahead of print) Painful Myofascial Trigger Points and Pain Sites in Men with Chronic Prostatitis/Chronic Pelvic Pain Syndrome, Anderson RU, Sawyer T, Wise, D Morey A. Nathanson BH.

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.

Psychometric Profiles of Men with Chronic Prostatitis – Journal of Urology, 2008, Psychometric Profiles and Hypothalamic-Pituitary-Adrenal Axis Function in Men with Chronic Prostatitis/Chronic Pelvic Pain Syndrome), Rodney U Anderson, Elaine K. Orenberg, Christine A. Chan, Angie Morey and Veronica Flores, From the Department of Urology, Stanford University School of Medicine, Stanford, California.

Men with chronic pelvic pain syndrome 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.

Cortisol and Men with Chronic Prostatitis – American Urological Association Poster, 2007, Variations in Psychometric Profiles and Awakening Cortisol Responses in Men with Chronic Prostatitis/Chronic Pelvic Pain Syndrome, Rodney U. Anderson, MD, Christine A. Chan, MD, Elaine K. Orenberg, PhD, Veronica Flores, Angie Morey, MS Department of Urology, Stanford University, Stanford, CA.

CPPS men scored exceedingly high on all psychosocial variables and showed evidence of dysfunctional HPA axis function reflected in augmented awakening cortisol responses compared with healthy, age-matched controls. Whether these observations represent preexisting characteristics of individuals before the onset of CPPS which are activated by chronic pain, or as a consequence of stress associated with this condition, remain in question.Supported by grant from NIDDK, U01 DK065297

Improvement in Sexual Functioning after the Wise-Anderson Protocol – Journal of Urology, 2006, Sexual Dysfunction In Men With Chronic Prostatitis/Chronic Pelvic Pain Syndrome: Improvement After Trigger Point Release And Paradoxical Relaxation Training Rodney U. Anderson, David Wise, Timothy Sawyer, And Christine Chan, From the Department of Urology (RUA, CC), Stanford University School of Medicine, Stanford, Sebastopol, (DW) and Los Gatos (TS), The Journal Of Urology, October, 2006, p. 1534-1538. ABSTRACT, 1: J Urol. 2006 Oct;176(4 Pt 1):1534-8, Sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome: Improvement after trigger point release and paradoxical relaxation training Anderson RU, Wise D, Sawyer T, Chan C., Department of Urology, Stanford University School of Medicine, Stanford, California, USA.

The therapeutic methods in this report provide a 2-pronged approach to treatment, including the physical approach, focusing on the release of internal and external pelvic trigger points, and the psychological approach, involving relaxation training to help the patient gain control of tension. While to our knowledge the relationship between pelvic pain and disturbances in sexual function remains to be elucidated, these methods enhance symptomatic improvement in patients with refractory CPPS and associated sexual dysfunction. Future clinical trials with sham treated controls are warranted to examine this new therapeutic approach in men with CPPS.

First Publication of the Success of the Wise-Anderson Protocol – Journal of Urology, 2005, Integration Of Myofascial Trigger Point Release And Paradoxical Relaxation Training Treatment Of Chronic Pelvic Pain In Men, Rodney U. Anderson, David Wise, Timothy Sawyer, And Christine Chan, From the Department of Urology (RUA, CC), Stanford University School of Medicine, Stanford, Sebastopol, (DW) and Los Gatos (TS), The Journal Of Urology, July, 2005, p. 155-160, ABSTRACT, 1: 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.

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.

The symptoms listed below are the typical symptoms of pelvic floor dysfunction. These symptoms are not normal.
Common Symptoms of Pelvic floor Dysfunction Include:
(few have more than 4-5 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 can be felt in the perineum, lower abdomen (on one side or another or in the middle),
  tailbone, low back, above the pubic bone
• Pain or discomfort can be exacerbated during/after sex, 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
• Accompanied by anxiety, depression, reduction in self esteem
• Significant reduction in quality of life

We do not consider it in any way hard to diagnose. We have a podcast describing the method we use to diagnose pelvic floor dysfunction
Conventional medicine’ diagnostic tools are not helpful in this diagnosis. There are no conventional tests including xrays, MRI’s and CT scans or sonograms that can detect it. If the person with pelvic pain didn’t complain about their pain and symptoms, no one would know it is happening. Few doctors are trained in the diagnosis of pelvic floor dysfunction because there are no drugs, surgery or procedures that help it but also because they were not trained in how to examine the muscles involved in pelvic floor dysfunction. Our senior physical therapist, whom we consider the best in the world in the diagnosis and treatment of pelvic floor dysfunction was trained by Janet Travell and David Simons, the doctors who introduced trigger points to medicine.

There are no convention medical test to diagnosis pelvic floor dysfunction. We believe our evaluation that takes an hour with our physical therapist and is a hands on evaluation of trigger points related to pelvic floor dysfunction is the definitive test.

We are the second opinion for most of the patients who have been treated by us.

We suggest one treatment option for pelvic floor dysfunction which is our protocol, the Wise-Anderson Protocol.

It has been our experience in working with many patients that a long time tendency toward anxiety and worry triggers the contraction and physical symptoms of pelvic floor dysfunction. Both the anxiety stress as well as physical dimension of pelvic floor dysfunction must be treated in order to have a chance of resolving this problem.

In our view both a physical therapist experienced in trigger point release and in treating pelvic floor dysfunction and a psychologist experienced in Extended Paradoxical Relaxation are the specialists that can help.