LEVATOR ANI SYNDROME
TREATMENT FOR LEVATOR ANI SYNDROME USING THE WISE-ANDERSON PROTOCOL (STANFORD PROTOCOL)
Since its first reference in the 1850’s and a seminal article by the prominent surgeon George Thiele in 1937 describing a disorder that involved pain in the rectal area with no evidence of pathology, the term ‘levator ani syndrome’ has been incorrectly defined. In fact, what is called levator ani syndrome, in our view, is more accurately called pelvic floor dysfunction, chronic proctalgia, or simply chronic pelvic pain syndrome because with this condition, more than one of the muscles of the pelvic floor can be painful–not just the levator muscle. Levator ani syndrome typically refers to pain that is experienced in the posterior or back part of the pelvis as opposed more anterior symptoms like supra pubic and genital pain, although those diagnosed with levator ani syndrome sometimes complain of these anterior symptoms as well.
SYMPTOMS LEVATOR ANI SYNDROME
(Most patients have at least several of the symptoms listed below. Few experience all of them)
- SITTING PAIN
- (EXCESSIVE) DISCOMFORT OR RELIEF AFTER A BOWEL MOVEMENT
- CONSTANT OR INTERMITTENT PAIN
- PAIN OFTEN RELIEVED WHEN LYING DOWN
- PAIN UPON PRESSING INSIDE THE SPHINCTER OR ABOVE
- PAIN ON ONE SIDE OF THE LEVATOR MUSCLE OR ANOTHER
- AN ABSENCE OF VISIBLE PATHOLOGY WHEN TESTS ARE CONDUCTED
- DEPRESSION, ANXIETY, AND A SEVERE REDUCTION IN QUALITY OF LIFE
- PAIN AGGRAVATED BY SEXUAL ACTIVITY OR STRESS
LEVATOR ANI SYNDROME IS MUSCLE BASED PELVIC PAIN WITH MANY NAMES
Because of the lack of communication between different specialties of medicine and the current fragmented nature of physician training, muscle based pelvic pain, whether felt in the back or front of the pelvic floor, is diagnosed as a number of different conditions, such as:
- LEVATOR SPASM
- PELVIC FLOOR DYSFUNCTION
- CHRONIC PROCTAGLIA
- PIRIFORMIS SYNDROME
- CHRONIC PROCTAGLIA
- CHRONIC ANORECTAL PAIN
This multitude of diagnoses has, obviously, led to much confusion among patients and doctors. Our research is based on our treatment of muscle based pelvic pain conditions regardless of the name of the disorder. Our understanding is that all of these diagnoses possess the same root cause.
LEVATOR ANI SYNDROME IS BOTH A LOCAL AND SYSTEMIC DISORDER
Relief from levator ani syndrome, with its often bewildering and troubling symptoms, is what those seeking help from any treatment are looking for when they go to a doctor. Conventional medical treatment, however, almost universally misunderstands levator ani syndrome. The remedies it offers at best are partial and short-termed and at worst, remedies like surgical intervention or certain injections, can exacerbate the problem.
The fundamental error of conventional treatment for levator ani syndrome is that it does not grasp the fact that it is both a systemic and local problem — systemic in that the nervous system, typically frequently aroused, chronically tightens up the pelvic muscles. It is a local problem in that chronic worry, anxiety and nervous arousal in certain individuals results in the local pain and dysfunction of the pelvic muscles. Without effectively treating both aspects, levator ani syndrome remains.
Our 6-day clinic, offered throughout the year, is devoted to resolving both the local and systemic dimensions of levator ani syndrome by training our patients in the most advanced internal and external physical therapy self-treatment (local treatment), and practicing our relaxation protocol, Extended Paradoxical Relaxation, which is aimed at reducing nervous system arousal daily.
RELIEVING LEVATOR ANI SYNDROME WITH THE WISE-ANDERSON PROTOCOL
Since 1995, we have helped a large number of patients who were previously diagnosed with levator ani syndrome. The following are some key points from our experience and understanding of what is referred to as levator ani syndrome:
• In our 2009 Journal of Urology trigger point study, we documented:
- The relationship between levator ani pain and trigger points.
- That trigger points in the levator ani and other pelvic muscles can refer pain to different places in the body.
• Pain from levator ani syndrome in selected patients, even when it lasts for years, can reduce and sometimes resolve with proper treatment involved in releasing painful trigger points in the levator muscles.
• In our 2011 study published in the Clinical Journal of Pain, we document that after 6 months, patients who did our protocol reduced the sensitivity of their trigger points from 7.5/10 to 4/10, a significant reduction in such sensitivity.
A major focus of the Wise-Anderson Protocol is relieving pain in the levator ani muscles by training patients to release trigger points in the levator ani and other pelvic muscles, as well as relaxing the muscles related to levator ani pain and through the reduction of nervous arousal.
THE WISE-ANDERSON PROTOCOL
6-Day Immersion Clinic
We began treating varieties of pelvic floor dysfunctions in patients at Stanford University in 1995 in conventional office visits. In 2003, we reorganized our treatment in a private practice in the form of a 6-day immersion clinic held in Santa Rosa, California. The clinic, limited to 14 patients and offered throughout the year, has evolved to implement the Wise-Anderson Protocol, a treatment to teach patients to rehabilitate the chronically contracted muscles of the pelvic floor and to reduce anxiety daily. The Wise-Anderson Protocol, done daily at home by patients we have trained in self-treatment, has helped to give many their lives back. The purpose of our self-treatment is to help patients become free from having to seek additional professional help. For over a decade, research has documented our results of training patients with self-treatment.
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