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My Experience Recovering from Pelvic Floor Pain

In this blog, I want to describe the road I travelled in my full recovery from
chronic pelvic pain and my realistic view of such recovery for others. Nothing
animates my enthusiasm and has enduringly given me confidence and optimism
about recovering from pelvic pain for others like my own recovery and the
recovery of patients we have treated over the years.
I had chronic pelvic pain for more than 20 years. An unfathomable period of
time for many who have had pelvic pain for a fraction of that time. Yet I
suffered through it. When asked how I did it, I have said that I had no option
but to muddle through each day and each year. During the time I suffered,
there was no internet, no support groups, no books, nothing about what I was
going through. During those very difficult years, no doctor had a clue what was
going on with me or how to help me. Unfortunately, in my view, not much has
changed in the conventional medical world treating pelvic pain.
During the time I was in chronic pelvic pain, I lived with the scary uncertainty
that my chronic, quality-of-life-killing pain would never go away. Regularly
catastrophizing, having difficulty sleeping, being in pain 24/7 with weird
symptoms no one seemed to understand, and feeling miserable most of the
time, with one eye on my life and the other on my pain and symptoms I looked
quite normal to most people who knew me. I shared my predicament with
almost no one. I lived the private, slow-motion nightmare of most people who
find themselves with chronic pelvic pain and with no one to help them.
And then, after amazing grace that has occurred to me only a few times in my
life, I finally found a way to stop my pain. And after several years of following a
method that we then implemented into what is now called the it stopped. In
my desire to share the miracle of what I did to stop my pain, in the mid 1990’s I

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met with a professor at Stanford University Medical School, an expert in the
field of treating pelvic pain, to share my experience. After we met, he hired me
to work with him and we have been collaborating since that time.
With the support of my Stanford colleague, for a number of years we began
treating other men and women who came to Stanford with pelvic pain using the
methodology that freed me. Slowly over years, a tested method emerged now
called the Wise-Anderson Protocol and a small team of us began treating
people with pelvic pain. We wrote a book called a Headache in the Pelvis, still a
popular selling book after 20 years. In 2003 I began doing clinics for pelvic pain
with a gifted colleague in a private practice in California. In total we have been
treating patients for almost 30 years up to the present time.
In 2007 invented a medical device called an Internal Trigger Point Wand
enabling someone to do internal trigger point release themselves – a device that
received FDA clearance in 2012. I invented another medical device called a
Trigger Point Genie in 2017 to enable someone to do to do trigger point release
of all pelvic pain related external trigger points. Starting in 2005, we began
publishing studies in major urological, pain and other medical journals about
our method and its results. To date I estimate we have treated several
thousand patients using the protocol we first developed at Stanford. It is
startling for me to recognize that I have spent the a very large portion of my life
first healing my own pelvic pain and then helping others suffering from it.
If you’d asked me when I was a teenager if I wanted to become an expert in
chronic pelvic pain syndromes when I grew up, I would have quickly replied,
“Don’t call me, I’ll call you.” Spending much of my life in the research and
treatment of chronic pelvic pain and dysfunction is not what I ever wanted to
do. In fact, I wanted to write Broadway musicals (I’ve actually written four), but
God often has different plans for us than our own. And in this talk, I look at
what I see to be entailed in recovering from the silent suffering of chronic pelvic
pain.
I want to share my understanding of pelvic pain and how to treat it and how not
to treat it. In my view there is a lot of junk on the internet about muscle-based
pelvic pain. I consider most of the information on the internet about pelvic pain
to be at best limited and inadequate and at worst ill-informed and stupid. I say

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this as someone who was on the ground with my pelvic pain for years and then
went through the long journey of stopping my pain. Over the years of treating
patients with chronic pelvic pain, I have had to regularly manage my outrage at
what I considered ignorance about understanding the problem and misguided
and sometimes harmful treatment.
In our small group, over the years we have seen patients whose pain increased
after being counselled to do kegel exercises, men and women who underwent
surgeries and procedures that left them with increased pain, patients who had
their urethras injected, men who had their prostate glands and testicles
removed, patients whose doctors created hematomas by doing trigger point
injections from the outside in, women who had their uteruses removed,
patients who had nerves ablated and organs removed, men given years-long
courses of antibiotics, routine nerve blocks and other interventions that either
had no effect on their symptoms or made them worse.
For those I have seen who do recover from muscle based pelvic floor pain and
related dysfunction, such recovery is not easy or quick. Flareups during recovery
from pelvic pain in my view are inevitable which is why it is important to have
support in continuing the course of competent treatment. The journey is made
much easier given all of its difficulty when you experience real symptom relief
and gain confidence that you are on the right path.
As I have come to understand it, muscle based pelvic pain is the expression of a
sore and irritated center of the body. This daunting fact is the problem and why
it takes so long for pelvic pain to go away even when properly treated because
it takes time for the irritated and sore muscles in the core of the body to heal up
from being chronically tightened. This is why this kind of pelvic pain has eluded
a solution in the history of medicine.
We commonly talk about core strengthening – that is, through various methods
making the pelvis and related core muscles stronger. When you have muscle
based pelvic pain, such strengthening is misguided. Pelvic pain involves
irritation, hypertonicity and spasm of the core muscles. It is typically caused by
the core of the body (centrally involving the pelvic floor) being tightened over
time impacted ongoing anxiety and worry. Resolving pelvic pain involves
loosening and relaxing these muscles, not tightening them. Loosening and

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relaxing chronically tightened pelvic muscles sounds simple but it is not. It
involves myofascial trigger point release in pelvic-related muscles r and a
different way of managing anxiety so that the center of the body is not
tightened with each anxious thought.
I was never told that my pelvic pain had anything to do with my anxiety and
tendency to worry. The doctors I saw mistakenly said it was some kind of
physical problem of my prostate gland, not the irritation and chronic tightening
of my pelvic muscles. My doctors didn’t understand my problem. Muscle based
pelvic pain in my experience, comes from the reflex in a subset of people to
tighten up their pelvic muscles under stress. The anxiety and worry that causes
someone to chronically tighten the core, focused in the pelvis, is typically not
debilitating; it simply involves the habitual tendency to fret and worry about
things in life.
What I was never told by my doctors in the many years I suffered from pelvic
pain is that anxiety and pain are the main drivers and perpetuators of the
condition in most patients. It is not pathological anxiety, not anxiety that stops
you from functioning — but anxiety in the form of habitual worry that shows
up from day to day in people who are successful, caring, intelligent, often
perfectionistic and deeply felt who care deeply about what they do and worry
inordinately
While few have offered a theory about the nature of this connection between
pelvic pain and anxiety, I’m clear from my own experience personally and
professionally: in a certain group of people, chronic anxiety and worry causes
the pelvic muscles to chronically tighten. When this pelvic tightening occurs
repetitively over time, the pelvic muscles eventually tighten and don’t
untighten. This leads to what in medicine is called pelvic-floor hypertonicity,
where the pelvic muscles are kept chronically abnormally tight.
Abnormally tight externally related pelvic muscles like gluteal, abdominal,
quadratus lumborum, psoas and iliacus , piriformis, adductor and other related
muscles, and certainly internal muscles of the obturator internus, coccygeus,
levator ani and other internal pelvic muscles cause havoc in the major functions
of the body. These disturbed functions involve disturbance in sexual activity,
sitting, urination, and defecation – basic activities of human beings. And, of

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course, there is the pain, odd and deeply distressing pain that no one without
pelvic-floor pain ever experiences.
This anxiety-tightened, irritated center of the body is the source of pelvic-floor
pain. Pelvic floor pain is both a physical and psychological event. Anxiety
prompts the outside and inside pelvic related muscles to painfully tighten.
When the pelvic muscles begin to hurt all the time and the functions of
urination, defecation, sexual activity, pain when sitting, more anxiety inevitably
ensues, which tightens the core of the body more triggering more pain and
anxiety in the unfortunate self-feeding cycle of pelvic pain.
So, to fully heal pelvic-floor dysfunction, the sore and irritated core of the body
has to heal up from chronic muscle guarding. To do this, one has to learn
trigger-point release, an amazing and often unrecognized method to release
chronically tightened muscles inside and outside the pelvis. I don’t believe that
pelvic floor pain can resolve without release the pain referring trigger points in
the pelvic musculature.
Trigger points are usually the size of a fat grain of rice, but are the heart of a
chronically tightened muscle. There are usually multiple trigger points in the
muscles in the core of the body, both outside and in. In my experience, to
recover from pelvic floor pain, one must learn how to do internal and external
trigger-point release to the outside and inside of the body and then to regularly
stretch them (a method called myofascial release). The pelvic muscles must
become trigger point free and return to a state of being able to relax.
Intimately associated with abnormally tight pelvic muscles is the central issue of
how to reduce anxiety every day to stop the regular and compulsive tightening
of the pelvis that caused the problem in the first place. I was privileged to study
Progressive Relaxation with Edmund Jacobson, MD who is considered the father
of relaxation therapy in the United States.
I adapted this method for dealing with anxiety related to pelvic floor pain. I
called this method Extended Paradoxical Relaxation, a method that was central
to my own recovery along with the physical release of my own pelvic floor and
related muscles. For it to work, It must be practiced every day to help reduce
pelvic pain-related anxiety.

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If I have a mantra related to pelvic pain, it is self-treatment. In our protocol,
pelvic pain begins to reduce when someone regularly practices and becomes
competent at myofascial trigger point release self-treatment. No one else
helped to heal my pelvis except my own dogged self-treatment. Could anyone
get me to stop tightening my pelvis when I got anxious? The answer is no. I
believe what is necessary to soften and heal the inner core of someone with
pelvic pain must done by the patient him or herself.
As someone who got better through the practice of what became known as the
Wise-Anderson Protocol, pelvic pain goes away when you support the healing
mechanisms of your body that enable the tissue in and around the pelvis to
relax and heal from bring chronically tight, sore and painful. Having the
knowledge, physical and psychological tools and support is what enables this
healing. Resolving chronic pelvic pain requires time, patience, knowledge, tools
and guidance. I believe that understanding what causes and perpetuates pelvic
floor pain and practicing a method to cooperate with the body to help it heal
chronically sore pelvic tissue can make it possible to become free of pelvic pain.