The History of the Stanford Protocol and Wise-Anderson Protocol

https://www.youtube.com/watch?v=DCw9LCHKsys

The History of the Wise-Anderson Protocol & Prostatitis Symptoms 

The Wise-Anderson Protocol began with David Wise, PhD, a psychologist in California who had suffered from Chronic Pelvic Pain Syndrome for many years. He contacted several urologists, including Dr. Rodney Anderson, a professor of Urology at Stanford University School of Medicine and leading practitioner and expert in the field of pelvic pain. Dr. Anderson was considered to be the court of last resort for patients with pelvic pain and prostatitis who had not been helped by any other treatment.

Through many years of suffering, David Wise, PhD discovered a way to become free of symptoms.

He reported the method he used to Dr. Anderson, who headed the chronic pelvic pain clinic in the Department of Urology at Stanford University Medical Center. Dr. Wise then began working as a Visiting Research Scholar at Stanford’s Department of Urology alongside Dr. Anderson, treating men and women with a variety of diagnoses. This included chronic pelvic pain, prostatitis, levator ani syndrome, pelvic floor dysfunction, pelvic floor myalgia, interstitial cystitis, and other chronic pelvic pain syndromes. Dr. Wise and Dr. Anderson worked together for eight years at Stanford, treating patients with the protocol that Dr. Wise used in his own recovery. At Stanford, the protocol was administered to patients on an individual basis in a conventional medical format.

During these early years, the results of the Wise-Anderson Protocol were presented at meetings for pelvic pain and to prostatitis researchers at the National Institutes of Health and other scientific meetings. In 2003, Dr. Wise and Dr. Anderson published the first edition of A Headache in the Pelvis, a book that described the new protocol in detail. In the first edition of A Headache in the Pelvis, this protocol was called the Wise-Anderson Protocol. As the protocol became more widely disseminated, those on the internet dubbed it the Stanford Protocol. The term Wise-Anderson Protocol is now again used, although it was popularly called the Stanford Protocol for many years. The Wise-Anderson Protocol is identical in form and substance to what has been called the Stanford Protocol in the public arena.

When Dr. Wise left Stanford he began treating patients using the Wise-Anderson Protocol in a six-day comprehensive clinic in Sonoma County, California. The immersion clinics have been offered in Sonoma County since 2003. Patients come from all around the world to learn the Wise-Anderson Protocol and prostatitis causes.

Competence in self-treatment has produced the best results in patients who have learned the Wise-Anderson Protocol.

The focus of the Wise-Anderson Protocol has evolved over the years to train patients to do the protocol without the assistance of professionals. While the immersion clinics in Sonoma County are not affiliated with Stanford, Dr. Anderson continues to evaluate patients with pelvic pain at Stanford and refer patients to the immersion clinic. Additionally, Dr. Anderson continues conducting and publishing research on the Wise-Anderson Protocol, as well as other medical research on a variety of subjects. From 2003 to the present, Dr. Rodney Anderson, Dr. David Wise and Tim Sawyer (Physical Therapist) have actively and enthusiastically collaborated on research involving patients seen at both clinics.

Since 2003, Anderson, Wise and Sawyer have published a number of articles in the Journal of Urology on data from patients they have collaboratively seen and treated. Abstracts of these articles can be found in the “Latest Published Research” post on this blog. In 2005, Dr. Wise was a plenary speaker at a National Institutes of Health conference on pelvic pain. There he presented research results on the Wise-Anderson Protocol. Dr. Wise presented the protocol to scientific meetings, including those of the International Continence Society. Both Dr. Wise and Dr. Anderson have written chapters in medical textbooks describing the Wise-Anderson Protocol. At the time of writing this section, Dr. Anderson presented a clinical poster at the American Urological Association. A report of Dr. Anderson’s presentation at the American Urological Association was published in Medscape Medical News. It was titled Intensive Therapy Regimen Helps Men With Chronic Pelvic Pain Syndrome.

Tim Sawyer, who is the architect of the physiotherapy program, was chosen to write the pelvic floor section for the new edition of Travell and Simons. It was called Myofascial Pain and Dysfunction: The Trigger Point Manual. This is the authoritative medical textbook on myofascial trigger point therapy. Tim Sawyer trained and treated patients with Dr. Janet Travell and Dr. David Simons, the physicians who introduced trigger point therapy to medicine. Dr. Travell was the White House physician to President John F. Kennedy, and Tim Sawyer is considered one of the top pelvic floor physical therapists in the world.

Recently, Anderson, Sawyer, and Wise published a pioneering article in the Journal of Urology. The article showed the relationship of trigger point location and symptoms in patients with pelvic pain, using the data from the immersion clinics held in Sonoma County. Another article updating these results has been completed and recently submitted for publication. Currently, Anderson, Wise and Sawyer have completed a study on the effectiveness of a new internal trigger point physiotherapy device for the self-treatment of trigger points. The study data on the physiotherapy device is being prepared for publication and will hopefully be published soon.

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.

Why Stress Triggers and Perpetuates Pelvic Pain Symptoms

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Even slight amounts of stress can trigger pelvic pain symptoms.

Studies have shown that myofascial trigger points that are found in sore and painful muscles inside the pelvic floor are strongly affected by stress. Gevirtz and Hubbard did electromyographic monitored studies of the electrical activity of trigger points and their relationship to stress. Even the slightest increase in anxiety and nervous arousal caused a significant increase in the electrical activity of the trigger points. Individuals suffering from pelvic pain often report an increase in pelvic pain symptoms with stress and a decrease of pelvic pain symptoms with the reduction of stress and anxiety. For this reason, the Wise-Anderson Protocol trains patients with a relaxation method. This regularly reduces anxiety and nervous system arousal.

While individuals with pelvic pain often notice the relationship between stress and their symptoms, some people with pelvic pain are only rarely aware of the impact. The reason is that if you live, for instance, in a marriage where there is ongoing resentment, a work situation in which you deal with frustration regularly, or live with a sense of dread because of a general tendency to jump to catastrophic conclusions, you get used to these emotional currents and think they are just a part of life. You may not connect the dots in seeing their relationship to your symptoms. When you live in water, you don’t notice that you’re wet.

Many of our patients tend to live in a world of constant worry.

We know that when you have pelvic pain symptoms, you usually live with some level of anxiety and/or depression. Our recent study at Stanford shows a greater early morning rise in salivary cortisol in pelvic pain patients as opposed to normal, non-symptomatic control subjects. These findings which suggest heightened anxiety in individuals who suffer from pelvic pain syndromes. We have discussed in our book A Headache in the A Pelvis that an increased level of psychological distress in patients dealing with pelvic pain symptoms is equivalent to dealing with the same kind of stress people deal with who have heart disease or Crohn’s disease. Absent are studies of levels of dread, resentment, and anger in those who deal with pelvic pain, though it is our anecdotal experience that such emotions often punctuate the lives of many of our patients.

https://www.youtube.com/watch?v=SndMj85EV8Y

Many patients do not recognize the relationship between their emotional states and their pelvic pain symptoms.

Most people dealing with pelvic pain symptoms are not aware of the significance of their condition. When you are able to relax and let go of a level of anxiety you normally live with, and you witness a dramatic improvement in your symptoms, you usually find the wherewithal to earnestly do something about anxiety. It’s all about seeing the relationship between cause and effect.

To stop catastrophic thinking, you first have to recognize it. Pelvic pain can provide the impetus to decide to see things differently. This is because seeing things differently can reduce your symptoms. It is part of our language to distinguish between optimistic and pessimistic viewpoints by using the analogy of ‘seeing the glass half full or half empty.’ It is not a lie to say the glass is half full or half empty; they are both equally true. But for someone who knows the glass as half empty, and suffers from such a viewpoint, it takes an effort to choose the ‘half full’ perspective, because the perspective is so strongly ingrained.

Chronic states of anxiety, fear, dread, sorrow, resentment or anger must be addressed for any real resolution. Unfortunately, at this time, contemporary medicine has not been interested in the profound relationship between pelvic pain symptoms and ongoing dysfunctional emotional states. This is the reason why, in our view, conventional treatments have failed. The rehabilitation of attitudes that promote chronic states of anxiety, fear, dread, sorrow, resentment or anger is essential for anyone who is serious about stopping their pelvic pain.

The paradigm implied in the treatment protocol for pelvic pain developed at Stanford University.

It is a new paradigm to think you can voluntarily relax your habitually tight core which includes the anorectal area. When you call someone a “tight ass,” the implication is that such a person is characteristically in a chronic state—someone who is “tight-assed” or “anal” is considered a kind of person whose tendency is to be perfectionistic and cannot be reformed. Our protocol is based on the understanding that voluntary efforts to behaviorally change the default tone of the pelvic floor can change to one that is relaxed and at ease. This new understanding asserts that “tight asses” can become “relaxed asses.”

Like the insights of the new paradigm of neuroscience regarding the plasticity of the brain, we propose that the chronically tensed core, including the intestines and pelvic floor muscles, can be trained to be relaxed. We propose that the tendency to brace the viscera under stress can be changed without surgery or drugs. This is done through training in calming a chronically vigilant nervous system. In other words, the chronic tension associated with nervous system arousal can be brought under our voluntary control.

Changing this habitual inner posture is not brought about by drugs or surgery. It can be brought under the control of the patients’ disciplined consciousness. For patients who come to our clinic, the suffering with pelvic pain is what we believe provides the motivation for someone to learn to control catastrophic thinking, an upset nervous system, and the pelvic pain related to them. We are proposing that resolving chronically tight insides can’t be done by anyone else except by the person who is suffering. Over a lifetime, we believe that teaching people to calm down their insides under their own volition is the most cost effective method of dealing with pelvic pain, despite the fact that initially training people to do this has its costs. In our view, the psychophysical treatment of the Wise-Anderson Protocol represents the best framework within which someone can modify a contracted core.

A gentle approach to breaking the cycle.

The Wise-Anderson Protocol intervenes in all aspects of the tension-anxiety-pain cycle. Paradoxical Relaxation lowers pelvic tension and anxiety by lowering autonomic nervous system arousal and habitual pelvic tension. Trigger Point Release and certain myofascial release methods, including what we describe as skin rolling and pelvic floor yoga, deactivates trigger point pain, lengthens chronically contracted muscles, and makes the pelvic muscles more capable of relaxation.

Our understanding is a significant departure from the conventional view of prostatitis and chronic pelvic pain syndromes. We see pelvic pain as a physical expression of the way a person copes with life. We propose that pelvic pain is the result of a neuromuscular state perpetuated by anxiety and chronic bracing in both men and women. It is not the result of a foreign organism in the prostate gland in the case of prostatitis, an autoimmune disorder, or other contemporary explanations.

When certain predisposed individuals focus tension in the pelvic muscles, this chronic tension, over time, creates an inhospitable environment in the pelvic floor that gives rise to a cycle of tension, anxiety, and pain. Once this cycle is set into motion, it takes on a life of its own. Our treatment aims to restore the capacity of the pelvic tissue to relax, to perform its normal functions, and to return to a pain-free and dysfunction-free state.

Why is there Confusion about Prostatitis Symptoms?

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Why is there Confusion about Prostatitis Symptoms?

Most cases diagnosed as prostatitis are actually problems of chronically tightened muscles of the pelvis – not problems of the prostate gland.

While Pelvic Pain Help treats both men and women with pelvic pain, a large majority of men are diagnosed with prostatitis. Unfortunately, most men with this diagnosis have mistakenly been told that their symptoms are caused by a problem with their prostate gland. In fact, the problem of genital, rectal, perineal pain, urinary symptoms, sitting discomfort, in most men has nothing to do with the prostate gland.

Approximately ninety-five percent (95%) of diagnosed cases are not prostatitis.

Approximately 95% of men with this diagnosis do not have symptoms caused by some pathology of their prostate gland. Most men do not understand the confusion among doctors about what is and isn’t prostatitis. In fact, many doctors do not understand this confusion either. Pelvic Pain Help hopes to clarify this confusion in this blog and on this website.

Most symptoms are not caused by an ‘itis’ of the prostate.

The overwhelming majority of cases do not appear to be caused by any known problem of the prostate gland. Nevertheless, most doctors currently have continued to use the term prostatitis and treat complaints of pelvic pain and urinary dysfunction as if they were caused by an infection or inflammation of the prostate. In careful studies, in past decades of treating the prostate in such men, the overwhelming majority derive no lasting relief from antibiotics or anti-inflammatory drugs.

Unfortunately, many doctors make a diagnosis of prostatitis symptoms and prescribe antibiotics without verifying that there is any infection present in the prostate.

Prostatitis, which means an infection or inflammation of the prostate gland, is often diagnosed without the doctor doing any definitive testing. As we have seen in a study of physicians in Wisconsin, a large majority of doctors view prostatitis symptoms as an inflammation or bacterial infection. More than that, almost all prescribe antibiotics as a treatment. Most urologists know from their own experience that antibiotic treatment without evidence of infection routinely fails to help symptoms. Yet, almost 100% of the cases of this kind receive antibiotics. We are always troubled to hear this experience in patients who come to see us, especially when the doctor made no attempt to establish the presence of infection.

https://www.youtube.com/watch?v=N-BSDxgNl6M

Antibiotics are the best treatment for bacterial prostatitis but rarely help men with no prostate infection.

Pelvic Pain Help wants to emphasize that the antibiotic treatment of bacterial prostatitis has been an achievement of modern medicine. If you have bacterial prostatitis, antibiotics are a very good treatment—certainly the only treatment. Viewing all conditions of pelvic pain and dysfunction in men, however, is an error in judgment.

That being said, prostatitis as a tension/muscle disorder. The contribution of our website is to make it known in the large majority of cases of this diagnosis, it is the muscles of the pelvis, not the organs, that are the source of the problem. The protocol of 6-day clinic that we developed at Stanford, the Wise-Anderson Protocol, focuses on rehabilitating the muscles of the pelvis through Internal Trigger Point Release and Paradoxical Relaxation. The success of our protocol has been confirmed in a number of published scientific studies.

For more information, a video discussion of this is found here. Pelvic Pain Help hopes to be a valuable resource to you in discovering true prostatitis symptoms.