MUSCLE SORENESS/TENSION AND URINARY FREQUENCY AND URGENCY

In our experience, and that reported by other centers and physicians who have worked in this field, it is quite common for both men and women who develop a chronic pelvic pain condition also exhibit urinary dysfunction.  Urinary frequency and urgency is one of the most common symptoms of patients who come to our 6 day immersion clinics. It has been well reported that approximately 71% of men experience symptoms such as urinary frequency, urgency, nocturia, poor urinary flow and even pain in the bladder upon filling.  In most of the male patients, there is little to no laboratory or imaging evidence to incriminate the prostate as the source of this pain and urinary symptomatology.

There are women as well suffering chronic pelvic pain with no bladder or organ pathology who have symptoms of urinary frequency and urgency. Both women and men typically have sore and painful anterior (which means located toward the front) musculature within the pelvis floor that refer sensations of urinary frequency and urgency when certain trigger points in the front of the pelvic are palpated. With almost all of the men and women with urinary frequency and urgency and no evidence of organ or related physical pathology, we find trigger points in the pelvic floor and related areas that tend to refer sensations of urinary frequency.

The relationship between sore, painful pelvic floor muscles and urinary frequency is not intuitively clear. Indeed how is it that one has urinary frequency and urgency but with no pathology, infection in or of the organs of the urogenital tract.

When I first had pelvic symptoms, I just had urinary frequency with no pain other than the uncomfortable symptoms you have with urinary frequency and urgency. As time went on, I had most of the symptoms we describe in our book including urinary frequency and urgency, sometimes in the extreme. The doctor could find no physical pathology. Nevertheless I suffered with sometimes extreme urgency, voiding little, never feeling emptied or relaxed the way urination feels in someone without pelvic pain. As I recovered, I went from sometimes feeling that I had to void every 15- 30 minutes to feeling normal in this area and noticing I went 3-5 hours with no undue distress. When I had urinary symptoms, I remember when I went to a movie, I always sat in an aisle seat at in a movie theatre because I could never sit through a whole movie without having to get up to go to the bathroom in the middle of the movie. I experienced a difficult to describe, gnawing, aching irritated feeling in and around the bladder. After my recovery, my urinary frequency and urgency disappeared and urination disappeared.

When someone is suffering from urinary frequency and urgency with no known physical pathology, they feel uncomfortable in and around the bladder, they feel like they need to urinate, often urinating small amounts which don’t resolve the feeling of having to urinate the way one normally feels resolved after a trip to the bathroom. When you have urinary symptoms related to pelvic floor pain and dysfunction, the sensation in and around the bladder simply doesn’t feel normal. So what is going on here? This is a question I believe some people suffering from pelvic pain are baffled by. Being able to easily wait to go to the bathroom is important in many situations in modern life including work, social and recreation related situations. That there is gnawing, uncomfortable feeling in the bladder and urinary tract can be very distressing as it persists without resolution.

So here are thoughts I share with you about the phenomenon of urinary frequency and urgency arising when someone has pelvic pain and subsiding or disappearing with the subsidence of pelvic pain. I would like to propose that afferent (sensory) nerves associated with the bladder or a neighboring receptor in the pelvic neural network may be affected by the tension, discomfort and anxiety originating within the pelvic muscles.  This afferent plexus, or branching network of intersecting nerves of the lower urinary tract is complex and responsive to a variety of different kinds of stimulation including stress and anxiety and pain. Many of us have experienced the need to urinary under circumstances of extreme anxiety or stress.  The theory I propose is that pain and anxiety triggers the branch of the autonomic nervous system related to bladder relaxation – bladder relaxation that is felt as the need to urinate. Absent pain in the pelvis using our protocol, we have often seen someone’s urinary frequency and urgency reduce or entirely go away without any drugs or other interventions.

We all know of the colloquial term to be so scared you pee in your pants. This colloquialism refers to a moment of urinary urgency occurring under conditions of extreme fear or stress. In my personal journey with pelvic pain, I thought that the pain in my pelvis was something that my brain confused with the discomfort of a full bladder that urination would relieve. In a person without pelvic pain, you feel relaxed after urination. My sense when I was symptomatic was that somehow my brain confused the discomfort in my pelvis with the discomfort of a full bladder that is relieved with urination. What is clear is that urinary frequency and urgency is often present when someone has pelvic floor pain and no other physical findings, and the urinary frequency and urgency can disappear once the pelvic pain resolves.

I hope this is a helpful essay about this interesting subject.

Cause and Effect In Muscle Based Pelvic Pain

What makes a difference in the journey of healing pelvic pain is seeing when you are doing something that reliably helps your symptoms. When I was symptomatic, I tried all kinds of things: acupuncture, supplements, reflexology, medications, considered surgical procedures which I gratefully didn’t pursue. My symptoms waxed and waned, often inexplicably. At that time, if you asked me if those things helped, I’d have said I didn’t really know. I’ve come to understand that if the answer to the question “Is something helping your symptoms?” is, “I don’t really know,” then it probably is not helping. Anyone with chronic pelvic pain really does know when something is reliably helping.

When I was in pain, I dreaded trying something new to help myself because I had had the experience of trying new things and being disappointed when they ultimately failed to help me, which was most things I tried. I think that disappointment is an underrated suffering. In myself and in my patients, I see that feeling hope of help and then being disappointed at the failure of what you have hoped would help you is a feeling that many people avoid after a number of failures, by being very reluctant to do new treatments and be hopeful about them. Often that reluctance to be hopeful about a new treatment is justified.

When our patients experience improvement, they dance; they say ‘Wow. Gosh. Amazing!” They are genuinely surprised that something worked. Their energy changes. And they move around and exclaim, ‘I feel better’. You know when something helps. The mental and emotional space around someone who has had pelvic pain and experiences something they have done has helped them resolve it is wonderful to be around.

Our patients tend to be intelligent, conscientious and accomplished, keen to find the relationship between their symptoms and the real cause of their symptoms. Not infrequently our patients are scientifically inclined, who sometimes keep charts and records of any relationship between their symptoms and what they eat, when they void, when they go to sleep and a variety of different things. Yet most people fail to helpfully identify the factors that really move the needle in improving the problem. They will look for some kind of food, activity, supplement or something that correlates to their flare-up of symptoms.   Most importantly, they find little that really helps in the direction of resolving their condition.

Not being able to see cause and effect has large consequence psychologically. It is greatly distressing not being able to find a relationship between what really helps a condition that goes on and on. A large part of the suffering of pelvic floor dysfunction comes out of this uncertainty of and helplessness about what the problem is, of often not being able to see a relationship between something that makes it worse or makes it better. In a word the distress comes from the helplessness of really understanding why the problem exists or what to do about it.

It is from this helplessness and inability to see the cause and effect that people catastrophize, that they feel lost, worrying that they will never get better, that their pain is out of their control.

But when you do find a relationship between cause and effect, especially when you see yourself being able to do something that routinely helps you, it’s a game-changer in your life. Not surprisingly, such a discovery tends to stops the catastrophic thinking. I’ve always said that being able to help yourself is the great antidote to catastrophic thinking.

What is the cause and remedy for pelvic pain in the view of those of us who train patients in the Wise-Anderson Protocol? We know it isn’t drugs, or surgery or procedures or supplements. We published an article in the Gold Journal of Urology stating that prostatitis in men, which we are clear is mostly pelvic floor dysfunction, a psychoneuromuscular disorder, involving sore an irritated pelvic floor tissue, the result of anxiety related chronic guarding in the pelvic muscles, held in the grip of chronic reflex guarding that prevents the sore tissue from healing. Our view is that supporting the healing of the pelvic tissue is the answer to this disorder.

The methods of the Wise-Anderson Protocol for pelvic floor related pain are, and are not intuitively obvious. We teach our patients treat how to repetitively loosen the sore, tightened tissue between the breast bone and the knees while practicing daily a method to allow the sore tissue to rest and heal. One of our early patients said that the most memorable moment in his recovery from pelvic pain was not when every little sensation of discomfort finally disappeared but when the pain would flare up and he would not be at all concerned about it because he knew he had the ability to calm down the flare up. Having the ability to do something that regularly is able to reduce or stop symptoms and move in the direction of no symptoms is a major moment in life for the patients we have treated who have such an experience.

It is hard to see the relationship between cause and effect until you practice a method that allows the sore pelvic tissue to heal. I came upon it after many years of experimentation and failure. This method is not intuitively obvious and confidence in it is really only available by practicing it and seeing the results. Our method has helped many of our patients (not everyone) out of pain. It is what I did to resolve my own pain when I was lost in the wilderness of chronic pelvic pain – the wilderness that most pelvic pain patients find themselves in. While our mantra is self-treatment, the methods of self-treatment require in person training. Our 6 day program is not an easy one and at the same time we consider by far it offers the best chance, when done competently and practiced earnestly, when done competently and practiced earnestly to help end chronic muscle based pain.

Cause and Effect In Muscle Based Pelvic Pain

What makes a difference in the journey of healing pelvic pain is seeing when you are doing something that reliably helps your symptoms. When I was symptomatic, I tried all kinds of things: acupuncture, supplements, reflexology, medications, considered surgical procedures which I gratefully didn’t pursue.  My symptoms waxed and waned, often inexplicably.  At that time, if you asked me if those things helped, I’d have said I didn’t really know. I’ve come to understand that if the answer to the question “Is something helping your symptoms?” is, “I don’t really know,” then it probably is not helping. Anyone with chronic pelvic pain really does know when something is reliably helping.

When I was in pain, I dreaded trying something new to help myself because I had had the experience of trying new things and being disappointed when they ultimately failed to help me, which was most things I tried.  I think that disappointment is an underrated suffering. In myself and in my patients, I see that feeling hope of help and then being disappointed at the failure of what you have hoped would help you is a feeling that many people avoid after a number of failures,  by being very reluctant to do new treatments and  be hopeful about them.  Often that reluctance to be hopeful about a new treatment is justified.

When our patients experience improvement, they dance; they say ‘Wow. Gosh. Amazing!” They are genuinely surprised that something worked.  Their energy changes.  And they move around and exclaim, ‘I feel better’. You know when something helps. The mental and emotional space around someone who has had pelvic pain and experiences something they have done has helped them resolve it is wonderful to be around.

Our patients tend to be intelligent, conscientious and accomplished, keen to find the relationship between their symptoms and the real cause of their symptoms. Not infrequently our patients are scientifically inclined, who sometimes keep charts and records of any relationship between their symptoms and what they eat, when they void, when they go to sleep and a variety of different things. Yet most people fail to helpfully identify the factors that really move the needle in improving the problem. They will look for some kind of food, activity, supplement or something that correlates to their flare-up of symptoms.   Most importantly, they find little that really helps in the direction of resolving their condition.

Not being able to see cause and effect has large consequence psychologically. It is greatly distressing not being able to find a relationship between what really helps a condition that goes on and on.  A large part of the suffering of pelvic floor dysfunction comes out of this uncertainty of and helplessness about what the problem is, of often not being able to see a relationship between something that makes it worse or makes it better. In a word the distress comes from the helplessness of really understanding why the problem exists or what to do about it.

It is from this helplessness and inability to see the cause and effect that people catastrophize, that they feel lost, worrying that they will never get better, that their pain is out of their control.

 

But when you do find a relationship between cause and effect, especially when you see yourself being able to do something that routinely helps you, it’s a game-changer in your life. Not surprisingly, such a discovery tends to stops the catastrophic thinking.  I’ve always said that being able to help yourself is the great antidote to catastrophic thinking.

What is the cause and remedy for pelvic pain in the view of those of us who train patients in the Wise-Anderson Protocol?  We know it isn’t drugs, or surgery or procedures or supplements.  We published an article in the Gold Journal of Urology stating that prostatitis in men, which we are clear is mostly pelvic floor dysfunction, a psychoneuromuscular disorder, involving  sore an irritated pelvic floor tissue, the result of anxiety related chronic guarding in the pelvic muscles, held in the grip of chronic reflex guarding that prevents the sore tissue from healing.  Our view is that supporting the healing of the pelvic tissue is the answer to this disorder.

The methods of the Wise-Anderson Protocol for pelvic floor related pain are, and are not intuitively obvious.  We teach our patients treat how to repetitively loosen the sore, tightened tissue between the breast bone and the knees while practicing daily a method to allow the sore tissue to rest and heal.  One of our early patients said that the most memorable moment in his recovery from pelvic pain was not when every little sensation of discomfort finally disappeared but when the pain would flare up and he would not be at all concerned about it because he knew he had the ability to calm down the flare up.  Having the ability to do something that regularly is able to reduce or stop symptoms and move in the direction of no symptoms is a major moment in life for the patients we have treated who have such an experience.

It is hard to see the relationship between cause and effect until you practice a method that allows the sore pelvic tissue to heal. I came upon it after many years of experimentation and failure.   This method is not intuitively obvious and confidence in it is really only available by practicing it and seeing the results.  Our method has helped many of our patients (not everyone) out of pain.  It is what I did to resolve my own pain when I was lost in the wilderness of chronic pelvic pain – the wilderness that most pelvic pain patients find themselves in. While our mantra is self-treatment, the methods of self-treatment require in person training.   Our 6 day program is not an easy one and at the same time we consider by far it offers the best chance, when done competently and practiced earnestly, when done competently and practiced earnestly to help end chronic muscle based pain.