I’d like to talk about the length of time it can take for pelvic-floor pain and symptoms to significantly improve or resolve when they do using the Wise-Anderson Protocol. Typically when an injury or illness happens – when people get a cold, cut themselves, break a bone, or have some kind of illness – over time, they get better. They take their medicine or they rest properly and the condition gets better and goes away.
Then there are peculiar conditions where instead of going away over time the symptoms just hang on and on. The symptoms don’t kill you. They generally don’t even disable you, although occasionally they can. But, they continue on and on and people don’t know why and suffer more and more silently. Pelvic-floor pain, often called chronic pelvic pain, is such a condition – where pain and dysfunction goes on and on. I personally suffered with pelvic-floor pain for over 20 years before I recovered. For most pelvic-pain patients, the condition is a mystery that cumulatively causes distress and confusion. Why is there pain? And why don’t the symptoms simply go away like other maladies once they’ve run their course?
In other writings and podcasts, I’ve discussed that chronic pelvic-floor pain is an invisible condition: it can’t be detected by conventional medical testing, and it can’t be seen by the eye or heard by the ear. It’s beyond the ability of a doctor’s senses to perceive the problem. As a result, sometimes a particularly insensitive doctor will dismiss the complaints of pelvic-pain sufferers because no symptom can be objectively documented by current medical testing. Sometimes the doctor sends these patients to a psychiatrist, a particularly useless thing to do.
When you’re the one with chronic pelvic pain, this problem is difficult to understand as well. Sufferers of pelvic-floor pain are often very intelligent and systematic. Many of the patients who have come to our clinic had tried to make sense of their symptoms by diligently documenting their pain – keeping journals and pain diaries noting what they eat or drink, what happens in their lives, their sleep patterns. However, these attempts to figure out pelvic pain for the most part result with no answers and the sufferer is left in frustration and bafflement.
Furthermore, when pelvic pain goes away spontaneously – as it sometimes does for a lucky few patients – the reason is usually just as mysterious as its arrival in the first place. The length of time it takes to go away is often mysterious as well. Sometimes, the symptoms simply peter out and one forgets about them.
As someone who experienced pelvic pain for many years, I’d like to share with you my own perspective about why the Anderson-Wise Protocol it often takes a good year or longer to show significant and reliable results in reducing or resolving pelvic pain. The typical course of a patients who successfully use our protocol begins with windows of relief… an few hours, an afternoon a day, several days or longer where there is a substantial reduction or an absence of symptoms. Then flare ups tend to occur mingled with longer and better windows of relief. When symptoms resolve with our protocol, the patient tends to forget about the condition over time as they learn what to do to help the sore pelvis heal.
Over the years, I’ve spent a lot of time observing the issue of the length of time it takes. As I’ve discussed recently and will share with you here, even though sometimes it feels like pelvic-floor pain occurs overnight, in my view this is very rare unless some kind of trauma or injury to the pelvis sets it off. Rather, chronic pelvic-floor pain occurs because the tissue in the pelvic floor has become irritated and sore over time. The pelvic floor becomes painful because the tissue has been abnormally tightened for a long period of time – typically tightened as physical part of an ongoing response of anxiety and fear as I discuss now.
Anxiety is not only a mental phenomenon – it’s a mental and physical event. Anxiety is a survival response to a perceived threat, and the body itself tightens up protectively as part of worry, fear, and apprehension. This tightening typically goes unrecognized but it is clear when the anxious person pays attention to his/her state of tension. The anxious person is usually aware that they have had always had a difficult time relaxing. With people who have pelvic pain, worry shows up physically in the muscles of the pelvis. This tightening isn’t debilitating – I’m talking about a slight but noticeable guarding and tension when you pay attention to it. My relaxation teacher, Edmund Jacobson referred to this tension as ‘residual tension’, tension that remains after you have attempted to consciously relax.
However, for those who are chronically worried or anxious, that is to say for those whose normal mental state is regularly fearful and worried, over time knots occur in pelvic muscles (and often elsewhere) that are habitually tightened in their typically anxious state. We call these knots trigger points, (we discuss trigger points extensively in our book, A Headache in the Pelvis) and it turns out that trigger points are mysteriously connected to nervous system arousal….they’re very sensitive to emotional distress. In a remarkable set of studies with hundreds of subjects examining the relationship between emotional distress and trigger-point activity, Drs. Richard Gewirtz and David Hubbard found that when emotional distress is heightened, trigger-point electrical activity is profoundly heightened as well. This is a central reason as their pelvic floor related trigger points increase in activity and the referral of pain .
I’m suggesting, then, that pelvic-floor pain not related to an injury or physical insult, is a consequence of worry-related pelvic muscle tightening over a long period forming trigger points and an inhospitable environment in the pelvic tissue. This is a central tenet of our book, A Headache in the Pelvis.
Now, somethings that’s not well understood – but becomes obvious when you examine people with pelvic pain – is how irritated and sore pelvic tissue reflexively tightens up against its own pain. This is one of the strange phenomena in pelvic-floor dysfunction: the pain inside the pelvis triggers a heightened guarding or protective reaction in the pelvis that then makes the pain worse. This leads to a cycle of pain in the pelvis, where pain triggers reflexive tightening which increases anxiety which leads to further trigger-point activity and pain. We call this the “pelvic pain cycle,” and we’ve written about it extensively in our book A Headache in the Pelvis.
The Wise-Anderson Protocol is a methodology whose goal is the help our patients free themselves from the cycle of chronically irritated, tightened pelvic-floor muscles – allowing the sore pelvic muscles to heal as they normally would in other places in the body. We’ve developed specific physical self-treatment methods to help our patients loosen the chronically sore and tightened pelvic tissue, including the use of our FDA approved Internal Trigger-Point Wand and our new Trigger-Point Genie, to release these trigger points and areas of sore and restricted muscle. These devices and the techniques we teach our patients that are required for their effective use, in our protocol are central to restoring sore tissue to a healthy state and to stopping the pain.
As we have repeatedly emphasized, physical intervention while essential to our protocol’s ability to help the patient heal, when used alone is limited and inadequate for the resolution of the condition of chronic pelvic floor pain. The reason is that no matter how skillful physical intervention is, it offers the tightened pelvic tissue a temporary respite from its tightened, painful condition because once the pelvic pain patient re-enters the stresses of life, the temporarily loosened pelvic muscles the pelvic pain cycle is triggered without placing it regularly in an internally quiet place.
So, in my view, the missing piece in the conventional understanding and remedy of the problem of pelvic floor muscle pain is that the sore pelvic tissue is not allowed to routinely relax and heal in conjunction with its physical loosening we teach our patients to do. In my broken bone analogy from other blogs and podcasts, I’ve noted that if you have a broken leg, you can’t walk on it once it’s been put in a cast and expect the bone to heal. Obviously, walking on a broken leg would sabotage the healing of the bone.
The principle of putting a broken limb in a cast to support its healing applies to the healing of painful pelvis
You give the broken limb the rest it needs so that the bone can heal without stressing and reinjuring it. The same principle applies to a sore, irritated pelvic floor. The healing of both a broken bone and of a sore pelvis takes time. The process of healing sore pelvic tissue involves both competently and regularly physically loosening the sore muscles of the pelvic basin, and regularly putting them in a stress-free environment that allows the tissue to remain loose and heal. This simply means regularly removing the sore tissue from the stresses that cause it to tighten up, from everything that bothers it. While this cannot be done 24 hours a day in normal life that requires many activities that aggravate a sore pelvis, in the Wise-Anderson Protocol it means resting the pelvis in an internal and external quiet place for a significant period of time every day. When someone is sick in the hospital, it’s not uncommon to see a sign up outside the room that says “Do Not Disturb.” Why? Because the patient needs time and rest without aggravating his condition so that the body’s healing mechanism can work.
In a certain sense, with the Wise-Anderson Protocol we teach our patients to regularly put up a “Do Not Disturb” sign in their life. This is what is done in the quiet environment required by the method we’ve developed over many years called Extended Paradoxical Relaxation . In order to practice this technique properly, you have to set aside considerable time every day, remove yourself from the normal responsibilities and physical and psychological stresses of life, and practice the vital skill of becoming quiet inside. In practicing Extended Paradoxical Relaxation , you learn to quiet mental activity. This kind of inner quiet, in which you have set time up not to be disturbed by things outside or by your own internal thoughts and emotions, allows a relaxed pelvic floor to heal. This is not a simple endeavor. I deeply understand this and lived it in my own recovery.
Entering into profound relaxation in modern life isn’t common or easy. I’ve said elsewhere that if you could take the pelvis and send it to Tahiti where it could relax in a little hut, undisturbed by the stresses of life for a month or two, then it would heal right up. In the reality of daily human life, what we ask our patients to do is find the time to allow ourselves to heal – to take time off every day so that that broken leg so the sore pelvis can heal.
All of this takes time. It takes patience, and sometimes the sacrifice of valuable time that would be put to other ends. In that sense, healing the pelvic floor is truly two steps forward and one step back. But, the goal is to come out in front of the stresses that promote the chronicity of the condition, to where the healing actually does get ahead of the stresses that interfere with its resolution.
While this is not hard and fast, and patients differ, we suggest a time from of about a year in doing our protocol diligently to allow the healing of the pelvis to significantly and reliably reduce symptoms or resolve. For those who are successful in our program, sometimes it takes longer and sometimes it takes less time, but it’s the creation of a practice of taking time that allows the tissue in the pelvic floor to heal up. This includes regularly physical loosening the tissue, and then hanging up that “Do not disturb” sign internally and externally. The Wise-Anderson Protocol requires time, patience, and tolerance of inconvenience and discomfort about how much time this takes out of a normal, active daily life. In my own experience, once I saw the light at the end of the tunnel, once I experienced my symptoms reducing from my own efforts, I stopped being concerned about how long the process of healing was going to take.
The practice of the methods we train our patients in occurs amidst the stresses of their lives and the necessity of continuing to function in all of the aspects of life. It is possible to continue to work and function while regularly providing the pelvis with a healing environment. The time this takes to do this is best acknowledged and honored. Healing of pelvic pain takes time. And, as I experienced, when the pelvic floor does begin to heal, the time it takes typically no longer feels onerous because the joy of the easing of pain through your own efforts, and knowing that you’re going in the right direction tends to remove the concern about the inconvenience, difficulty and time taken in one’s own healing.