Based on the gold-standard nondrug, nonsurgical Wise-Anderson Protocol for treating chronic pelvic pain, A Headache in the Pelvis is the definitive resource for anyone suffering from pelvic pain.
Pelvic pain afflicts millions of men and women and goes by many names, including pelvic floor dysfunction and prostatitis. David Wise, Ph.D., searched for relief for his pelvic pain for more than 20 years. After researching medical journals and performing outside-the-box self-experimentation, he found a way to resolve his symptoms. He then joined forces with Stanford urologist Dr. Rodney Anderson in the mid-1990s, and together they treated patients and did research on what is now called the Wise-Anderson Protocol.
Often incorrectly diagnosed, debilitating, and disruptive, pelvic pain is correlated with psychological distress. Using a holistic treatment integrating physical therapy and meditative relaxation, this book guides you through understanding your pain, why conventional treatments haven't worked, and describes the details of the physical and behavioral protocol that can help to heal the painful pelvic floor. At last, this life-changing protocol offers hope and help to lead a pain-free life.
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About the Author
DAVID WISE, PhD, partnered with Stanford urologist Dr. Rodney Anderson in developing the Wise-Anderson Protocol for pelvic floor related pain after he resolved his long standing condition pelvic floor pain. He is a psychologist in California and his research interest are in behavioral medicine and autonomic self-regulation.
RODNEY U. ANDERSON, MD, FACS, is professor of urology (emeritus-active) at Stanford University School of Medicine. His subspecialty clinical expertise is neurourology and female urology. He continues to be actively engaged in clinical research at Stanford on the Wise-Anderson Protocol and other research.
Read an Excerpt
Chronic Pelvic Pain Is Easy to Understand
Millions of men and women suffer from pelvic pain, discomfort, or dysfunction that drugs, surgery, and conventional treatment do not help. If you are one of them, you may have experienced rectal, genital, or abdominal discomfort or pain, increased discomfort or pain sitting down, discomfort or pain during or after sexual activity, or urinary frequency, urgency, and hesitancy.
If you’re reading this book, you’ve probably gone to a doctor or many doctors who found little or no physical basis for your symptoms. Your tests came back normal. You may have been diagnosed with pelvic floor dysfunction, prostatitis, chronic pelvic pain syndrome, coccydynia (tailbone pain), chronic proctalgia, proctalgia fugax, pelvic floor myalgia, piriformis syndrome, interstitial cystitis, urethral syndrome, or other related diagnoses, but found no relief. We are proposing in this book that all of these different diagnoses are essentially different names for the same problem, a problem we are calling A Headache in the Pelvis.
The amelioration or resolution to the kind of pelvic pain we treat and discuss in depth in this book has eluded the best medical minds for recorded history. Most people reading this book would not be reading it if they were able to find help within the context of conventional treatment. It is not uncommon for individuals with pelvic pain to either have it on a continual basis or to have it wax and wane for many years and to go from doctor to doctor receiving little help. To date, there is no solution to this problem offered by the best conventional medicine. Conventional or not, for the most part, there is very little that has helped pelvic floor related pain and dysfunction. The Wise-Anderson Protocol offers real understanding and help.
Pelvic pain we describe is a condition of sore, irritated pelvic floor tissue that is never given a chance to heal. Our book offers an intimate understanding of this problem based on one of the author’s twenty-two-year history with it and his experience of its resolution as well as a subsequent twenty-four years of experience of treating several thousand patients in collaboration with skilled colleagues. We discuss this understanding in detail in the next chapter. Instead of pelvic pain with related symptoms discussed in this book being the result of an infection, a trapped nerve, an autoimmune disorder, or degenerative disease, we propose that it is a psychophysical problem. Both the physical and psychological aspects must be strongly addressed for any chance at a satisfactory resolution of symptoms.
An Intimate Look at Pelvic Pain
The major contributing factor involves a chronically knotted up, contracted pelvis—typically a physical response to years of worry—that leads to tight, irritated pelvic floor tissue, leading to a reflex response in the pelvic tissue of protective guarding that creates a self-feeding cycle that gives pelvic pain a life of its own. In what we can call pelvic pain related to pelvic floor dysfunction, sore pelvic floor tissue once established doesn’t have a chance to heal the way other sore human tissue heals. You can think about the ongoing reflex protective guarding of irritated, sore pelvic tissue as a kind of ongoing pelvic charley horse.This chronic charley horse keeps the pelvic tissue irritated and preventing its otherwise natural healing. Ongoing pain from this sore tissue leads to protective pelvic muscle guarding, anxiety, continued dysfunctional protective guarding, and chronic painful tissue irritation.
In scientific studies, it has been documented that the Wise-Anderson Protocol helps a majority of patients.
Dealing with these central aspects of pelvic pain is daunting in the most ideal of circumstances. With the best of treatment we can offer, resolving one’s pelvic pain is a challenge and with some individuals beyond our ability to help. But we do help the large majority of those we treat. Indeed, the large majority of qualifying patients are helped by the program explained in this book, called the Wise-Anderson Protocol.
How This Book Can Help You
You are holding in your hands the seventh, definitive edition of A Headache in the Pelvis. It is a streamlined edition of a book that we originally published in 2008. Since its publication, the book has been read by tens of thousands, and the feedback from readers has informed our refinements to the protocol, as has our clinical work. Some readers of our book have reported that they have significantly reduced their symptoms by reading about and then applying the methods we describe here. That being said, we cannot recommend using the methods that we describe here on oneself or others without proper supervision from someone competent in these methods. We don’t know how a reader relates to his or her body and do not want to be responsible for actions individuals take, in relationship to themselves, that we cannot supervise and correct when necessary. Pressing on a trigger point for one individual may mean using too little pressure, for another just enough pressure, and for another bruising pressure. The process described in Extended Paradoxical Relaxation may result in a significant relaxation of tension and symptoms in one individual, yet in another individual this instruction may be wholly misinterpreted and result in tension that increases and that sours him on using this method.
Nevertheless, some readers have designed their own programs using our model and have helped themselves. They have written to us with gratitude for our road map. Others have been less successful at doing this on their own.
The basic goal of the Wise-Anderson Protocol is to train patients to become expert in reducing or stopping their own symptoms. We have found that when treatment for pelvic pain by a professional is confined to weekly or biweekly visits without a committed self-treatment daily program of pelvic floor relaxation, stretching, and effective physical therapy self-treatment, it tends to be a tepid intervention. The Wise-Anderson Protocol sees the treatment of pelvic pain as an inside job.
Self-Treatment Is the Core of Our Method
For understandable reasons relating to constraints of time in conventional treatment, training patients in self-treatment tends to be an afterthought in most treatments of pelvic pain. Lip service is given to patient daily self-treatment but with little time for patient training or backup. The Wise-Anderson Protocol makes the training of the patients in doing their treatment its primary goal.
The Wise-Anderson Protocol Is Not Easy or Quick
Most of us are resistant to changing our routine. It is our experience that taking at least two hours or more a day to do one’s home program for at least many months is the bare minimum for our protocol to be effective. Carving out two hours or more from one’s life bumps up against real barriers for most people. These barriers include the huge inertia of a routine shaped by the demands of work and family and a desire for downtime that often makes one feel there is no room for any other activity. Our patients tend to stick to their home practice over the long term when they see that their symptoms are improving.
In our experience, only the yearning to get out of pain and the related suffering of pelvic pain syndromes is a strong enough motivation for patients to accommodate the self-treatment requirements we describe.
A Road Map of Pelvic Pain Healing
The biggest contribution we have to offer is a new view of the problem of pelvic pain and a road map for its amelioration. If we have done this in writing this book, we have accomplished something important. However this book is used, we hope that the Wise-Anderson Protocol can shine a light on the path of resolving pelvic pain.
The Different Names for Pelvic Pain: The Elephant and the Blind Men
Chronic pelvic pain goes by many names. You will find a comprehensive list in this chapter. It may be called prostatitis by a urologist or coccygodynia or pudendal nerve compression syndrome by a colorectal surgeon. Other names used to describe the same condition include chronic genital pain, prostatodynia, pudendal neuralgia essential anorectal pain, idiopathic pelvic pain, pelvic floor dysfunction, pelvic floor myalgia, levator ani syndrome, and spastic piriformis syndrome. Three specialists may give you three different diagnoses.
There’s an old parable about ten blind men who came upon an elephant. One touched the elephant’s leg and remarked, “Oh, this creature is like a tree trunk.” Another was under the stomach, pushed up, and said, “Oh, no. This creature is like a soft ceiling.” A third pulled the tail and said, “No, this creature is a rope connected to a tree.” All the blind men were right and all the blind men were wrong; their answers were incomplete because they each had access to limited information. Similarly, there’s a lack of communication among many medical specialists; if they all spoke to each other, they would see that they are often talking about the same condition. In this book, we aspire to see the whole elephant.
The Source of Pelvic Pain Symptoms
There is a simple physical basis for chronic pelvic pain symptoms. The seemingly wide array and variability of the symptoms are simply expressions of the same underlying problem, whether you’re a man or a woman. The Wise-Anderson Protocol does not treat the symptoms; instead, it treats what triggers those symptoms. Our approach substantially reduces or abates symptoms in a large majority of qualifying patients who undertake our full protocol.
In this book we will use the terms a headache in the pelvis, chronic pelvic pain syndrome(s), chronic pelvic pain, pelvic pain, and CPPS synonymously to refer to all the conditions discussed.
Diagnoses You May Have Received
• Prostatitis (National Institutes of Health categories)
I. Acute bacterial prostatitis
II. Chronic bacterial prostatitis
IIIA. CPPS nonbacterial inflammatory prostatitis
III. CPPS nonbacterial noninflammatory prostatitis
IV. Asymptomatic inflammatory prostatitis
• Orchalgia and/or epididymitis
• Proctalgia fugax
• Urethral syndrome
• Vulvodynia (vulvar vestibulitis)
• Proctalgia fugax
Both Men and Women
• Interstitial cystitis
• Levator ani syndrome
• Pudendal nerve entrapment syndrome (pudendal neuralgia)
Throughout History, Pelvic Pain Disorders Have Never Had a Solution
For many years, chronic pelvic pain syndromes have posed an enigma to the medical/healing community. In men, nonbacterial prostatitis, for example, has routinely been confused with acute or chronic bacterial prostatitis, even though an accurate and easy method for diagnosis has been available for years. At the same time, nonbacterial prostatitis, which makes up the overwhelming number of cases of prostatitis, tends to be regarded by doctors as a kind of wastebasket diagnosis for pelvic symptoms that the doctor does not understand or know how to treat. Gross pathology, as measured by the latest medical instruments, has not been able to explain the degree of suffering caused by these disorders.
Doctors often tell patients with chronic pelvic pain syndromes that they can find little or nothing wrong with them.
What we are proposing in this book is that these conditions are rather like a headache, except that the location of the headache is in the pelvis. Hence A Headache in the Pelvis is our title. And the basis for all these conditions is chronic pelvic floor muscle irritation, triggered and perpetuated by chronic muscle tension. If chronic pelvic pain syndromes are, in fact, a headache in the pelvis, then treatment needs to be radically different from what has traditionally been followed.
A Headache in the Pelvis is the name we are giving to chronic pelvic pain syndromes where no gross pathology has been found. These syndromes often include pain and dysfunction related to urination, defecation, and sexual activity. This discomfort or pain and dysfunction occurs in both men and women. One person may experience only one symptom while another may experience all symptoms. Sometimes symptoms inexplicably vary from day to day or week to week. Symptoms vary, as do their anatomical locations, yet we propose that the trigger for these symptoms is the same and that a common effective treatment exists for all of them.
Even though many people suffer from a headache in the pelvis, most of them feel alone in their difficulty. The pelvic area is considered private and is often very difficult to talk about, even with close friends or relatives. Basically, most people want the areas of the genitals and rectum to work but don’t want to know much about them or to have to pay any attention to them.
These areas of the body are not treated with much appreciation. This is a truth that is reflected in how we word profanities. What do we call people with whom we are angry? Usually terms related to defecation or procreation. Indeed, these are terms of denigration. In our culture, the genitals and rectum are shrouded in shame and guilt. When a pelvis becomes chronically sore and irritated, sufferers often feel alone and afraid and are reluctant to share their experience, especially as they find neither a doctor or friend who can really understrand their symptoms.
Quite simply, if you haven’t experienced chronic pelvic floor pain and dysfunction, you don’t understand it because you’ve never experienced the weird kinds of symptoms that occur with it. The healing of the abused pelvis, as Steven Levine has stated eloquently, in part involves bringing the genitals and rectum “back into the heart.” To begin with, this means changing one’s attitude from shame, and rejection to compassion and appreciation.
Common Symptoms in Men and Women with Pelvic Pain
Below is a list of the most common symptoms we see in the patients we have been able to help. Most experience several to many of the symptoms. Rarely do patients have all of them.
Urinary Symptoms: Frequency, Urgency, Hesitancy, Dribbling, Dysuria (Burning with Urination), Nocturia (Nighttime Urination)
Frequency and Urgency
• Urinary frequency in our patients ranges from annoying to debilitating.
• There is commonly a feeling of something always nagging in the bladder/urethra/genitals, and typically, after patients urinate, they report that they don’t feel “emptied” during or after urination and are left with the feeling of having to urinate again even though there is little to urinate.
• Frequency/urgency can result in the feeling of having to be near a bathroom; sometimes one can hardly hold in the urge to urinate when it arises. Some patients feel that their lives revolve around staying near a toilet.
Nocturia (Frequent Nighttime Urination) for Men and Women
• Urinary urgency and frequency at night can deprive patients of sleep.
• Exhaustion from sleep deprivation tends to feed into the cycle of tension, pain, protective guarding, and anxiety.
Dysuria (Discomfort, Pain, or Burning Before, During, or After Urination)
• Discomfort, pain, or burning during urination is associated with pelvic-floor dysfunction.
• When the trigger points, chronic spasm, and myofascial contraction of the pelvic muscles are resolved, dysuria is also resolved in many of our patients.
• Some patients experience discomfort only after urination, not during.
• In a subset of individuals, dysuria can be quite painful, and urination becomes an ordeal and sets off further pain.
Table of Contents
A Personal Note from Dr .Wise xiii
A Personal Note from Dr. Anderson xix
Chapter 1 Chronic Pelvic Pain Is Easy to Understand 1
Chapter 2 Understanding the Wise-Anderson Protocol 17
Chapter 3 The Wise-Anderson Protocol, Part 1: Trigger Point Release 59
Chapter 4 The Wise-Anderson Protocol, Part 2: Extended Paradoxical Relaxation (EPR) 130
Chapter 5 The Wise-Anderson Protocol, Part 3: Understanding How Your Attitude Affects Your Condition and What You Can Do About Your Attitude 208
Chapter 6 Pelvic Pain in Women 277
Chapter 7 The Medical Science of Chronic Pelvic Pain 306
How to Contact Us 341
Appendix: Stories of Patients in Their Own Words 343