Excerpt
A Headache in the Pelvis
Chapter 1Chronic Pelvic Pain Is Easy to UnderstandMillions 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 PainThe 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 YouYou 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 MethodFor 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 QuickMost 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 HealingThe 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 MenChronic 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.
