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Why Stress Triggers and Perpetuates Male and Female Pelvic Pain
Studies have shown that myofascial trigger points that are found in sore and painful muscles inside the pelvic floor are strongly affected by slight degrees of 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 being monitored. 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. It is for this reason that the Wise-Anderson Protocol trains patients in a relaxation method that 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 of these underlying emotions on their symptoms. The reason for this is that if you live, for instance, in a marriage where there is ongoing resentment, a work situation in which you deal with frustration and disappointment regularly, or live with a sense of dread because of a general psychological 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 and catastrophic thinking
We know that when you have pelvic pain, 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; 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 there is an increased level of psychological distress in patients dealing with pelvic pain syndromes 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.
Many pelvic pain patients do not recognize the relationship between their emotional states and their symptoms
Rehabilitating the tendency toward dysfunctional thinking and mood
One of the major obstacles to finding a way to live free from disturbing emotions is that most people dealing with pelvic pain are not aware that such emotions go on inside them or are significant in 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 your normal level of 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, 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 usually sees glasses as half empty, and suffers from such a viewpoint, it takes a decision and effort to choose the ‘half full’ perspective, because the half empty perspective is so strongly ingrained.
Changing the tendency to stay in chronic states of anxiety, fear, dread, sorrow, resentment or anger must be done for any real resolution of pelvic pain
Unfortunately, at this time, contemporary medicine has not been interested in the profound relationship between pelvic pain 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 new paradigm implied in the treatment protocol for muscle related 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 habitual tendency is to be perfectionistic, compulsive or picayune and cannot be reformed. Our protocol is based on the understanding that concerted voluntary efforts to behaviorally change the default tone of the anal sphincter and other muscles of the pelvic floor, can change one that is tight and chronically contracted to one that is relaxed and at ease. This new understanding asserts that “tight asses” can become “relaxed asses.” It is possible to change the tendency to chronically tighten the pelvis.
Like the insights of the new paradigm of neuroscience regarding the plasticity of the brain, we propose that the chronically tensed core of us, including the intestines and pelvic floor muscles, can be trained to be relaxed. We propose that the tendency to chronically brace the viscera under stress can be modified without surgery or drugs. It can be modified with training in calming down a chronically vigilant nervous system. In other words, the visceral reaction of chronic tension associated with nervous system arousal can be, with a certain level of training, brought under our voluntary control.
Changing this habitual inner posture is not brought about by drugs or surgery, but can be brought under the control of the patients’ disciplined consciousness. For those patients who come to our clinic, the suffering with pelvic pain is what we believe provides the motivation for someone with a tight gut and pelvic floor to learn to control catastrophic thinking, an upset nervous system, and the pelvic pain related to them. We are proposing that ultimately 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 that exists, 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 chronically contracted core.
A gentle approach to break the tension-anxiety-pain 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 in general, and habitual pelvic tension in particular. 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 and not the result of a foreign organism in the prostate gland in the case of prostatitis, an autoimmune disorder, or other contemporary explanations of pelvic pain in men and women. 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 the cycle of tension, anxiety, and pain 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.
