PelvicPainHelp.com Blog

The Wise-Anderson Protocol is a pioneering treatment that was developed over an 8 year period at Stanford University in the Department of Urology. In the latest published research, it was shown to help a large majority of patients who attended the 6-day immersion clinic we offer to those who were suffering from muscle based pelvic pain and dysfunction.

The Wise-Anderson Protocol focuses on training patients who suffer from pelvic pain and dysfunction to learn how to rehabilitate the chronically contracted and spastic muscles of the pelvic floor and to relax the tension of the pelvic muscles and the arousal of the nervous system that feeds and perpetuates chronic pelvic pain. It is offered to eligible patients in a monthly 6-day immersion clinic held in Santa Rosa, California.

The clinic is limited to 14 patients who learn the protocol in private and group sessions. The aim of these clinics is to train patients in how to reduce or resolve their pelvic pain and related symptoms without the need for on-going professional assistance.

Use the form to the right for more information and questions about eligibility.

Growing number of scientific articles on stress and prostatitis and pelvic pain related disorders

Over the past number of years there have been a growing number of articles appearing in the major journals like the Journal of Urology and World Urology that point out the significant association between stress and prostatitis and related pelvic pain syndromes. This is a new phenomenon because in the past the world of urology has largely been uninterested in the psychological aspects that are related to chronic pelvic pain syndromes.

Symptoms of prostatitis that is muscle based have typically not responded to conventional medical treatment

When the men we have seen have complained to their doctor of pain in the anus or genitals, urinary frequency and urgency, post ejaculatory discomfort, sitting pain or the sensation of a ‘golf ball’ in the rectum, they are usually diagnosed with prostatitis, and are given antibiotics and told to avoid caffeine, alcohol and spicy foods, ejaculate more frequently and take hot baths.

Chronic prostatitis and chronic pelvic pain and their relationship to mind and body

We are often asked whether the physical or behavioral parts of the Wise-Anderson Protocol treatment for chronic prostatitis and chronic pelvic pain is more important. This is a major issue for patients, researchers and doctors alike because it determines the course of treatment and the outcome of treatment.  

Abstract

Background and Purpose. Myofascial trigger points (TPs) are found among patients who have neck and upper back pain. The purpose of this study was to determine the effectiveness of a home program of ischemic pressure followed by sustained stretching for the treatment of myofascial TPs.

Paradoxical Relaxation and the treatment of prostatitis/chronic pelvic pain syndrome

In a recent New York Times article (see excerpt below), the usefulness of concentration as an integral part of a discussion of mindfulness is discussed.  The ability to concentrate is not a subject that is often discussed in psychological literature on pain reduction; thus, this article is a welcome addition in the narrative of what we consider a critical issue in dealing successfully with chronic pelvic pain.

A recent article in the Korean Journal of Urology (see below) documented that men diagnosed with chronic prostatitis/chronic pelvic pain syndrome (chronic prostatitis, chronic pelvic pain syndrome) were significantly more stressed than control groups. The report showed that higher levels of depression, anxiety, and perceptions of stress were closely related to increased levels of pain and decreased quality of life levels.

Swiss researchers looking into brain activity in men with prostatitis, chronic pelvic pain syndrome report that in a small group of men there is a reduction in relative gray matter volume in a part of the cortex.  

A new article written in the October 2012 Journal of Urology identifies some changes in the anterior cingulate part of the brain in men suffering from prostatitis, chronic pelvic pain syndrome. The anterior cingulate cortex and other related parts of the brain, comprising part of the limbic system, are known to be connected with the perception of pain and emotion. The Swiss researchers’ observations of changes in this area of the brain may support the idea that when one has prostatitis, chronic pelvic pain, the chronic anxiety fed by catastrophic thoughts that the pain will never go away is reflected in some changes in the brain. 

By: Dr. David Wise Ph.D.

This paper is about sharing my observations about healing my own pelvic pain

Millions of men suffer with urinary frequency, urgency, pain with sitting, pain after sex, genital pain and pelvic pain and other symptoms called prostatitis/chronic pelvic pain syndrome. I suffered for over 20 years from what was is now diagnosed as prostatitis/chronic pelvic pain syndrome. This diagnosis is confusing to patients and doctors alike, and the story about this confusion surrounding the treatment of the condition remains to be told to a large audience.

Today, gratefully, my pain is gone and I have become an expert in a field I never wanted to be an expert in. As I think about it now, I can’t imagine the devastation of my life had I continued to be in pain. I always feel grateful. I hope this article can help clarify the confusion, misdiagnosis, and ineffective treatment of what is diagnosed as prostatitis in men and help many silently suffering men find a way back to having a life again.

It is not the symptoms of chronic prostatitis that can destroy one’s quality of life but the thought that the symptoms will never go away

A group of European urologists reported in a recent international study of 1563 patients* that the pain associated with chronic prostatitis or chronic pelvic pain syndrome (CCPS) impacted the quality of life of those suffering from this disorder more than the impact of urinary frequency/urgency or other common symptoms.  The study reported that pain in the perineum was the most common symptom.  Almost ½ of men reported discomfort after ejaculation.  Discomfort in the testicles and area above the public bone were common symptoms.  About 1/3 of men complained of pain in the penis.  

  • The word ‘cure’ comes from the 14th-century-old French word curer and from the Latin curare which means “to take care of.”  It has been used in European languages to mean “make whole.”
  • Despite the almost universal use of antibiotics for symptoms diagnosed as chronic prostatitis, credible and highly regarded studies over the past years have shown that antibiotics, alpha blockers, and
  • There is no credible evidence to show that surgery helps prostatitis. While there is sporadic experimentation with surgery for prostatitis and pelvic pain, it has been our clinical experience that surgery typically
  • Many men we have seen diagnosed with symptoms of chronic prostatitis report no benefit from diet 
  • Many men who see a urologist for chronic prostatitis will be given the advice to increase ejaculation.

Chronic Pelvic Pain Syndrome (CPPS): Definition and Facts 

  • In 1995, the National Institutes of Health, in a consensus conference on prostatitis, acknowledged that the terms chronic nonbacterial prostatitis and prostatodynia neither explained nor were even related to the

Prostatodynia: Definition and Facts

  • Prostatodynia means prostate pain.

 Levator Ani Syndrome: Definition and Facts

  • Levator Ani Syndrome is a condition of chronic muscle-based pelvic pain up inside the muscles of the pelvic floor. It is felt as chronic rectal and/or anal pain.

Pelvic Floor Dysfunction: Definition and Facts

  • Pelvic Floor Dysfunction is used to describe the inability of the pelvic muscles to either contract or relax normally, which leads to a variety of strange and debilitating symptoms.

Chronic prostatitis: definition and facts

  • While prostatitis* means an inflammation or infection of the prostate gland, most men diagnosed with prostatitis do not have prostate infection or inflammation.
  • Prostatitis is a condition that can confuse both doctors and patients.

In this essay I want to address the issue of the validity of many speculative theories on the internet about prostatitis and CPPS and our view of the issue of the healing of the pelvic floor and the resolution of symptoms of prostatitis and chronic pelvic pain syndromes.

Anyone with prostatitis should be aware of the disagreement among professionals about the cause of prostatitis. 

At some time or another, many people find a little blood in their stool, usually after a particularly hard bowel movement and can become confused and upset at such an event. At other times, alarmed individuals go to the doctor complaining of rectal pain after a bowel movement with no apparent blood in the stool. Often the doctor gives the diagnosis of anal fissure or hemorrhoid to these complaints. To most people this can sound foreboding. In fact an anal fissure is like a paper cut in the internal anal sphincter. Hemorrhoids constitute another condition that is painful and sometimes the source of blood in the stool. A hemorrhoid is a kind of varicose vein in the anus.

Many men diagnosed with prostatitis are confused about what the doctor is saying is wrong with them.  As we have written about extensively on our website, in our book, A Headache in the Pelvis and in our published research, most men diagnosed with prostatitis have no prostate infection or inflammation responsible for their symptoms.  Yet most men given the diagnosis of prostatitis don’t understand this (quite understandably) and suffer silently when medicines aimed at the prostate fail to help them.   This is an essay featuring the writing of a renounced physician and expert in prostatitis/chronic pelvic pain syndrome who speaks strongly to doctors to clarify their misunderstandings about prostatitis that we involved in the Wise-Anderson Protocol have been  have been saying for many years.  In his admonitions to the doctors who treat pelvic pain, he clarifies the issues than many patients are confused about.

Most of the symptoms of pelvic pain or discomfort, urinary frequency and urgency, and pain related to sitting or sexual activity in cases diagnosed as prostatitis are not related to infection but are caused by chronically tightened muscles in and around the pelvis. Our natural protective instincts can tighten the pelvic basin, causing pain and other perplexing and distressing symptoms. Stress is intimately involved in creating and continuing these symptoms. Once the condition starts, the symptoms tend to have a life of their own.

And the good news is that it is possible for a large majority of sufferers to reduce and sometimes eliminate symptoms. A Headache in the Pelvis: A New Understanding and Treatment for Prostatitis and Chronic Pelvic Pain Syndromes, now out in the 6th edition, describes how chronic tension in the pelvic muscles can cause many of the bewildering symptoms of prostatitis and chronic pelvic pain syndromes.

Essays on Pelvic Pain – WHY INTRAPELVIC BIOFEEDBACK MEASUREMENT IS NOT A RELIABLE INDICATOR OF THE USEFULNESS OF THE STANFORD PROTOCOL AND THE ISSUE OF THE THERAPEUTIC USEFULLNESS OF PELVIC FLOOR BIOFEEDBACK

David Wise, Ph.D.

I am responding to a request for a comment about the usefulness of INTRAPELVIC biofeedback measurements in determining if pelvic pain is a tension disorder and appropriate for the Stanford Protocol. My short answer is that electromyographic measurement of the anal sphincter with a biofeedback anal probe, used alone, is an unreliable measure of what is going on inside the pelvic floor. Unremarkable readings of the anal sphincter should not be used to rule out tension disorder prostatitis and pelvic pain nor to dismiss the appropriateness of a treatment of the Stanford protocol.

The following are excerpts and abstracts of publications regarding the latest CPPS and Wise-Anderson Protocol research:

The following is an abridged version. For the full version, see the link at the bottom.

Article Dec 2009

Department of Urology, School of Medicine, Stanford University, Stanford, California.

PURPOSE: A combination of manual physiotherapy and specific relaxation training effectively treats patients with chronic prostatitis/chronic pelvic pain syndrome. However, little information exists on myofascial trigger points and specific chronic pelvic pain symptoms. We documented relationships between trigger point sites and pain symptoms in men with chronic prostatitis/chronic pelvic pain syndrome.

MATERIALS AND METHODS: We randomly selected a cohort of 72 men who underwent treatment with physiotherapy and relaxation training from 2005 to 2008. Patients self-reported up to 7 pelvic pain sites before treatment and whether palpation of internal and external muscle trigger points reproduced the pain. Fisher’s exact test was used to compare palpation responses, i.e., referral pain, stratified by reported pain site.

“The goal of the Wise-Anderson Protocol is to enable the patients to reduce and/or resolve their symptoms without dependency on drugs or others to do so for them.”

David Wise, Ph.D.
Plenary address to the
National Institutes of Health (NIH)
Scientific Workshop on Prostatitis/Chronic Pelvic Pain Syndromes
Baltimore, Maryland
October 21, 2005

Introduction

Thank you for giving me the opportunity to discuss the Wise-Anderson Protocol at this National Institutes of Health sponsored scientific meeting on Prostatitis/Chronic Pelvic Pain Syndrome.

The purpose of Paradoxical Relaxation in the Wise-Anderson Protocol is to teach a patient to profoundly relax the tensed and shortened muscles within the pelvic floor basin associated with certain kinds of pelvic pain. It involves a daily practice of the cultivation of effortlessness in the presence of pain, anxiety, and tension in order to abate them.

The Wise-Anderson Protocol began when Dr. David Wise, a psychologist in California who had suffered from Chronic Pelvic Pain Syndrome for many years, contacted several urologists including Dr. Rodney Anderson, a professor of Urology at Stanford University School of Medicine and a leading practitioner and expert in the field of pelvic pain. Dr. Anderson was considered to be the court of last resort for patients with pelvic pain and prostatitis who had not been helped by any other treatment.

We have identified a group of chronic pelvic pain syndromes that we believe is caused by the overuse of the human instinct to protect the genitals, rectum, and contents of the pelvis from injury or pain by contracting the pelvic muscles. This tendency becomes exaggerated in predisposed individuals and over time results in chronic pelvic pain and dysfunction. The state of chronic constriction creates pain-referring trigger points, reduced blood flow, and an inhospitable environment for the nerves, blood vessels, and structures throughout the pelvic basin. This results in a cycle of tension, anxiety, and pain, which has previously been unrecognized and untreated.

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.

Most cases diagnosed as prostatitis are problems of chronically tightened muscles of the pelvis and not problems of the prostate gland

While we treat both men and women with pelvic pain, a large majority of men with pelvic pain are diagnosed with prostatitis.  Most men diagnosed with prostatitis have mistakenly been told that their symptoms are caused by a problem of their prostate gland.  In fact the problem of genital, rectal, perineal pain, urinary symptoms, sitting discomfort, (click here for symptoms of prostatitis) in most men has nothing to do with the prostate gland.