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Chronic Pelvic Pain Syndrome (CPPS)

HomeChronic Pelvic Pain Syndrome (CPPS)

MAJOR SYMPTOMS WE TREAT

Most of our patients have at least two or more symptoms. See a more detailed list with descriptions of the symptoms at the bottom of this page.

  • Urinary Frequency / Urgency / Hesitancy
  • Pain with Sitting
  • Rectal / Perineum Pain
  • Genital Pain
  • Pain During or After Sex
  • Pain or Relief After Bowel Movement
  • Lower Abdominal Pain
  • Tailbone / Low Back Pain
  • Stress Can Increase Pain
  • Hot Baths or Heat Help
  • Depression / Anxiety About Symptoms
  • Symptoms Reduce Quality of Life
  • Conventional Treatments Don’t Help
  • Medical Tests Find No Disease

CHRONIC PELVIC PAIN SYNDROME (CPPS)

CHRONIC PELVIC PAIN SYNDROME OR PROSTATITIS

In 1995, the National Institutes of Health (NIH) reclassified what was formerly called prostatitis into four general categories. This was done because the largest category of men diagnosed with prostatitis did not have a prostate infection and the cause of their symptoms could not reasonably be attributed to problems of the prostate gland. Indeed, 90%-95% of men diagnosed with prostatitis have no prostate infection. Thus, in 1995 NIH renamed this condition as Chronic Pelvic Pain Syndrome (CPPS), a more befitting name to the correct diagnoses of pelvic pain. This reclassification was a long time coming.

CHRONIC PELVIC PAIN SYNDROME (CPPS) IS BOTH A LOCAL AND SYSTEMIC DISORDER

Relief from chronic pelvic pain syndrome (CPPS), with its often bewildering and troubling symptoms, is what those seeking help from any treatment are looking for when they go to a doctor. Conventional medical treatment, however, almost universally misunderstands CPPS. The remedies it offers at best are partial and short-termed and at worst, remedies like surgical intervention or certain injections, can exacerbate the problem.

The fundamental error of conventional chronic pain treatment is that it does not grasp the fact that it is both a systemic and local problem — systemic in that the nervous system, typically frequently aroused, chronically tightens up the pelvic muscles. It is a local problem in that chronic worry, anxiety and nervous arousal in certain individuals results in the local pain and dysfunction of the pelvic muscles. Without effectively treating both aspects, CPPS remains.

Our 6-day clinic, offered throughout the year, is devoted to resolving both the local and systemic dimensions of CPPS by training our patients in the most advanced internal and external physical therapy self-treatment (local treatment), and practicing our relaxation protocol, Extended Paradoxical Relaxation, which is aimed at reducing nervous system arousal daily.

THE SOURCE OF A LARGE PROPORTION OF CPPS IS A ‘CHARLEY HORSE’ UP INSIDE THE PELVIS

In over twenty years of clinical experience, we have identified a large number of painful, myofascial trigger points (a charley horse in the pelvis caused by stress) in the internal and external pelvic muscles in patients previously diagnosed with CPPS. We understand that over time, usually decades, this stubborn cycle of chronic anxiety manifests itself by tightening the pelvic floor to a point that it doesn’t untighten and becomes painful and dysfunctional. The Wise-Anderson Protocol treats the core issue, both the stress that is initially causing the pain and directly where the pain is stemming from in the pelvis. This protocol helps reduce trigger point/pelvic floor sensitivity and pain from 7.5 out of 10 to 4 out of 10 in 6 months.

THE WISE-ANDERSON PROTOCOL HELPS THE SYMPTOMS OF CHRONIC PELVIC PAIN IN WOMEN AND MEN EQUALLY

The same percentage of women as men with muscle-based pelvic pain is helped using the Wise-Anderson Protocol. In other words, our understanding is that the symptoms of CPPS are either identical or substantially similar to the symptoms found in men and women, and that our treatment provides the same promise of improvement or resolution to women as it does to men. Read our latest published article: “Improvement in Symptoms equal in Men and Women with Urologic Chronic Pelvic Pain Syndrome (UCPPS) using a newly FDA approved Internal Myofascial Trigger Point Wand and training in Paradoxical Relaxation”, Journal of Applied Psychophysiology and Biofeedback.

THE WISE-ANDERSON PROTOCOL

6-Day Immersion Clinic

We began treating varieties of pelvic floor dysfunctions in patients at Stanford University in 1995 in conventional office visits. In 2003, we reorganized our treatment in a private practice in the form of a 6-day immersion clinic held in Santa Rosa, California. The clinic, limited to 14 patients and offered throughout the year, has evolved to implement the Wise-Anderson Protocol, a treatment to teach patients to rehabilitate the chronically contracted muscles of the pelvic floor and to reduce anxiety daily. The Wise-Anderson Protocol, done daily at home by patients we have trained in self-treatment, has helped to give many their lives back. The purpose of our self-treatment is to help patients become free from having to seek additional professional help. For over a decade, research has documented our results of training patients with self-treatment.

For more information, please visit our clinics page by clicking here.

For questions about cost and eligibility please fill out the form below, email us at ahip@sonic.net or contact our office at +1 (707) 332-1492.

 

SYMPTOMS OF CPPS

(Most of our patients have at least two or more symptoms)


  • For patients, urinary frequency can range from being annoying to debilitating
  • There is typically a feeling of something always nagging in the bladder/urethra/genitals
  • Typically after someone urinates, patients don’t feel ‘emptied’ and are left with the feeling of having to urinate
  • Frequency/urgency can result in the feeling of often having to be near a bathroom. Sometimes one can hardly hold in the urge to urinate when it arises
  • If one is in a movie theatre, or at a sports event etc., one usually sits in an aisle seat to be prepared to exit easily
  • Urinary urgency and frequency can deprive patients of sleep because of how often they wake up during the night or because they have difficulty going back to sleep after they wake up

  • Dysuria can be very painful and thus, urination becomes a large ordeal and sets off further pain
  • Burning or pain with urination is often disconcerting and associated with pelvic floor dysfunction
  • Sometimes people feel no pain during urination but only after
  • When the chronic spasm and myofascial contraction of the pelvic muscles is resolved, in many of our patients, dysuria is also resolved

  • Often nocturia is a major problem because a patient’s sleep is so disturbed he or she is exhausted all the time
  • Exhaustion from sleep deprivation tends to feed into the cycle of tension, pain, protective guarding and anxiety

  • In men this is an important symptom to medically evaluate as to whether the source of the reduced stream is from prostate enlargement or other issues
  • Some people with muscle based pelvic pain have to wait to initiate a stream of urine
  • Reduced urinary stream can be a contributing symptom to low self-esteem and hypochondriasis, especially in younger men
  • When urinary symptoms are part of muscle based chronic pelvic pain syndrome, after rehabilitating the pelvic floor, the flow of urine can improve

  • Perineum is one of the most common sites of pelvic pain, is intimate, can hurt 24/7 and can be very distressing
  • The perineum is the place where most muscles of the pelvic floor attach and therefore has many sources of referred pain (pain felt at a site other than where the cause is situated)
  • Perineum is often the site of bicycle riding pain
  • Perineum pain can be made worse by sitting or standing
  • The perineum and the anal sphincter are parts of the body where the patients feel the feeling of “sitting on a golf ball”
  • In a 2009 Stanford study of our work published in the Journal of Urology, it was documented that 79% of subjects complained of pain in the perineum
  • We documented key abdominal and pelvic muscles that all refer pain to the perineum (rectus abdominus, adductor magnus, and coccygeus)

  • Increased discomfort hours or the day after sexual activity is common
  • Sexual activity is painful either during or afterward
  • Pain is felt on the outside of the vagina, inside or both
  • Pelvic examination in which trigger points are palpated can often recreate symptoms of pain during sex
  • Our explanation about why there is often an increase in discomfort during or after sexual activity in men and women with chronic pelvic pain syndromes is as follows:
    • Orgasm causes strong contractions of the pelvic, prostate and seminal vesicle muscles lasting about once a second during orgasm
    • There is a significant increase in nervous system arousal during sexual activity
    • The pleasure spasm of orgasm in the form of the increased series of contractions during orgasm will tighten the pelvic muscles further
    • This increased tightening temporarily contracts an already contracted area which doesn’t relax well and it tends to throw the patient further above the symptom threshold
    • When our patients learn to release the muscles inside the pelvic floor, they usually can feel this increased muscle contraction
    • After a certain time frame (from hours to days), the pelvic muscles relax and return to their baseline level, the normal tightened state of the pelvic floor reasserts itself (which is back to some degree of pain or discomfort when a person has chronic pelvic pain syndrome)
    • For this reason we do not recommend increasing sexual activity (as has often been suggested by physicians our male patients have seen) when a person has an increase in symptoms after sex

  • Sitting is one of the great sufferings and scares in pelvic pain and makes all aspects of normal life difficult
  • Patients often look for the padded seats in a restaurant because sitting is so uncomfortable
  • Sitting pain can make it miserable to sit with friends or family and socialize
  • Difficult to fly or drive for any distance without pain
  • Sometimes patients have to go on disability because they can’t work because their job is a sitting job
  • Sitting can trigger or exacerbate discomfort/pain/symptoms and can hurt in the front, back of the pelvis, or both
  • Sitting pain usually starts out milder in the morning but increases after sitting through the day, and can last into the night

  • Genital pain is usually referred from the anterior levator ani and one of the easier symptoms to resolve
  • In men, pain at the tip and shaft of the penis is a common symptom
  • In men, sometimes there is a redness at the tip, which can be accompanied by an irritation so that rubbing against underwear is uncomfortable
  • In women, pain inside the vagina, on one side or another is common
  • In women, sometimes vulvar pain accompanies pelvic pain

  • Suprapubic (above the public bone) pain is a common symptom
  • Suprapubic pain is common with patients who have urinary frequency, urgency, hesitancy and other anterior symptoms
  • Sometimes pressing on this area can refer into the anorectal (anus and rectal) area and sometimes bladder pain is experienced here as well
  • Pain can be on one side or another or in the middle

  • In men this is an important symptom to medically evaluate as to whether the source of the reduced stream is from prostate enlargement or other issues
  • Some people with muscle based pelvic pain have to wait to initiate a stream of urine
  • Reduced urinary stream can be a contributing symptom to low self-esteem and hypochondriasis, especially in younger men
  • When urinary symptoms are part of muscle based chronic pelvic pain syndrome, after rehabilitating the pelvic floor, the flow of urine can improve

  • Low back pain is common and often confuses patients and practitioners because the symptoms are referred from the muscles of the pelvic floor, not the low back
  • Discomfort can be on one side or another or migrate from one side to another

  • Groin pain often is confused with a hernia
  • We have seen patients who have had hernia repair for their pain that did not resolve their groin pain

  • Relief after a bowel movement occurs when the tight pelvic muscles relax
  • Discomfort after a bowel movement can be particularly disconcerting if it triggers symptoms more strongly for the rest of the day
  • Little is written about this symptom when it occurs in the absence of hemorrhoids or anal fissures, but in our experience it is common
  • The mechanism of defecation typically involves the filling up of the rectum with stool, which then sends a signal for the internal anal sphincter and puborectalis muscle to relax and triggers the experience of urgency to have a bowel movement
  • Once the stool passes through the relaxed anal sphincter and out of the body, the internal anal sphincter reflexively closes
  • When someone has pelvic pain and exacerbation of symptoms after a bowel movement, we propose that the internal anal sphincter tends to ‘over close’
  • That is, it tightens up more than it was tight before the bowel movement and sometimes appears to go into a kind of painful spasm
  • Post bowel movement pain appears to occur less frequently when someone is relaxed and not hurried, and whatever contributes to a more relaxed state during a visit to the bathroom may reduce this symptom
  • Resolving post bowel movement pain in our patients tends to occur as their entire chronic pelvic muscle tension releases

  • Because sex can be painful during or afterward, there is often a conditioned withdrawal from having sex to avoid pain
  • This anxiety can result in difficulty in maintaining an erection which adds to relationship difficulties and courting difficulties, particularly in younger patients
  • Anxiety with having sex, in our view, is the major reason for performance anxiety and what is ‘medicalized’ as erectile dysfunction
  • In our experience when pain goes away, so does the anxiety and what is called erectile dysfunction connected to it

  • Reduced interest in sex is common with pelvic pain
  • In muscle related pelvic pain, there is typically no pathology of the physical structures involved in sexually activity
  • Our view is that reduced libido is a mix of anxiety, reduced self-esteem and pelvic pain which all mitigate against sexual arousal and sexual interest, and resolution of pain and dysfunction of the pelvic muscles usually resolves reduced libido

  • The scariest part of pelvic pain is the catastrophic thought that it will never go away
  • It is a focus that distract your attention away from your life and with many patients, paints an unacceptable future

  • Depression involves the feeling of helplessness in being able to do anything about what feels critically wrong in one’s life
  • When one is in the throes of pelvic pain, the thought that it will never go away triggers depression in many patients
  • Where doctors cannot help and one sees no light at the end of the tunnel, depression and/or anxious depression is the rule rather than the exception

  • Pelvic pain robs patients of the ability to be fully present in relationship with family and friends
  • Social withdrawal often stems from chronic pain and it can detrimentally affect any enjoyment of the moment
  • There is a major toll that chronic pelvic pain takes on relationships, including the partners of those in pain, such as the patient’s withdrawal from sex, withdrawal from going out and doing things with others, planning trips, parenting, socializing, and doing the normal activities of partnership or marriage

  • Self-esteem almost always goes down when one has pelvic pain because patient’s almost always worry that no one will want to be with them

  • Sleep disturbance is common
  • Many patients wake up anxious, wondering if the pain has gone, disappointed every day that it isn’t
  • Patients either wake up to urinate or because of pain and anxiety
  • We wrote a paper about precipitous rise in cortisol in the morning amongst pelvic pain patients. Cortisol and Men with Chronic Prostatitis– American Urological Association Poster 2007

  • Helplessness and hopelessness is the real suffering with chronic pelvic pain
  • Helplessness comes from a patient’s inability to stop pain/discomfort that is draining and scary

  • Ordinary stresses, as well as extraordinary stress, tend to increase symptoms
  • When stress has triggered pelvic pain, it also tends to trigger the tension-anxiety-pain-protective guarding cycle that continues after the stress has gone

  • Testicular pain/discomfort is particularly miserable and scary
  • Pain/discomfort is felt in one testicle or another
  • Sometimes the cremaster muscles pull up the testicles or penis especially when the anal sphincter is sore and this can be very disconcerting
  • Patients with testicular pain have come to see us who had their testicle(s) removed and their pain remained unchanged
  • Sometimes testicular pain can be distally (far from the center) referred pain from muscles in the stomach and sides, which is confounding and often overlooked by most physicians and patients


WHAT TEMPORARILY CAN HELP:

  • Hot water or heat often helps temporarily
  • Heat sometimes flares up symptoms; patients feel relief using cold packs or ice

  • The family of drugs called benzodiazepines can often relieve symptoms for a few hours and are helpful when used skillfully
  • Benzodiazepines are addictive and when used regularly for pelvic pain, they can lose their effectiveness
  • Benzodiazepines typically make the user tired and should not be used when driving or having to be alert

  • Naps, or vacations can sometimes help reduce pain