Pelvic Pain Symptoms
Pelvic Pain Syndromes and their Treatment in Men & Women
Chronic pelvic pain syndromes have been a puzzle to the best medical minds for a century. Antibiotics, anti-inflammatory drugs, pain medications, surgical procedures in men and women and prostate massage in men which form the backbone of traditional treatments, have been of little use in dealing with these debilitating afflictions. In A Headache in the Pelvis, we describe a new treatment protocol developed over a period of 8 years at Stanford University’s Department of Urology that has stepped out of the box of conventional medical treatment. It involves a treatment that has been successful in substantially abating or resolving the symptoms of pain and dysfunction in a select group of patients with chronic pelvic pain syndromes. This protocol is based on a new understanding that chronic pelvic pain syndromes are caused by a chronically contracted pelvic floor that has made an inhospitable environment for the organs and tissues found within it.
Typical Symptoms of Muscle Based Pelvic Pain
Note: most men or women with pelvic pain have 2 or more of the following symptoms:
- Urinary frequency (need to urinate often, usually more than once every two hours)
- Urinary urgency (hard to hold urination once urge occurs)
- Sitting triggers or exacerbates discomfort/pain/symptoms
- Pain or discomfort during or after ejaculation
- Discomfort/aching/pain in the rectum (feels like a “golf ball” in the rectum)
- For men: discomfort/pain in the penis (commonly at the tip or shaft)
- For men: ache/pain/sensitivity of testicles
- For women: pain inside or outside the vagina
- For women: pelvic pain related or unrelated to menstruation
- Suprapubic pain (pain above the pubic bone)
- Perineal pain (pain between the scrotum and anus)
- Coccygeal pain (pain in and around the tailbone)
- Low back pain (on one side or both)
- Groin pain (on one side or both)
- Dysuria (pain or burning during urination)
- Nocturia (frequent urination at night)
- Reduced urinary stream
- Hesitancy before or during urination
- Reduced libido (reduced interest in sex)
- Anxiety about having sex
- Pain during and/or after intercourse
- Discomfort or relief after a bowel movement
- Anxiety and catastrophic thinking
- Social withdrawal and difficulty in intimate relations
- Impairment of self-esteem
The Wise-Anderson Protocol involves the coordinated treatment of a physician, psychologist, and physical therapist. Successful results are largely dependent upon the willingness of the patient to actively comply with the regimen described in A Headache in the Pelvis for an extended period of time. This is in contrast to the conventional form of medical treatment which looks to a solution by drugs or surgery with minimal participation of the patient. The solution to this vexing condition is neither quick nor easy and requires a large expenditure of effort. Our patients are typically people who have had pain and dysfunction for years, have seen numerous doctors, and have unsuccessfully used the conventional treatments.
We have established these monthly 6 day clinics to allow us to treat in a 6 day period patients who live far away. They are the most effective and comprehensive form of the treatment available described in A Headache in the Pelvis. Also, watch the video below where one of the co-authors Dr. David Wise explains the treatment of pelvic pain in men.
Perhaps the greatest suffering for patients with pelvic pain syndromes is the sense of helplessness that patients feel in the presence of their pelvic pain and dysfunction. We are not able to help everyone we treat. When we are successful in helping people with this problem, we are able to give them tools to reduce or abate their symptoms. When the treatment is successful and participants comply with the home practice portion of the protocol, some clear reduction of symptoms is usually seen within a period of three to four months. Stable reduction or resolution of symptoms can take several years and in many individuals who respond to our treatment, improvement continues with the use of the protocol.
These clinics train participants to do self-treatment at home. They are done in a small group and consist of approximately 20-30 hours of treatment over the period of 6 days. The content of the workshops consists of:
Individual medical evaluations are done by the urologist associated with our clinics prior to the intensive program, at which time the nature of the condition of the participants will be evaluated and the appropriateness of the treatment protocol determined.
Training in Paradoxical Relaxation is done over a period of 6 days. A yearlong 52 lesson audio course in Paradoxical Relaxation is an integral part of the protocol and instruction during the clinic is geared to training participants to use the recorded lessons of the course at home. Specific cognitive strategies for reducing the impact of frequent negative/catastrophic thinking that accompanies chronic pelvic pain syndromes are part of the curriculum.
Participants undergo a specific form of physical therapy consisting of pelvic floor related Trigger Point Release developed for chronic pelvic pain syndromes and physical therapy self-treatment instruction on a daily basis. When a partner is available and willing, the partner can receive instruction in the Trigger Point Release geared to the treatment requirements of their partner. This attendance and instruction of partners is included as part of the clinic cost. The intention of this training is to train participants to self-administer the physical therapy component of treatment at home on a regular basis. Patients receive a map of their trigger points and areas of restriction.
Participants receive information and recommendations on different aspects of treatment of pelvic pain syndromes.