Facts about Symptoms of
Pelvic Floor Dysfunction (PFD)

Definition of Pelvic Floor Dysfunction
Pelvic Floor Dysfunction is used to describe the difficulty of the muscles of the pelvic floor to tighten and relax normally. Pelvic Floor Dysfunction leads to a variety of somtimes strange and debilitating symptoms.

Common Symptoms
Pain Urinary Psychological
  • Sitting pain
  • Pain during/after sex
  • Genital/groin/perineal pain 
  • Discomfort/relief after bowel movement
  • Pains increases with stress
  • Valium/hot baths/heat temporarily helps
  • Urinary frequency and urinary urgency 
  • Dysuria
  • Nocturia 
  • Reduced urinary stream and hesitancy of urination
  • Reduced libido 
  • Sleep disturbance
  • Anxiety, depression, catastrophic thinking
  • In men erectile dysfunction
  • Helplessness and hopelessness

Click here for more details about symptoms

The Wise-Anderson Protocol treatment for
Pelvic Floor Dysfunction

The Wise-Anderson Protocol, developed at the Stanford University Department of Urology, has treated Pelvic Floor Dysfunction (see below for its different names). The results of our treatment protocol have been published in scientific journals and the results have been shown to help a large majority of patients who complied with its regiment (see published research on the Wise-Anderson Protocol). Our website is devoted to a discussion of pelvic floor dysfunction and a thorough reading of it may be greatly informative to anyone suffering from it. 

Understanding the Pelvic Floor as a cereal bowl



Why it is easy to get confused: The different names of Pelvic Floor Dysfunction

Pelvic Floor Dysfunction can be devastating - often putting a patient's life on hold.

When people suffer from pelvic pain and go to the doctor, they are often given a variety of diagnoses and treatments. This is confusing both to patients and to doctors. Unless you suffer from Pelvic Floor Dysfunction, it is difficult to understand the profound effect it has on patients’ lives. The impact of Pelvic Floor Dysfunction that is not resolved or healed can be devastating—often putting a patient’s life on hold.

Finding help that restores the pelvic floor muscles to normal is often much harder than finding someone who can make a proper diagnosis. Because Pelvic Floor Dysfunction affects such private parts of patients’ lives, most patients have never met anyone who has the problem. 

Different names for Pelvic Floor Dysfunction

  • Chronic pelvic pain
  • Chronic pelvic pain syndrome
  • Levator ani syndrome
  • Prostatitis or chronic prostatitis
  • Prostatodynia (prostadynia)
  • Non-bacterial (abacterial), prostatitis
  • Coccydynia or coccygodynia (tail bone pain)
  • Myofascial pain symptoms often associated with Interstitial Cystitis 

More about Pelvic Floor Dysfunction in which the pelvic muscles are chronically clenched

  • The pelvic floor muscles are the muscles you clench to stop yourself from urinating.
  • In Pelvic Floor Dysfunction sufferers (the kind of Pelvic Floor Dysfunction the Wise-Anderson Protocol treats), these muscles tend to remain chronically clenched interfering with their normal ability to contract and relax.
  • This chronic muscle contraction can cause pain and dysfunction in the basic life functions, such as urination, defecation, sexual activity, sitting, and sleeping

An easy way to understand Pelvic Floor Dysfunction by making a fist

 Imagine if you made a tight fist with both hands for 24 hours straight. 


Now imagine how painful your hands would feel immediately after this prolonged period of strenuous clenching. 


It would be difficult to...

Thread a Needle


Draw very detailed
figures with a pen


Play a precise passage on a piano


Just use your hands normally


Why Pelvic Floor Dysfunction becomes chronic:

How Pelvic Floor Dysfunction takes on a life of its own

Figure 2: In A Headache in the Pelvis describes the Wise-Anderson Protocol for Pelvic Floor Dysfuction

One of the reasons traditional medicine struggles to treat Pelvic Floor Dysfunction is because it often fails to identify and address the tension-anxiety-pain-protective guarding cycle.

In this cycle, chronic tension has shortened the muscles in the pelvic floor and created an environment in which the pelvic floor is functioning like a clenched fist that cannot properly relax and contract. It is common for Pelvic Floor Dysfunction sufferers to feel that their pelvic muscles are chronically contracted despite their earnest intention to relax them. 

How protective guarding perpetuates Pelvic Floor Dysfunction

The pain caused by the chronic contraction of the pelvis triggers a survival instinct in the body to protectively guard itself against the pelvic pain. It is the same instinct that causes the muscles in our body to retract from the pain when we inadvertently touch a hot stove. Similarly, when there is pain in the pelvis, the pelvic muscles tighten up to guard against it.

Unlike the genuine self-protective reflex that causes us to pull our hand away from a hot stove, the reflex to tense up pelvic muscles against pain in the pelvis is dysfunctional because it tightens what is already tight and tends to make the pain worse. 


The Tension-Anxiety-Pain-Protective-Guarding Cycle that perpetuates Pelvic Floor Dysfunction

Anxiety tends to make Pelvic Floor Dysfunction worse

The sore and painful pelvis is usually hypersensitive to anxiety. Anxiety tends to produce increased tension, which then produces more pain, which triggers protective guarding, which then produces more anxiety; thus, the cycle perpetuates.s

In the experiments of Gevirtz and Hubbard, who studied the relationship between electrical activity in myofascial tissue and anxiety, they found that when a needle electrode was inserted into an active trigger point, its electrical activity dramatically increased when the subject was stressed. Remarkably, it normalized when the subject practiced relaxation. Anxiety and the symptoms of Pelvic Floor Dysfunction are often inextricably intertwined. It is for this reason that one of the central methods used in the Wise-Anderson Protocol trains patients in Paradoxical Relaxation, which allows patients to reduce their level of nervous system arousal.

Ending the Cycle

Over time, the chronic tension tends to cause the pelvic floor muscles to become short and form trigger points. Once the tension-anxiety-protective-guarding cycle is established, the tension of Pelvic Floor Dysfunction continues even after you attempt to voluntarily relax the pelvic muscles. Unlike unclenching a fist where there is no self-feeding cycle, you have to interrupt the self-feeding cycle of Pelvic Floor Dysfunction in order for the tissue to become normal. This is no small task when the areas to be treated are up inside the pelvis and have to be accessed vaginally or rectally and the cycle has been present for many years.

The therapeutic goal of the Wise-Anderson Protocol is to give patients the ability to stop this cycle. (See Wise-Anderson Protocol treatment for Protocol for Pelvic Floor Dysfunction)

Detailed description of typical symptoms of pelvic floor dysfunction when the muscles are chronically contracted

Below we attempt to describe more fully the symptoms of Pelvic Floor Dysfunction and the experience of having to chronically deal with it. Most patients with PFD have two or more of the following symptoms.

Symptom Details

Urinary frequency and urinary urgency (the need to urinate too often and hard to hold urination once urge occurs) 

  • For patients, urinary frequency can range from being annoying to debilitating
  • There is typically a feeling of something always nagging in your bladder/urethra/genitals. Typically after someone urinates, they don’t feel ‘emptied’ and have the feeling of having to urinate again even though there is no urine in the bladder
  • The normal relaxation you would feel after urination when you have no pelvic pain is not there
  • Frequency/urgency means you have to always be near a bathroom and sometimes can hardly hold in the urge to urinate
  • If you are in a movie theatre, sports event etc. you usually look to sit in the aisle seat in case the urge to urinate comes
  • Some patients feel that their life revolves around being near a toilet
  • Urinary urgency and frequency can deprive people of sleep because of how often they wake up during the night 

Dysuria (pain or burning during urination)

  • Burning or pain with urination is always disconcerting
  • It is often associated with Pelvic Floor Dysfunction
  • We have observed when the chronic spasm and myofascial contraction of the pelvic muscles in many of our patients is resolved, dysuria is also resolved
  • Sometimes people feel no pain during urination but only after
  • Dysuria can be so painful that urination becomes a large ordeal and sets off further pain 

Nocturia (frequent urination at night)

  • Often this is a major problem because a patient's sleep is so disturbed they are exhausted all the time
  • Exhaustion from sleep deprivation tends to feed into the cycle of tension, pain protective guarding and anxiety 

Reduced urinary stream and hesitancy of urination    

  • In men this is an important symptom to medically evaluate to see whether the source of the reduced stream is from prostate enlargement or other other issues
  • Hesitancy of initiating urination can be worsened when urine is held in longer than comfortable 
  • This is sometimes a contributing symptom to low self-esteem and hypochondriasis especially in younger men
  • Some of our patients have reported their urinary flow has improved after loosening the pelvic floor
  • Some people with muscle based pelvic pain have to wait for a while to get a stream of urine going 

Heat (hot bath or shower, heating pad) helps temporarily

  • Hot water or heat often helps temporarily
  • Cold weather flares up symptoms in some patients 

The Wise-Anderson Protocol can help Pelvic Floor Dysfunction

The Wise-Anderson Protocol for Pelvic Floor Dysfunction is offered in a monthly 6-day immersion clinic in California (read about our monthly clinic).The therapeutic strategy of the Wise-Anderson Protocol focuses on the breaking tension- anxiety-pain-protective guarding cycle described above. We do this by focusing on both the physical and mental dimensions of Pelvic Floor Dysfunction. Physically we train our patients to restore the ability of the pelvic muscles to relax and contract by teaching them to do trigger point release and myofascial release inside and outside the muscles of the pelvic floor (click here for a description of the methodology). To intervene mentally in this difficult disorder, we train our patients in the practice of Paradoxical Relaxation (click here for a description of Paradoxical Relaxation for pelvic pain).