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Why Stress Triggers and Perpetuates Pelvic Pain Symptoms

Even slight amounts of stress can trigger pelvic pain symptoms.

Studies have shown that myofascial trigger points that are found in sore and painful muscles inside the pelvic floor are strongly affected by 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. 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. For this reason, the Wise-Anderson Protocol trains patients with a relaxation method. This 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. The reason is that if you live, for instance, in a marriage where there is ongoing resentment, a work situation in which you deal with frustration regularly, or live with a sense of dread because of a general 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.

We know that when you have pelvic pain symptoms, 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. These 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 an increased level of psychological distress in patients dealing with pelvic pain symptoms 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 patients do not recognize the relationship between their emotional states and their pelvic pain symptoms.

Most people dealing with pelvic pain symptoms are not aware of the significance of 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 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. This is 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 knows the glass as half empty, and suffers from such a viewpoint, it takes an effort to choose the ‘half full’ perspective, because the perspective is so strongly ingrained.

Chronic states of anxiety, fear, dread, sorrow, resentment or anger must be addressed for any real resolution. Unfortunately, at this time, contemporary medicine has not been interested in the profound relationship between pelvic pain symptoms 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 paradigm implied in the treatment protocol for 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 tendency is to be perfectionistic and cannot be reformed. Our protocol is based on the understanding that voluntary efforts to behaviorally change the default tone of the pelvic floor can change to one that is relaxed and at ease. This new understanding asserts that “tight asses” can become “relaxed asses.”

Like the insights of the new paradigm of neuroscience regarding the plasticity of the brain, we propose that the chronically tensed core, including the intestines and pelvic floor muscles, can be trained to be relaxed. We propose that the tendency to brace the viscera under stress can be changed without surgery or drugs. This is done through training in calming a chronically vigilant nervous system. In other words, the chronic tension associated with nervous system arousal can be brought under our voluntary control.

Changing this habitual inner posture is not brought about by drugs or surgery. It can be brought under the control of the patients’ disciplined consciousness. For patients who come to our clinic, the suffering with pelvic pain is what we believe provides the motivation for someone to learn to control catastrophic thinking, an upset nervous system, and the pelvic pain related to them. We are proposing that 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, 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 contracted core.

A gentle approach to breaking the 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 and habitual pelvic tension. 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. It is not the result of a foreign organism in the prostate gland in the case of prostatitis, an autoimmune disorder, or other contemporary explanations.

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 this cycle 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.

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