Anal-Rectal-Tailbone Pain

MAJOR SYMPTOMS WE TREAT

Most of our patients have at least two or more symptoms for painful anal and rectal pain for which they’re seeking overall pelvic pain relief. 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 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

ANAL AND RECTAL PAIN

TREATING CHRONIC ANAL AND RECTAL PAIN WITH THE WISE-ANDERSON PROTOCOL

The Wise-Anderson Protocol (Stanford Protocol) is a treatment that addresses the key physical, behavioral, and psychological dimensions of anal and rectal pain. The Wise-Anderson Protocol was developed over a period of 8 years at Stanford University’s Department of Urology and has documented being able to substantially reduce the symptoms of chronic anal and rectal pain and dysfunction in a select group of people.

DOCTORS GIVE ANAL AND RECTAL PAIN DIFFERENT NAMES

Doctors give chronic anal and rectal pain a number of names depending on what subspecialty of doctor you see. Among them are:

• LEVATOR SYNDROME/SPASM
• PELVIC FLOOR DYSFUNCTION
• COCCYDYNIA
• PUDENDAL NEURALGIA
• CHRONIC PROCTALGIA
• PUBORECTALIS SYNDROME
• PIRIFORMIS SYNDROME
• CHRONIC PROCTALGIA
• PROSTATITIS

The most helpful original article written on the subjects was authored by George Thiele, colorectal surgeon in Kansas in the 1930: Coccygodynia and Pain in the Superior Gluteal Region.

A PELVIC “CHARLEY HORSE”

The Wise-Anderson Protocol is a method that treats anal and rectal pain as a chronic kind of ‘charley horse’ in the muscles in and around the pelvis. This charley horse forms a self-feeding cycle of tension-anxiety-pain-protective guarding. This cycle tends to have a life of its own when left untreated, which is why the condition becomes chronic and doesn’t naturally resolve like most other disorders.

This pelvic ‘charley horse’ is related to the instinct to pull the tail between the legs that occurs in mammals. When an animal is afraid, the muscles of the pelvis tighten, pulling in the tail. While humans no longer have a tail, the pelvic muscles still tighten up in certain individuals who chronically deal with stress. This chronic contraction/spasm in the pelvic floor can cause chronic pain from the area above the pubic bone, through the penis, testicles, perineum, anus, tailbone and low back. This chronic contraction can result in problems with urination, defecation, ejaculation, sitting, and other basic day-to-day functions.

ANAL AND RECTAL PAIN IS BOTH A LOCAL AND SYSTEMIC DISORDER

Relief from anal and rectal pain, 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 anal and rectal pain. 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 treatment is that it does not grasp the fact that anal and rectal pain 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 for pelvic pain relief, anal and rectal pain remains.

Our 6-day clinic, offered throughout the year, is devoted to resolving both the local and systemic dimensions of anal and rectal pain 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 WISE-ANDERSON PROTOCOL AND ANAL/RECTAL PAIN

By repetitively releasing the spasm, trigger points and restriction in the painful pelvic floor/related muscles using our FDA approved Internal Trigger Point Wand, as well as implementing physical therapy based on the work of Travell and Simons, many of our patients have been able to help themselves without having to seek additional professional help.

Though conventional treatment rarely includes a comprehensive effort to reduce anxiety and the upregulated nervous system, the Wise-Anderson Protocol trains patients in regular relaxation of the pelvic muscles and the reduction of nervous system arousal, which is a central component of treatment. Perhaps the greatest suffering with pelvic and anorectal pain is the sense of helplessness patients feel in the presence of their chronic pain and dysfunction. The ultimate aim of the Wise-Anderson Protocol is to empower patients to help resolve their own symptoms through their own patient, skillful efforts.

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 pelvic pain relief. 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) 874-2225.

SYMPTOMS ASSOCIATED WITH CHRONIC ANAL AND RECTAL PAIN

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

Urinary Frequency and Urinary Urgency

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

Sitting Pain

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

Discomfort or Relief After a Bowel Movement

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

Reduced Libido (reduced interest in sex)

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

Anxiety and Catastrophic Thinking

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

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

Anal and Rectal Pain

Pain in the anal sphincter, levator ani and other pelvic muscles above the anal sphincter
Constant or irregular pain that can feel like something is lodged in the rectum
Pressing inside the anal sphincter or above is painful
Pain is typically on one side or another but can be central
Sometimes temporarily relieved by hot baths and benzobiazetis

Conventional Medical Tests Reveal No Disease

Anal manometer test or electromyography sometimes reveals increased sphincter tone
No conventional treatments resolve this syndrome

Constipation/IBS

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
Sometimes (not always) associated with constipation/IBS

WHAT TEMPORARILY CAN HELP:

Heat or Ice

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

Benzodiazepines

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

Rest, Vacation

Naps, or vacations can sometimes help reduce pain