Why Relaxation of the Pelvic Floor Cannot Be Learned from Stand Alone Recorded Tapes

WHY RELAXATION OF THE PELVIC FLOOR CANNOT BE LEARNED FROM STAND ALONE RECORDED TAPES

David Wise, Ph.D.

Half of the Stanford Protocol for the treatment of prostatitis and chronic pelvic pain syndromes (CPPS), described inA Headache in the Pelvis, involves the practice of Paradoxical Relaxation, a method aimed at the profound relaxation of the pelvic floor. Many people have requested purchasing the relaxation tapes we use as a part of our training in Paradoxical Relaxation and in the last number of years, I have made a decision not to sell these tapes on a stand-alone basis. Numerous relaxation tapes can be bought from many different sources. I certainly could sell the recorded course we use in our training on a stand-alonebasis. To the novice at pelvic floor relaxation, the reason not to sell these recorded lessons by themselves may not be obvious

Chronic pelvic pain has eluded solution for the past century. In an age of enormous technological advance in medicine, pelvic pain remained unsolved and those who have suffered from it have done so with little help from a perplexed medical community.

We have written at length in our book A Headache in the Pelvis that the medical model of this problem is incorrect and that abacterial prostatitis and other related chronic pelvic pain syndromes is not caused by infection or inflammation but by the consequences of chronic tension in the pelvic floor muscles, which over time causes havoc to the delicate nerves, tissues and structure within it. We propose that the treatment for these disorders involves the rehabilitation of the chronically shortened pelvic muscles and the modification of the habit to focus tension in the pelvic floor.

Hence, our treatment of Paradoxical Relaxation and intrapelvic Myofascial/Trigger Point release which is now called the Stanford Protocol.

From my own experience and the experience of treating many patients, that the relaxation of the pelvic floor is no simple matter. The habit of tensing in the pelvic floor is usually very deep. When one has pelvic pain, there is a reflexive biological response to tighten up the pelvic muscles to protect against the pain and this very tightening, whose aim is self-protective, is an important part of the self-perpetuation of the symptoms. Tightening up the pelvic floor is often connected with managing anxiety. In many cases, it is a life-long predisposition where anxiety is hidden in tightening up the pelvis – a response that is very good at hiding one’s anxiety from others, but often at great cost to the pelvic floor.

To learn to relax the pelvic floor, especially in the presence of pain, is an enigma and the method to do this is anti intuitive. Our instinct is to tighten against pain and not to relax with it and yet relaxing with the tension of certain kinds of pelvic pain can dissolve it. Learning to do this is a major event in someone’s life because it is from this place that it can become possible to break the cycle of pain, anxiety, and tension and allow the sore and irritated tissue in the pelvic floor to heal.

To do this requires guidance and instruction with regard to many issues that must be dealt with on the road to the relaxation of the pelvic floor. Among these issues are: what to do with the pain during relaxation; how to not add tension the tension of ‘trying’ to relax tension; what to do when emotions arise that the tension in the pelvic floor is suppressing; how to accept the resistance to accepting the tension; what it means to rest while there is discomfort; what to do when a plateau is reached and tension doesn’t reduce; what to do when symptoms abate during relaxation and then resume afterward; how to overcome the homeostasis of the body being used to pelvic pain, how to bring the skill allowing for a relaxed pelvis into daily life and many more issues are all among numerous other general as well as idiosyncratic issues that arise.

Furthermore, if the muscles in the pelvic floor are shortened due to chronic tension, relaxation of the pelvic floor at best is very limited and at worst not possible… hence our requirement of doing trigger point release and myofascial stretching inside the pelvic floor simultaneous with the relaxation protocol.

The 34 lessons on tape that we use with patients therefore are part of the relaxation protocol and are incomplete without instruction and guidance. The tapes are not a formula. They are a Stradivarius that cannot play itself without instruction from a skilled player. In other words, relaxation tapes that reflect a skillful method of relaxing the pelvic floor are like fine instruments, which require skill and understanding to play. The instrument does not play itself. The tapes do not cause relaxation…. They assist someone who understands how to use them.

I do not have confidence that sending out the course on tape that I use on a stand-alone basis is particularly useful.

I am still pondering how I can make the relaxation protocol more available and am considering a wider video/audio format that I could be comfortable sending out to people. To date I have not figured out how to do this. I believe that sending out our tapes without ongoing instruction and guidance is unlikely to help.

Many people with pelvic pain have tried many solutions from broccoli to magnetic chairs, from zinc and other supplements to electrical stimulation and pelvic floor biofeedback. When I was symptomatic, I tried many things, all of which failed and left me disheartened and discouraged. What I tried had the appearance of helping but in fact failed to help me. Over the years, I have observed many of the same things have failed to help others I have treated.

I have resolved not to offer anything that I believe has no real chance of significantly helping someone. Recorded relaxation instruction without the help of someone who is himself able to relax his own pelvic floor, in my view usually fails and the tapes wind up sitting on the shelf. I do not want to support half measures, which is what I believe using relaxation tapes without instruction are or doing only the physical therapy protocol we describe in our book. Half measures in my opinion give no chance of offering real recovery from this problem. I have decided that if I am to err, I will err in the direction of not offering anything instead of offering a half measure in which I have no confidence.