Your Health

A different approach to pelvic pain


Chronic pelvic pain is not something we like to talk about, yet taboo topics such as incontinence and sexual dysfunction mean that people may suffer in silence for years.

Pelvic pain syndromes can affect anyone. Men, women and even children can be diagnosed with this under-recognized and misunderstood problem.

Among the most common diagnoses associated with pelvic pain are prostatitis, interstitial cystitis, levator syndrome, urethral syndrome, vulvodynia and overactive bladder.

It is often difficult to determine the underlying cause of pelvic pain. A thorough medical examination for gynecological, urological or gastrointestinal origin should be the first step toward diagnosis and treatment. If a medical cause is found, treatment with antibiotics, antidepressants or antiflammatory medication may be warranted. When pelvic pain is not caused by an infection, trapped nerve, autoimmune disorder or degenerative disease, it may be time to explore musculoskeletal involvement.

“A Headache in the Pelvis: A new understanding and treatment for chronic pelvic pain syndromes” (National Center for Pelvic Pain Research, 2008), by Stanford urology professor emeritus Rodney Anderson, M.D., and David Wise, Ph.D., discusses pelvic pain syndromes caused by a chronically contracted pelvis and a treatment modality known as the Stanford Protocol. The Stanford Protocol uses myofascial/trigger point release to relieve this “pelvic charley-horse.”

According to the authors, “Trigger point release is a method of identifying and releasing knots or taut bands in muscles that refer pain either at the site of the trigger point or to a site remote from the actual trigger point. Myofascial release is a name given to stretching the fascia or connective tissue around muscles that over time has tightened up and restricted the muscles that it surrounds.”

The authors claim that more than 70 percent of men diagnosed with prostatitis who did not respond to other treatment found relief when treated with the Stanford Protocol.

The book is written for laypeople to help them relieve their symptoms, however the authors make it clear that this is not a self-help book and patients should consult with professionals competent in the therapy. They also stress the importance of initial medical evaluation to rule out physical illness and pathology. For more information on the book, visit

In “The Pelvic Floor” (Thieme, 2006), editors Beate Carriére and Cynthia Markel Feldt gathered an international team of experts to examine pelvic floor dysfunction from a range of perspectives. The book examines pelvic anatomy, causes of pain and the psychosocial impact of chronic pelvic pain.

The book focuses on a physical approach to therapy and emphasizes the value of evidence-based treatment. Among the treatment modalities discussed are connective-tissue massage, therapeutic exercises, electrotherapy, manual visceral therapy and trigger point release. This book is intended for physiotherapists and physicians, but anyone interested in the topic will find it increases understanding of the condition and aids in the search for effective treatment.

Also written for professional therapists, yet of interest to many, is “A Massage Therapist’s Guide to Lower Back and Pelvic Pain” (Churchill Livingstone, 2007). While most of the book deals with nonspecific low back pain, there is an excellent chapter on pelvic pain and an in-depth discussion of pelvic pain caused by trigger points and “drag” on the body caused by sagging organs or adhesions.

Authors Leon Chaitow and Sandy Fritz believe this type of pelvic pain can be relieved through appropriate soft-tissue treatment. Diagnostic tests are described in detail, and graphic features are the highlight of this book. Anatomical illustrations show the complex systems of muscles, ligaments and fascia that support pelvic organs during movement and rest. Illustrations provide good instruction for massage and exercise techniques aimed at relieving low back and pelvic pain. Photographs also show therapists at work.

These books are available at the Stanford Health Library. To learn more about chronic pelvic pain, visit the library in person, call or send an e-mail. Research assistance and customized information packets on medical conditions and treatment are available free of charge.

The Stanford Health Library has three locations: the Stanford Shopping Center near Bloomingdale’s, on the third floor of Stanford Hospital and on the main level of Stanford’s new Cancer Center.


Nancy Dickenson is head librarian at the Stanford Health Library. For more information, call 725-8400 or e-mail [email protected]

Lecture on pelvic floor disorders


As part of Stanford Health Library’s ongoing Community Lecture Series, Stanford physicians Kim Rhoads, M.D.; Eric Sokol, M.D.; and Craig Comiter, M.D., are scheduled to discuss “Pelvic Floor Disorders” 7 p.m. April 9 at Tresidder Union on the Stanford University campus.

For more information or to register, call 498-7826 or visit http://

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