Leading Integrated Healthcare

Pelvic, Bladder & Genital Pain (CPPS)

 

Pelvic Pain Syndrome

Chronic discomfort or pain in the pelvis is commonly only recognised in men, but is frequently seen and often misdiagnosed in women. Now commonly known as CPPS/CP – Chronic Pelvic Pain Syndrome/Chronic Prostatitis

Pelvic floor disorders involve a dropping down (prolapse) of the bladder, rectum, or uterus caused by weakness of or injury to the ligaments, connective tissue, and muscles of the pelvis.

The vestibule is where the vulva (area of the skin on the outside) meets with the vagina. It is an extremely sensitive part of your body and contains the Bartholin’s gland (which produces vaginal lubrication), the urethra (where you pass urine) and a number of the small minor vestibule glands which also produce vaginal discharge.

Vestibulitis was the former term for vestibulodynia. This term is out of date now. It is slightly misleading as it implies that the vestibule is inflamed – hence the term vestibulitis. It is not believed that an inflammatory process in the skin is to blame for symptoms. An excessive sensitivity of the nerve fibres and even, on occasions, overgrowth of the nerve fibres in the area is believed to be responsible for symptoms.

Vaginismus is a continuous prolonged spasm of the pelvic floor muscles that contract in orgasm. A continuous spasm of these muscles can lead to severe pain and make penetration or intercourse impossible. Vaginismus may be a result of various conditions that cause vulvar pain or irritation. It can also be a result of the anticipation of pain or a recollection of a negative sexual experience.

Vulvodynia refers to a disorder of vulvar pain, burning, and discomfort that interferes with the quality of life. No discernible physical lesion other than perhaps some redness of the vestibule is present. The cause can sometimes be attributed to trauma, but in many other cases its origin is unknown.

Pelvic pain is also very common in men. In fact, a recent study from Standford University found that the majority of men diagnosed with prostatitis in fact had pelvic pain syndrome.

We are particularly interested in helping people with pelvic pain. There are many different types of pelvic pain (interstitial cystitis alone has seven categories in TCM), os individualised treatment is important. We have a health model based around the concept of Mind-Metabolism-Myofascia-Meaning, so everybody with a complex syndrome such as pelvic pain will have a programme incorporating support on all four of those levels.

 

Read more about our approach to treatment:

 

Chronic Pelvic Pain Syndrome comes in many guises, and people may have any of the following diagnoses:

  • Interstitial cystitis (IC)
  • Pelvic Floor Dysfunction (PFD)
  • Vestibulitis, vulvodynia, clitorodynia, vaginismus, prostatodynia
  • Non-bacterial cystitis or prostatitis
  • Reproductive pelvic pain
  • Dyspareunia
  • Bladder pain syndrome/interstitial cystitis (BPS/IC)
  • Overactive Bladder Syndrome (OBS)
  • Irritable Pelvis Syndrome (IPS)
  • Urgency-Frequency Syndrome (UFS)
  • Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS )
  • Prostate Pain Syndrome (PPS)
  • Painful Bladder Syndrome (PBS)
  • Endometriosis Associated Pain Syndrome
  • Urethral Pain Syndrome
  • Penile Pain Syndrome
  • Scrotal Pain Syndrome
  • Vaginal Pain Syndrome
  • Vulvar Pain Syndrome
  • Pudendal Pain Syndrome
  • Vestibular Pain Syndrome
  • Clitoral Pain Syndrome
  • Epididymal Pain Syndrome
  • Post-vastectomy Pain Syndrome
  • Perpetual Arousal Syndrome (PAS)

Sources

  • Anderson, Wise et al, Treatment Protocol for Refractory Chronic Prostatitis/Chronic Pelvic Pain Syndrome Using Myofascial Release and Paradoxical Relaxation Training, The Journal of Urology, DOI: 10.1016/j.juro.2010.11.076

Testimonials

Dr Kaplan: Provocative Therapy

In December 2012, as result of a stress at work, I suffered from severe anxiety, fear, panic attacks, tachycardia and insomnia.These symptoms became increasingly severe and were associated with low self-esteem and loss of self-confidence. I consulted my GP who prescribed Citalopram and beta blockers for the tachycardia. The antidepressant did not suit me and I felt worse. I was then referred to Dr Brian Kaplan, to be treated with the ‘Provocative Therapy’. This treatment adapted by Dr Kaplan, is based on the principle that the therapist ask questions covering all aspects of the patient’s life, by exaggerating the meanings of it. During the 1 hour session, the patient experiences a strong reaction, triggered by the ‘Provocative’ input of the therapist. Initially, there is an increased fear with regression to the childhood, associated to strong emotions and sorrow, which may precipitate sobbing. Subsequently, this state is followed by a phase of self-analysis which is more constructive. The ‘provocation’ breaks the pattern of the patient’s own feelings of hopelessness and discomfort. In fact, there is an opening of the self-image and a critical strong desire for change, in response to the provocation, which can be at times, outrageous. I underwent 9 weekly sessions during which I progressively became free from fear. The anxiety and panic attacks reduced significantly and I started to know what I want from my life and became more positive and optimistic. At the end of the 9 weeks, I acquired my self-confidence and self – esteem together with a new approach in my life which initially appeared to me broken and rather useless. The 9 sessions – in my opinion – were sufficient to resolve the initial acute state with anxiety and I felt a person full of interest and happier.  It is more than one year since I started the ‘provocative therapy’ with Dr Kaplan and I have not had any relapse to the original symptoms and discomfort. I strongly recommend this this therapy as a novelty; this is medication- free and can produce resolution of the acute psychological/mental conditions, quicker than the conventional therapies. In order to be successful, it is crucial that the patient collaborates and has complete trust in the therapist. The scientific process of such a treatment is not yet known and /or clarified. However, a number of recent studies in Neurophysiology and Psychiatry have shown the importance of hexogen and endogen stimuli, which can triggers and induce changes in the brain in response to the external inputs, acting via the hypothalamic/endocrine axes. It can be suggested that some of these mechanisms may be involved in the therapeutic process of the Provocative Therapy, but a lot of work needs to be in hand.

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