The book A Headache in the Pelvis, by David Wise, Ph.D. and Rodney Anderson, M.D., has been briefly discussed on the AF Support Forum before, and I wondered if any current forum members have read it, have an opinion about it, or have followed the Wise-Anderson Protocol as a treatment for anal fissure.

I'm currently at the point where I feel that I've nearly exhausted the possibilities of conservative treatment for AF, and am faced with the dilemma of choosing some alternative approach - either Botox and surgery, or a pelvic floor-oriented method like the one outlined by the authors of the book, who turn some of the accepted wisdom about the treatment of AF on its head. In one passage, they write:

The surgical concept for anal fissures is based on the peculiar idea that cutting the sphincter is the best way to reduce the tone, tension and spasm in the anal sphincter. While surgery can be successful, there is a risk of short-term and sometimes long-term fecal incontinence.

In the large majority of cases, it is the chronic tension in the pelvic floor, including the anal sphincter, usually combined with diet, anxiety and time urgency around bowel habits that strongly contributes to constipation, anal fissures and hemorrhoids. The chronic pelvic tension, diet, and bowel habits associated with most constipation, anal fissures and hemorrhoids do not come out of the blue. In a word, a person’s mind, body, and lifestyle are involved in the creation and perpetuation of these conditions.

I should add that I have no connection with the book's authors, and my interest is based solely on curiosity and the need to find some form of physical and psychological therapy that works for me - and others.

I can confirm that pelvic floor therapy helped a lot with my pain from the fissure. The internal sphincter doesn't exist in isolation but is affected by the muscles around it. I don't know if it's a permanent solution though.

I guess in a sense it's a case of what one believes will be helpful in bringing about healing and relief from pain. I'm not yet convinced that pelvic floor therapy will really help me, but on the other hand I'm now aware of the limitations of traditional medicine, conservative or surgical, in the treatment of conditions like AF and pelvic floor dysfunction. Being told that the problem is all in one's mind (as one doctor tried to convince me) is no solution, and indeed becomes a source of increased anxiety - while the approach that advocates the mere cutting of a muscle as a solution doesn't necessarily spark much confidence, either. There has to be a method of treatment that combines the physical with the psychological and spiritual, and I'm coming to the conclusion that I am still looking for it.