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ICN PHYSICIAN PROFILES: Dr. Jerome Weiss
Occasionally, the ICN will highlight the work of prominent IC physicians who are on the cutting edge of IC research and treatments. Dr. Jerome Weiss (San Francisco, CA) is a fitting first profile for the ICN and is well known among patients in the SF Bay Area for both his compassion for IC patients and knowledge of pelvic floor disorders.
Dr. Jerome Weiss
The Pacific Center for Pelvic Pain and Dysfunction
1199 Bush St., Suite 650
San Francisco, CA 94109
(415) 441-5800
Dr. Jerome Weiss is the Director and Founder of the Pacific Center for Pelvic Pain and Dysfunction, located in downtown San Francisco. He specializes in a technique called myofascial release, a form of physical therapy used to get rid of chronically hypersensitive nodes in the pelvic muscles and connective tissue, called "trigger points."
This technique, used for years to treat injured muscles, is the cornerstone of a holistic program for pelvic pain and bladder dysfunction. Since the bladder rests on the pelvic floor muscles, and the urethra passes through them, interstitial cystitis and bladder pain may be aggravated when these muscles develop increased tension.
In addition to the close connection of these structures, their nerves are close to the spinal cord, and as such influence each other. This explains the bladder's voiding response to pelvic floor relaxation and contraction. The nerve connection is the reason that a painful input from the pelvic floor muscles to the spinal cord can affect the bladder nerves, causing them to secrete irritating substances that dilate blood vessels, contract muscles, and stimulate mast cell release of a variety of pain producing agents. Some of these substances can even thin the bladder lining, making it more permeable to toxic agents in the urine.
What causes trigger points to form? The muscles become overloaded by chronic or acute strain. Emotional or physical stress, surgery, childbirth, and infections are some of the causes that can make a trigger point active.
Evaluation begins with a thorough history to determine if there are reasons for pelvic trigger points to develop and whether the symptoms fit a typical pattern. Patients are observed and examined to detect whether any abnormalities of the spine, sacrum or attaching muscles could affect the pelvis. Next, Dr. Weiss performs an internal examination, where he applies
pressure to all pelvic muscle groups to determine if there are tender points.
Treatment consists of a five-part program that recognizes the way the pelvis effects and is affected by the entire body. Dr. Weiss emphasizes the patent's mind-body connection as essential to accomplishing long-lasting results.
Treatment includes:
Dr. Weiss is an Associate Clinical Professor of Urology at the University of California at San Francisco and is on the staff at St. Francis Memorial Hospital. He has been in private practice for 30 years and has a special interest in the treatment of pelvic pain. His research led him to conclude that pelvic floor muscle spasm was a major cause of these symptoms.
The Pacific Center for Pelvic Pain and Dysfunction was established so that he could treat these complex symptoms in a comprehensive and effective manner. He has assembled a group of health care professionals who evaluate, treat and instruct patients. They include
physical therapists, a gynecologist, back care specialists, a
psychotherapist, a nutritionist and a biofeedback specialist. - Contributed by Dianne Jacob, June 1997
1. How do the pelvic floor muscles affect the bladder?
The urethra, vagina and rectum pass through and connect to the pelvic floor
muscles. When these muscles tighten as a result of stress or injury, they
pull forward toward the pubic bone and compress the urethra and vagina. The
result is a multitude of symptoms, including urinary urgency and frequency,
and vaginal and rectal pain.
2. How does this muscle tightness cause bladder changes?
When these muscles tighten for long periods of time, they may develop tender
areas around the urethra. The resultant pain signals can theoretically
stimulate the interconnecting bladder nerves and cause them to release
substances that inflame and thin the bladder lining. To date no studies have
been done to confirm this, but some studies prove this particular reflex does
exist.
3. Could myofascial therapy reduce pain and frequency?
Yes. Internal pelvic floor myofascial release techniques consist of
compressing, stretching and occasionally injecting the muscles with an
anesthetic agent to disrupt the cycle of pain and spasm. The contracted
connector tissue and muscle around the urethra can be manually loosened to
decrease urinary urgency and frequency.
4. What is the future research outlook for pelvic pain problems?
I believe the future direction will require going back to the past when patients were viewed in their entirety -- holistically -- rather than by each individual organ. Every factor that contributes to pelvic pain must be identified and treated. These range from stress and anxiety to dysfunction of externally attaching muscle groups, and nutritional and hormonal deficiencies. To achieve long-lasting freedom from symptoms, all of these areas must be addressed with the use of stress reduction, pelvic floor re-education, and the physical therapy correction of any external musculoskeletal and pelvic floor myofascial dysfunction.
5. What is your success rate?
Approximately 25 percent of the 250 patients with chronic pelvic pain problems that I have treated have interstitial cystitis. Most report an improvement in pain as a response to treatment of releasing tight and tender muscles. The urgency and frequency symptoms take longer to resolve, since they are the result of sensitive nerves and tissue changes. Ongoing comprehensive treatment to correct anything that could cause painful nerve
stimulation is necessary.
Speed of recovery is proportional to the length of time that the problem has existed, its severity and other contributing factors. Dr. Weiss has seen more than more than 225 pelvic pain patients and approximately 60 interstitial cystitis patients. Almost all say their symptoms have improved. Some say they are now completely pain free, for months at a time.