Pelvic Pain
Why should you worry about pelvic pain? Well, there are so many different types and causes, ranging from hormonal cramps, bladder pain, endometriosis and more. Dr. Anna provides an overview of the most common symptoms and causes of pelvic pain, as well as her own personal experience. Many times it does not involve any underlying illness, however in other instances it may be a symptom of something more serious. Click play below to listen and subscribe to Health is PowHer wherever you listen to podcasts!
I wanted to talk about something near and dear to my heart. This is something I had never even heard of, until I got it.
I had no idea the pelvic area could manifest itself into what is called “pelvic pain syndrome.” This includes painful bladder syndrome with interstitial cystitis, rectal/anal pain, and endometriosis (which can include severe pain around menses outside of what is traditionally known as menstrual cramps).
When I served as the Education and Fellowship Director of an academic integrative medicine program, I had actually created an entire women’s health module on pelvic pain for healthcare professionals as one of the main workshops. I consulted with many women healthcare professionals including physical therapists who treated pelvic pain to develop this educational course.
And then it happened to me.
It was a few days after I received my first mandatory flu vaccination at the hospital. I woke up at 4 am the next day with severe pelvic pain. It was like something ripping apart my insides. I thought something was going to burst inside. I found myself bent over and began to vomit from the pain. After multiple visits and diagnostics tests with my medical team, we came to discover it was indeed “pelvic pain syndrome” (and not something much worse thankfully). That was when I began major treatment with physical therapy, yoga, meditation, emotional purging, bladder numbing instillations, botanicals, acupuncture, medicines, vaginal creams and rectal suppositories to relax the myofascial tissue and the nerves.
I couldn’t have done it without the help of my amazing nurse practitioner who worked with me every step of the way. She really cared, listened to me and always had a plan every month. She titrated the medicines so carefully in order to minimize or prevent side effects. Though I worked very hard at doing my therapies at home to get better (it was nearly a part-time job in the evenings!), she guided me and I think it was honestly her presence and love that really got me through. We will have her on the show!
One of the recipes for success on your healing path is a doctor or provider who really believes in you. And you too must do the work to get there.
So pelvic pain…
What is it?
It is not the typical menstrual cramps that you may get monthly. It is pain that occurs below the belly button even when you don’t have a period. Usually your OBGYN or a pelvic pain urogynecologist specialist can help diagnose it. Diagnosis may be done with a pelvic exam and/or other diagnostic tests to rule out other causes. It can occur with endometriosis and painful bladder syndrome. Painful bladder syndrome is when your bladder feels like you have to go pee all the time, it feels squeezing/tight/pressure/aching/ or even throbbing. Rectal and anal pain can occur with it because it is all part of the pelvic floor.
What is the pain coming from?
The pain can be from inflammation in the tissues and the muscles/fascia/tissue tightening up. Studies have recently shown that it is a “central sensitization syndrome” in which the pain pathways in the central nervous system become WAY overactive. Hence, this is the reason why medications such as tricyclic antidepressants (such as amitriptyline) or serotonin norepinephrine reuptake inhibitors (like duloxetine) may work. These may be prescribed in conjunction with muscle relaxants like tizanidine or baclofen in the form of rectal or vaginal suppositories (since these medications taken by mouth can make you very sleepy and drowsy!).
How do I get the pain to stop?
Ultimately, the most important therapies are the integrative therapies. These include physical therapy, diaphragmatic breathing (see our video link below), acupuncture, emotional release including counseling/journaling/stress coping, meditation, hypnosis, and other self-empowering modalities such as an anti-inflammatory diet and movement therapies.
Practical Tips:
Always seek the advice of your healthcare professional as this is for information only and can’t replace any medical professionals’ advice/management or treatment plan.
Depending on how severe your pain is, medications or bladder instillations/cocktails/apells may be recommended until the pain cycle decreases and the integrative therapies begin to rewire all those pain pathways
Your practitioner may likely recommend physical therapy and it is really important to do these therapies daily and as often as you can. It will feel like a full time job but it is about retraining all those tight muscles and nerve tissue to relax and settle down. Usually physical therapists can teach you correctly how to do diaphragmatic breathing - the breathwork is so important for the movement and the relaxation of the pelvic floor
Emotional release of any stress, anxiety, guilt, fear, worry, anger that is repressed within the body may need to happen - so working with a psychoanalyst, a counselor, a psychologist while journaling daily and discovering your truth is one of the most important aspects of deactivating that pain cycle
Self-massage or myofascial release (that sometimes physical therapists will teach you to do at home) helps desensitize the pelvic area to pain. You know when you hit your elbow on a door for example, you rub it vigorously and that always helps the pain, well that’s really what you’re doing with self-massage - rubbing that area to decrease the pain signals!
Hypnosis and meditation is very powerful at rewiring those pain pathways. Now, I could never meditate or relax my mind well enough until I started reading more about it. I found a mentor to start practicing with me and teaching me how to meditate. Also, I became certified in clinical hypnosis. Now I use it daily, and it has been my regimen that keeps the pain at bay! We’ll talk more about hypnosis too in later episodes (we have so much to get to!)
The gut microbiome, vaginal microbiome, diet and inflammation have been found to be associated with pelvic pain syndromes. A gluten-free diet has been shown in research to improve endometriosis and pelvic pain. Decreasing trans-fats and unhealthy fats (aka the overheated/over cooked and damaged omega-6 fats) and decreased anti-inflammatory fats including GLA (a healthy omega-6 fat from evening primrose oil) and omega-3’s. Seek out high-quality sources of fat (more resources on that to come as well).
Movement therapies such as yoga that also help stretch and release the pelvic tissues/abdominal tissues can decrease pelvic pain as well and improve sexual function!
So those are my top 8 tips with more to come in our pelvic pain series! I can’t wait to share more information with you in the episodes to come.