One of the many shared common motivations we discovered soon after founding the New Medicine Group was a mutual interest in the very poorly recognised area of unexplained pelvic pain. It was clear to us that there were tens of thousands of women in particular experiencing very significant lower abdominal pain, for which there was no diagnosis or no treatment, and often both.
A Headache in the Pelvis
A Headache in the Pelvis is the name of the book by Dr David Wise, and describes the protocol devised by Stanford University, Department of Urology for the treatment of pelvic pain and prostatitis. It’s the most thorough published work on this area of medicine. We like it because it comes to the same conclusion we have! There are many potential causes for pain or discomfort in the lower abdomen or pelvis.
Some of them are obvious, easy to diagnose and either self-limiting or relatively easily treated using a holistic approach. Others are complex combination of problems, often impossible to diagnose definitively conventionally and resistant to most forms of medical intervention. In the majority of cases, the problems are quality-of-life threatening, rather than life-threatening, but I always advise appropriate testing to try and eliminate serious possibilities.
It is painful!
The range of symptoms people present with is quite broad, but pain is always present, associated with urination or sex, or there may just be some discomfort much of the time. The start of the symptoms, frequently linked in with the menstrual cycle, can usually be linked to a specific event such as an infection or traumatic experience.
A visit to the GP results in a prescription which is ineffective, or only works for a time (usually antibiotics). Referral to a Urologist or Gynaecologist follows, with many tests, procedures and diagnoses, but the symptoms ultimately persist. When the bladder is primarily involved, chronic cystitis or non-bacterial cystitis (interstitial cystitis) is usually the diagnosis, with long-term antibiotics being prescribed, even in non-bacterial cases.
Patients tell me these often help reduce the symptoms but seldom eliminate the problem. Tricyclic antidepressants or antihistamines are also frequently prescribed, although there is no conventional explanation for why these work. A procedure to stretch the bladder may also be offered, but my experience of this is that it seldom seems to help and can make you feel worse. Therefore, Irritable Bladder Syndrome can be the best description for some of these recurring but diagnosis-eluding symptoms. When the pain is associated more with the genitals, the diagnosis can be vestibulitis, vulvodynia, thrush, vaginitis or vaginismus, amongst others. In men, it is referred to as penidynia or often simply penile pain or maybe Peyronie’s disease and is often, but not always associated with erection.
What’s the answer?
Well, it depends. The right combination of help and self-help is essential in most cases, but it is not always easy to know exactly what that combination is, at least on the initial consultation as a thorough understanding of the symptoms and the person who has them is required. However, we know there are some common practices likely to be involved for many people suffering with pelvic pain and that certain actions are likely to change these. Learning to breathe! Breathing, unlikely as this may sound, is one of the primary issues associated with pelvic pain, either as a cause or a side-effect.
This is not so strange when we understand that the pelvic floor is much like the respiratory diaphragm, and moves, or at least should, in close association with it. If one is not moving properly, the other becomes stuck, so one being effected can start to involve the other over time. When any diaphragm becomes less mobile, the connective tissue and muscles associated with it will develop painful areas. Also, poor breathing has a fundamental affect on the physiology of the body, leading to muscle spasm, lowered pain tolerance and constriction, as well as increased stress levels in general.
The other aspect we find is frequently involved is trauma. A higher proportion than normal of people with pelvic pain mention some form of traumatic experience when questioned carefully. This can range from physical trauma such as a car accident to an emotional one such as a shocking bereavement or abuse. The understanding of trauma has development significantly over the last ten years, and there is now much more to offer people who have experienced something traumatic, including some of those who have pelvic pain.
- Guidelines on Chronic Pelvic Pain (2009). M. Fall (chairman), A.P. Baranowski, S. Elneil, D. Engeler, Hughes, E.J. Messelink, F. Oberpenning, A.C. de C. Williams. EURURO-3176; August 31, 2009
- van de Merwe JP, Nordling J, Bouchelouche P, Bouchelouche K, Cervigni M, Daha LK, Elneil S, Fall, M, Hohlbrugger G, Irwin P, Mortensen S, van Ophoven A, Osborne JL, Peeker R, Richter B, Riedl, C, Sairanen J, Tinzl M, Wyndaele JJ. Diagnostic criteria, classification, and nomenclature for painful bladder syndrome/interstitial cystitis: an ESSIC poposal. Eur Urol 2008;53(1):60-7.
- Chronic Pelvic Pain and Dysfunction: Practical Physical Medicine. Leon Chaitow, Ruth Lovegrove Jones Churchill Livingstone 2011
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