Pelvic pain in women
It is estimated that 15% of women of child-bearing age in the United States have experienced pelvic pain of at least 6 months in duration. Pain can range from acute sudden onset attacks, recurrent attacks of pain that may or may not be related to a woman’s menstrual cycle to chronic persistent pain that lasts longer than three to six months or more. The sensation of pain can be anything from stabbing, wrenching or twisting pain to more mild dull aching. Depending on the severity and chronic nature of pain, it can affect a woman’s overall ability to cope with everyday life. She may experience changes her mental and emotional being which may cause strain on relationships and can affect her ability to work or take care of her children. She may also notice changes to her sleep patterns, her desire to eat, ability to engage in physical activities and motivation in general. Since the symptoms can include everything from the physical to the psychological, a holistic treatment approach such as acupuncture and Chinese medicine coupled with counseling and physical rehabilitation exercises is the ideal approach.
There are several conditions that can lead to pelvic pain, including:
- Endometriosis – a condition in which the lining of the uterus colonizes outside of the uterus on other tissues of the body. This tissue continues to be influenced by the hormones that regulate menstruation in the female body and as such continue to grow in size throughout the month and then slough with menstruation causing bleeding at the site of these tissue deposits.
- Pelvic inflammatory disease – this is inflammation of the female genital tract that can be caused by various infectious agents as well as internal factors and is often accompanied by fever and lower abdominal pain.
- Interstitial cystitis – a urinary bladder condition which is characterised by pain in the lower abdomen or upon urination and increased frequency of urination with a sensation that there is always some urine that has not been expressed or a feeling of pressure in the area around the bladder
- Ectopic pregnancy – this is a serious medical emergency and requires immediate intervention. This occurs when a fetus attaches and develops outside of the uterus.
- Ovarian cyst – a deposit of fluid or inert follicle surrounded by a very thin wall that develops within an ovary. These can range in size from something smaller then a pea to as large as a lemon or orange.
- Inflammatory bowel disorders – these include colitis, irritable bowel syndrome and crohns. The pain experienced with each of these can be persistent but is more commonly experienced in recurrent attacks or flare ups. Food sensitivities and allergies may also contribute to inflammation of the digestive tract and result in pelvic pain.
- Previous abdominal surgery or infection – in the healing process following abdominal surgery or infection, it is possible to have adhesions form between adjacent tissues which can limit movement within the abdomen and cause pain with certain activities.
- Muscular or myofacial pain – this is pain that arises in the musculature of the pelvic area and can be a result of trauma, over use, exercise, child labour and others.
- Cancers – cancers of the reproductive and urinary system are possible and may cause pain depending on the size and area affected.
Diagnosis and treatment
The most important component to the treatment of pelvic and vaginal pain is to take a thorough history and clinical intake. It is important that we understand the symptoms that you experience, if there is a pattern to their frequency or intensity and if other therapies have helped in the past. At Yinstill Reproductive Wellness we do not perform gynecological exams and these are not essential for treatment with acupuncture and Chinese medicine, however if you have already gone for, or are planning to go for an exam please bring these results with you to your appointment.
Pelvic pain can be caused by and related to several conditions.
To investigate the cause of the pain a doctor may order any of the following tests:
- Vaginal examination – your gynecologist with examine both the external and internal tissues of the vagina and surrounding area.
- Hysteroscopy – a scope of the uterus to examine the lining and shape to determine if there is the presence of fibroids, polyps or other abnormal growths. A biopsy can also be done at this time to examine the lining more closely. Minor surgical procedures may also be performed during the hysteroscopy.
- Colonoscopy or sigmoidoscopy – a scope of the bowel and large intestine to determine if there is the presence of abnormal growths or constrictions. Minor surgical procedures may also be performed during one of these scopes.
- Neurological tests – these are performed to determine if the pain is related to the nerves that distribute throughout the pelvis and its organs. Electromyograms (EMG) is usually used.
- Cystoscopy and urinary tests – these are performed to investigate the possible involvement of the urinary system, including the urinary bladder, urethra, kidneys, and chemical make-up of the urine.
- Psychological exam – this may be performed if the pain does not have an organic cause and previous investigative testing came back clear. Following trauma or abuse, psychological intervention or counselling would be beneficial.
Research for pelvic pain and Chinese medicine
- The ACTIV study: acupuncture treatment in provoked vestibulodynia
- Interstitial cystitis patients’ use and rating of complementary and alternative medicine therapies
- Use of complementary and alternative medicine in recurrent vulvovaginal candidiasis–results of a practitioner survey
- Japanese-style acupuncture for endometriosis-related pelvic pain in adolescents and young women: results of a randomized sham-controlled trial
- Chinese herbal medicine for endometriosis