Unraveling Pelvic Pain

Pelvic conditions, especially pelvic pain, can be quite disorienting to figure out! The pelvis is this central region in the body, which is the converging point for many different and diverse systems, all supported by the pelvic floor. All these systems not only share the pelvic floor but also share the nerves and the vascular complex and can, therefore, impact one another… Let’s understand these systems one at a time:

• GI system: Your plumbing (intestines) ends in the pelvic region (rectum). The rectum and pelvic floor muscles share the nerves and the blood vessels; so, common gut issues (constipation, Irritable Bowel Syndrome (IBS), bloating, etc.) can directly affect pelvic pain. The pelvic floor muscle, Puborectalis plays a special role in keeping the rectum closed, so we don’t end up leaking the bowel movement! The Puborectalis hooks around the rectum at rest and when it’s time to go, it expands to allow the rectum to open up and eliminate the bowel movement. If this muscle does not work properly, you can either experience ribbon-like bowel movements or constipation. Inflammation in the gut due to IBS can also irritate the pelvic floor muscles, causing overactivity in the muscles that can aggravate your pain.
  
  • Digestion is a tell-tale sign of your gut health and paying attention to your bowel movements is the best way to check whether your gut’s working optimally.

• Urinary System: Your bladder CAN’T function without the pelvic floor muscles. It’s like they are engaged in constant chatter like two best friends (via pelvic/pudendal nerves). Ensuring that your bladder stays happy and healthy is the surest way to calm pelvic pain and vice versa. Pelvic floor muscles hold the tension around the urethra to prevent leakage at rest and allow the bladder to keep filling. Once the bladder reaches its full capacity and is ready to void, the pelvic floor muscles need to fully relax, so that the urethra can open and help empty the bladder. To maintain a healthy bladder, be sure to:
  • Hydrate well consistently during the day
  • Try to stay away from known bladder irritants (caffeine, alcohol and acidic foods)
  • Use the toilet every 2-4 hours (recommended). Remember that either holding the urine too long or urinating too frequently isn’t considered healthy bladder behavior
  • If you find yourself waking more than once at night, try to avoid drinking water for 2 hours before going to bed.

• Reproductive System: Sex hormones (estrogen, testosterone, and progesterone) run the show here, controlling lubrication, pelvic floor muscles’ strength, expandability & quality of the tissue in the vulva & the vagina.
  • Research has shown that the long-term use of combined birth control pills can affect the hormonal availability locally (reduced levels of estrogen &testosterone), making some people more prone to pelvic pain
  • The decline in estrogen levels during early postpartum and menopause is also responsible for reduced lubrication, dryness, itching sensation and in some cases even pelvic pain

• Nervous System: The brain is the ‘supreme boss’... ALWAYS; so, even a minor stressor can trigger existing pelvic pain during a fight or flight state. We know that all pain is processed and created by the brain (the pain is always real!). Our brains take in our past and present beliefs, memories, culture, thoughts, and social environment, while processing a danger signal coming from a body to produce pain. Therefore, it is imperative that you:
  • Identify your stressors
  • Find activities that help calm the nervous system. This can be achieved by either top-down or bottom-up approaches. If you want to understand this at length, then do check out my blog post on top-down and bottom-up approaches.

• Musculoskeletal System: Pelvic Floor is a part of the core, along with the deep abdominal muscle, diaphragm, and spinal stabilizers. It also shares muscles and ligaments with the hips, spine, and abdomen (do read the blog post [placeholder] to understand this in greater detail). It is important to remember that:
  • Weakness or injury in these areas can affect the pelvic region
  • Keeping the neighbors strong and healthy also helps reduce the strain on the pelvic region

The pelvic floor also communicates with the foot, with both performing the function of shock absorbers while walking, running, and jumping. A lack of effort from one means that the other has to work extra hard to compensate. Feet and genitals also sit next to each other in the somatosensory cortex (the region of the brain responsible for receiving sensory information from the entire body), and for that reason, the two have a reason to cross-talk and influence each other.

The human body is so intricately and beautifully designed that we often find ourselves marveling at its interconnectedness. But despite that realization, when it comes to assessing the effect of various systems on one another, we tend to miss out on basic details. The pelvis acting as the point of confluence for diverse systems is the perfect reminder that the optimal way to achieve well-being is when all the systems are working in unison. This might seem like a lot to wrap your head around and I understand that the mere thought of making so many sweeping changes might feel intimidating at first, but trust me once you start seeing the benefits right in front of your eyes, none of this would feel like drudgery!