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The Evil Triplets – or Angels in Disguise?

By October 3, 2022No Comments

When I attended my first International Pelvic Pain Society (IPPS) conference in 2009, there was a presentation that talked about the “Evil Twins” of chronic pelvic pain (CPP). This included the combination of Interstitial Cystitis/ Painful Bladder Syndrome (IC/PBS) and Endometriosis. A few years later CPP specialists started talking about the “Evil Triplets” of IC/PBS, Endometriosis, and Pudendal Neuralgia (PN). Then came the “Evil Quadruplets” of IC/PBS, Endometriosis, PN, and Irritable Bowel Syndrome (IBS). Then came the acknowledgment of the even bigger picture of the “Evil Quintuplets”, which included all of the above PLUS Myofascial Pain Syndrome (MFPS). What do they all have in common?


Let’s take a moment to briefly define each one of these diagnoses and take a look at the anatomy – notice they are all neighbors!

IC/PBS is when the bladder lining becomes super sensitive from chronic inflammation and, in extreme cases, cause ulcerations in the lining of the bladder (the mucosal layer).

Endometriosis is a type of inflammation that looks and smells (literally) a lot like menstrual fluid, but it grows outside of the uterus and can create rigid connective tissue, adhesions and scarring that aggravate nerves and deteriorates the protective coating on nerves called myelin – and can act like rubber cement in the abdominal cavity, making it difficult, if not impossible, for the organs and ligaments and muscles to move fluidly next to each other. Consequently, movement of the organs (such as the bowels and uterus during menstrual cycles) and surrounding muscles can cause excruciating pain. The strange thing about endo, is that some people can have a little bit of it with tons of pain, and others can have a ton of endo with zero pain. We’re still trying to figure that one out in the research world (but I’m convinced it has everything to do with the brain and history of traumas).

IBS refers to inflammation anywhere along the gastrointestinal track, which can create patterns of constipation, diarrhea, and fluctuation between the two.

MFPS includes the inflammation and associated neuromuscular spasms within the fascia, ligaments, and muscles in the body – especially the pelvic floor.

As discussed in an earlier blog post, the intradisciplinary approach is necessary because of the connection between all of these organ and neuromuscular systems.  It’s always important to rule out more serious diagnoses that could benefit from Western Medicine’s interventions.

We also know that the body is an important messenger in our lives. Therefore, what if these “evil quintuplets” were actually “angels in disguise”? What if our body was trying to tell us something, and the only way the body knows how to express itself is through inflammation, muscle tension, and nerve sensitivity?

We need to dialogue with our bodies, no matter what the ailment, and allow the answers to come into our consciousness.

There is a great book titled The Body Keeps The Score by Bessel van der Kolk, which talks about how all of our stress and trauma is stored on a molecular and cellular level in our bodies. There is a breadth of science that demonstrates that the more fear we are experiencing during an event of injury, the “deeper” the wound and the “louder” the body’s reaction to that injury or event.

Another good book is titled Your Body Knows The Answer by David Rome. This book talks about the importance of dialoguing with the body and allowing ourselves to learn how to “tune in” to what our body is trying to tell us. So how do we do this? Let me start by telling you a story. **Please note that this story may be triggering for some of you because this is an unfortunately common scenario of sexual harrassment.**

I once worked with a young woman who had developed a tumor in the lymph nodes of her neck on one side. The lumps had “appeared randomly” one day, shortly after returning from vacation. She reported a very healthy lifestyle, including daily exercise, yoga, and meditation, along with an organic, vegetarian diet for years. She felt relaxed for the past month because she had chosen to take a long vacation in Hawaii as a reward for herself for completing her dissertation and doctoral degree. She couldn’t think of anything “traumatic” that she had experienced and she didn’t want to go through the surgery that her doctors were recommending.

I gave her the option of dialoguing with her body in two different ways: 1) writing out a script between her and the lymph nodes, or 2) a guided visualization where she imagined sitting with the energy of the nodes around a campfire and having a casual conversation. She chose to write out a script. As usual, the “monkey mind” can get in the way at first, which sounds like the conscious mind doubting the process. She thought she was just “making it up” and that the dialogue “wasn’t real”. I encouraged her to keep going and just allow it to flow. We did a little meridian tapping to shift the fear on the surface – the fear of what she might discover – and neutralize the doubt – the doubt of her intuition, which turns out to be a pattern in her life.

After the meridian tapping and a few breaths with long exhalations, she returned to the script. I had her listening to bilateral stimulation music by Jeffrey Thompson at the same time, to help balance the activity of her brain and calm the nervous system.  After about five minutes, tears started streaming down her face and she buried her face in her hands, and sobbed. After a few moments, she took a deep breath in, and had a long exhalation, and looked at me.

She said, “I know what happened.”  She went on to tell the story of a professor who had kept her in the office after her dissertation defense. He had closed the door after the other committee members left, pulled her close to him and whispered in her ear, “now that you’re no longer my student, I can have you how I want you” and kissed her neck – right in the spot where her lymph nodes were swollen. She reported how her body froze in fear and shock and she didn’t know what to do. Luckily, one of the other committee members had forgotten her purse, so she came back into the office and interrupted the moment. My client took that opportunity to grab her stuff and leave the office with the other professor.  She went on to tell me she wanted to forget what happened and never go back to that school again. She never reported it because she wanted to “forget about it” and she worried she “wouldn’t be believed anyways”.

She reported feeling angry, afraid, ashamed, and disappointed in herself for freezing and not doing more. “I’m a strong woman – I never thought I would freeze like that.” We continued tapping and utilizing an exercise called “brainspotting” to neutralize the images and feelings associated with the event. We thanked her body for reminding her about this trauma and giving her the opportunity to heal that wound, release the shame, and forgive herself (and her body) for not being able to do more in that moment. We invited in the energy of compassion and love to surround her, and to surround the lymph nodes – the part of her body that was holding on to that memory and associated feelings.

One week later, she called to tell me that the lymph nodes had shrunk and the doctors couldn’t explain it. I encouraged her to write a thank-you letter to the body to help “seal the deal” and to continue the practice of dialoguing with the body and listening to her intuition…the “angels in disguise”.

No matter how many imbalances your body is currently navigating, it’s trying to tell you something. The longer you have gone without listening, the more the domino effect can occur, such as the spreading of inflammation, sensitization, and disruption. Nevertheless, your body is always capable of returning to its natural state of wellbeing.

You have an opportunity to begin the dialogue with your body and help support the process of returning to homeostasis through soothing old wounds, old traumas, old fears, old narratives. The body is brilliant in letting us know exactly what we’re holding on to…and what we need to let go of. This doesn’t mean we need to “forgive and forget” – in fact, quite the opposite sometimes.

We want to invite compassion and love and give ourselves the opportunity to offer our younger self the resources we wish we had at the time. Trust that you did the best you could with the resources you had at the time. You always do. There is no linear time-space reality for the brain and body. We can heal the past, and see the benefits of that in the present and moving into the future.

Listen to bilateral stimulation music as you dialogue with your body, either out loud or in writing. This will help support your brain and nervous system as you process difficult emotions and associated memories.

Listen to the angels in disguise in your body – and allow them to guide you.

You have all the resources you need.