Chronic pelvic pain (CPP) is experiencing pain in the region between the belly button and mid-thigh for longer than three months. CPP involves and affects all of our physical systems: gynecology, urology, gastrointestinal, neuromuscular, physiatry and physical rehabilitation medicine, pelvic floor physical therapy, pain management, and â€“ my personal favorite â€“ the brain and the mind-body connection.
CPP affects more than 30 million females in the United States, and an unknown number of males. Only 30-50% of patients are accurately diagnosed, and even less receive adequate treatment. For those who do, it often takes 5-7 years before they find a provider that guides them on an effective healing path.
Whatâ€™s the deal, yo?!
One of my biggest frustrations is the lack of adequate training, useful funding for research, and apparent disinterest in providing the resources needed to boost not only our understanding, but our confidence in our ability to treat CPP. As a Board Member of the International Pelvic Pain Society (pelvicpain.org), professionals want to attend scientific meetings, but most feel allergic to the conversation of pain, let alone sexual pain. Comparing the amount of funding and sponsorship we get compared to other similar conferences, such as PAIN Week and ISHWSH, we discover that pharmaceutical and corporate companies prefer to offer money towards pain and sex, but not when the two are combined.
Painful sex = no fun = no funding.
On the contrary, my colleagues at the IPPS are the most incredible, fun, loving, compassionate, and willing-to-work-as-a-team professionals Iâ€™ve ever encountered. Once you understand how itâ€™s all connected, it becomes a fascinating, challenging, yet simple jigsaw puzzle to recreate and inspire the body to return to its natural state of wellbeing and homeostasis.
Start by ruling out the obvious: the organ systems. Then move to the nerves and muscles â€“ did you know there are nerves and muscles in the pelvis? Youâ€™d be surprised how many physicians seem to â€œforgetâ€ this. Granted, they are taught to zoom in and look at their organ system, and if they rule out the big dangerous stuff, then they point their finger at the organ next door.Â
Then we need to remember that scans and tests donâ€™t necessarily look at how these body parts function. You canâ€™t see a muscle stuck in spasm or a nerve mis-firing on an x-ray, cat scan, or MRI. Furthermore, these tests donâ€™t show you the emotional and mental state of the person (affects the entire autonomic nervous system = the overall function and coherence of our physical systems). These tests also donâ€™t show you the past traumas, stressors, and learned experiences this person has absorbed, perceived, and filed away for reference.
Everything is connected â€“ and itâ€™s all connected in the pelvis. The pelvis is the main stabilizing machine of the body physically and functionally. We use the pelvis to move, sit, stand, pee, poop, procreate, and just about everything we do. The stuff inside the pelvis is always working: digestion, lymphatic drainage, reproductive organs, kidney and bladder function, andâ€¦drum roll please..the vagus nerve. Iâ€™ll talk more about the vagus nerve in a later blog. For now, know that the pelvis holds many of our vital organs that fluctuate in function and health based on our emotional and mental states. For example, stress creates the release of cortisol, increasing inflammation all over the body and specifically within the gastrointestinal system. This inflammation is spread through our circulatory system (the blood) to the brain, creating brain inflammation.
Brain inflammation leads to more fluctuations in our ability to emotionally self-regulate, which creates mental health symptoms such as anxiety, depression, obsessive-compulsive disorder, attention and focus impairments, and much more. Consequently, the autonomic nervous system remains in â€œfight-or-flightâ€ mode, which keeps the cycle going, stimulating the vagus nerve to create sensitivity in the pelvic nerves and spasms in the pelvic floor muscles. Therefore, we need to calm the system from all angles.Â
CPP requires an intradisciplinary team, which means not only seeing multiple different providers, but also providers that will work together in collaboration and support of all the other members. Furthermore, the multi-disciplinary care needs to be simultaneous for optimal effect and sustainable results. Yes, that means you may need to experience pain education, training in relaxation techniques, pelvic floor physical therapy, and other medical interventions all at the same time. Yes, itâ€™s a lot of appointments and youâ€™ll feel like you need a separate calendar just for your self-care regimen.
Yes, itâ€™s worth it.Â
Research demonstrates that when CPP patients receive effective, accurate, and simultaneous interdisciplinary care, they save more time and money in the long-run.Â
Another way to think of this â€“ utilizing the metaphorical approach I discussed in last weekâ€™s blog â€“ is to think of being a gardener. As a gardener, you need to manage the amount of sunlight, water, fertilizer, pruning, weeding, and positive vibes around a plant for optimal growth. Yes, all gardeners will speak to the difference in vegetation and fruit production based on these variables, including the â€œpositive vibesâ€. Plants will grow faster, stronger, and â€œhappierâ€ when the gardener is kind and loving. When a plant is in an environment of stress and negativity, it grows slower, weaker, and doesnâ€™t produce the same results, and sometimes not at all.Â
The garden of your mind is a major variable for healing CPP. You can start healing your system right now by planting seeds of positive intention, enjoying long exhalations, and imagining what healing looks like and feels like for you.
Encourage your healthcare providers to seek expert training in CPP by attending this yearâ€™s annual conference by the International Pelvic Pain Society in Orlando this Fall! I currently Chair the pre-conference Clinical Foundations Training Course, where I am joined by top faculty in multiple disciplines to teach how to:
assess and effectively treat chronic pelvic pain
how to create your â€œA-Teamâ€ to provide interdisciplinary care and prevent burnout
and learn about the main disciplines involved with chronic pelvic pain: gynecology, urology, gastrointestinal, neuromuscular, physiatry and physical rehabilitation medicine, pelvic floor physical therapy, pain management, and â€“ my personal favorite â€“ the brain and the mind-body connection.
CPP is a complex, multidimensional manifestation of the culmination of everything you have experienced. Itâ€™s possible to treat it and heal it. It requires your curiosity, compassion, persistence, and dedication to one main thing: your greatest self and your greatest life.
Itâ€™s worth it. Youâ€™re worth it.
If youâ€™re reading this blog, youâ€™re already on your way!
More helpful information can be found in my new book: Hello, Down There: A Guide to Healing Chronic Pelvic and Sexual Pain. Available next week on Amazon!Â Sign up HERE on my website for updates on my book release.