Pelvic Pain and Functional Disorders

Female figure, Dogon peoples, Mali, Late 19th ...
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Female pelvic cavity
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Your pelvis, referred to as the Lower Jiao in Chinese  medicine is the area that lies roughly between your hips below the umbilicus (belly button), within the pelvic girdle of the skeleton.  It includes the intestines, rectum, bladder, genitals and their supporting and connecting structural elements like the messentery (connective tissue attaching the intestines), urethera, ureters, muscles holding the structures in place and the external skin.

In men the pelvis includes the penis, testes, prostrate and associated internal organs.

The vestibule is where the vulva (area of the skin on the outside) meets with the vagina, going up to the clitoris. It is an extremely sensitive part of your body and contains the Bartholin¹s gland (which produces vaginal lubrication), the urethra (where you pass urine) and a number of the small minor vestibule glands which also produce vaginal discharge.

The pelvic floor muscles go from the end of the coccyx (tailbone) to the front of your pubic bone. forming a muscular floor to your torso.  The muscles are designed to both tighten and loosen, providing support but allowing a flow that supports walking, and allows you to differentially tighten your urinary, anal and vaginal sphincters. When you always tuck your pelvis, the muscle contracts. A muscle that is usually contracted will tend to shorten, leaving itself unable to be strong enough to stop the flow of urine or to support your spine.It also reduces your ability to move, which is why my flamenco dance teacher used to tell us not to tighten our anus when dancing!  A useful explanatory video by Katy Bowman explains why it may be more important to tone your glutes  to continuously tighten your pelvic floor.

 

Pelvic disorders manifest in a variety of ways, as the various definitions show:

Pelvic Pain Syndrome the overall category of painful pelvic disorders.  It is defined as chronic discomfort or pain in the pelvis.) If untreated it can lead to an overall sensitivity to stimuli from a variety of  even nonsexual sources such as food or herbs.  It often has to do with Liver Blood Stagnation or Phlegm Stasis but can be complicated by a variety of factors including emotions.

Pelvic floor (pelvic support) disorders involve a dropping down (prolapse) of the bladder, rectum, or uterus caused by weakness of or injury to the ligaments, connective tissue, and muscles of the pelvis.  This is generally seen as a form of Spleen Qi deficiency.  The uterus is normally resting in a hammock of ligaments, which suspend it away from the blood supply, the bowels and the bladder.  A uterus can be tilted from birth, from activities that jolt the uterus out of the “hammock” or from having a baby. This can cause pressure on the bladder, causing incontinence, pressure on the intestines causing digestive or elimination disturbances, and can by reducing the blood supply change the vaginal pH, increasing the chance of infections.   Uterine massage can help center the uterus and other organs in the pelvic cavity and remove adhesions, while  properly done squats and pelvic floor exercises help strengthen the pelvic floor.  Visceral manipulation, an osteopathic technique can help as well. Men suffer from a form of organ prolapse as well, especially with abdominal fat.  Acupuncture and herbal medicine to increase Spleen Qi can help reverse prolapses, but exercise is necessary as well.

Vestibulodynia refers to an excessive sensitivity of the nerve fibers and may include an overgrowth of nerves fibers which tend to produce pain either during intercourse or all of the time.  The old term for vestibulodynia is vestibulitis which is slightly misleading as it implies that the vestibule is inflamed. It is no longer believed that an inflammatory process in the skin is to blame for symptoms.  In  Chinese medicine we would look at Liver Heat, Liver Damp Heat or Blood Stasis.

Roman bikini 2
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Vaginismus is a continuous prolonged spasm of the pelvic floor muscles that contract in orgasm. A continuous spasm of these muscles can lead to severe pain and make penetration or intercourse impossible. Vaginismus may be a result of various conditions that cause vulvar pain or irritation. It can also be a result of the anticipation of pain or a recollection of a negative sexual experience.  Acupuncture and counseling can help the psychological issues.  Learning how to do proper squats and to transfer contraction to the glutes can help lengthen the muscles and reduce spasms. It helps not to tuck the coccyx (tailbone.)  Antispasmodic herbs can help as well.

Vulvodynia refers to a disorder of vulvar pain, burning, and discomfort that interferes with the quality of life. No discernible physical lesion other than perhaps some redness of the vestibule is present. The cause can sometimes be attributed to trauma, but in many other cases its origin is unknown.  There may be Liver Qi stagnation or other conditions involved. Acupuncture especially using leg points can be useful.

Urinary Incontinence is a significant problem for a large proportion of the population.  One in five women suffers from urinary leakage which often occurs due to childbirth, episiotomies, excessive tucking of the tailbone and poor posture.  Men also suffer, often in old age.  Sitting excessively can also be a factor since humans were designed for movement and the posture of sitting often compresses the coccyx. In Chinese medicine  terms this weakens the Kidney meridian.  A weak Kidney meridian is associated with low back pain, dribbling urine, morning diarrhea, weak bones, and aging.

Male Impotence can come from prostate conditions (BPH or prostate cancer,) old age (“use it or lose it”), medication side effects, psychological conflicts and depression.  In Chinese medicine terms this can be from loss of Jing Essence, Kidney deficiency, Phlegm stasis, liver qi stagnation and similar issues.  Even excessive sex- losing more essence than can be replenished by nourishment- can ultimately deplete sexual function.  In addition to acupuncture and herbs, the (unfortunately named) Iron Crotch Qigong,  proper squats and male pelvic floor exercises can restore male sexual function.  Note that in Chinese herbal medicine, we seek  to address the underlying condition since herbs that only increase an erection can make the underlying condition worse.

There are a number of things that can help your pelvic health.  First is  walk whenever possible- we were designed to be in motion and sitting puts an unnatural stress on your coccyx.  Although hunter-gatherers probably walked more, we know that the average Amish male walks about 9 miles a day.  A study in the UK showed that most people walk 1 1/2 to two miles per day.  Use negative heels, barefoot style foot gloves or at least flat shoes since raised heels tilt your pelvis and throw your glutes and spine off.  If you sit, get up frequently.  Consider a rocking chair when you are not on your feet.

Black Beans.
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Second is to eat for your underlying condition.  To increase your Kidney Qi, eat foods like black beans, black sesame seeds, toasted pine nuts, shellfish, sesame oil, toasted walnuts, beans, millet, cauliflower lamb, chicken, fish, cinnamon, soybeans, garlic, eggs, lentils, ginger, red wine red,  black or purple grapes, wild rice, imperial black rice, raspberries, spirulina, parsley, onions,  mulberries, trout, salmon and root vegetables.

If you are prone to dampness, phlegm and UTIs or vaginal infections, then avoid dairy, fruit that is not seasonal in your climate, grains, particularly glutenous grains and anything iced or cold.  With prolapse and other Spleen Qi deficiency diseases restrict carbohydrates and choose from foods like quinoa, parsnip, adzuki beans, black beans, pine nuts, garbanzo beans, cooked squash, cooked turnips, oats, rice, cooked cherries, cooked carrots, cooked leeks, mussels, shrimp, cardamom, black pepper, cooked strawberries, ginger, tapioca and custards, cooked yams, cooked onions, cooked rutabagas, cooked pumpkin, cooked peaches, dried litchi, cinnamon, arrowroot, dried figs, nutmeg, sweet potato, garlic and, fennel.

If you have Liver Qi constraint which is common with an emotional issue choose from liver, beef, chicken, mussels, black sesame, kelp, plums, mulberries, celery, nori, lotus seeds, Chinese red dates,vinegar, amasake, beets, coconut milk, garlic, leeks, marjorams, safflower, basil, black pepper, dill seed, ginger, longan fruit, rosemary, scallions, bay leaves, cabbage, litchi, kohlrabi, saffron, peaches, oregano, turmeric, eggplant, chives, chestnuts. and  schisandra berries.  With anxiety, stress cooling foods like lettuce, tofu, mung beans, mint tea and fish.

Qigong which involves twisting or tapping your lower back is good for the kidneys.  So is standing like a tree, envisioning sending roots down from your feet deep into the earth then drawing up nourishment into your “branches.”  If emotions are a significant component of your condition, then rub your elbows across the area under your ribs as you twist to give the liver and the Liver meridian on the opposite side a massage.  You can also massage the web between your big toe and second toe.  There are seasonal variations to qigong practice which can improve your results so it is useful to work with a teacher.

Do your squats.  Pelvic floor exercises should always be accompanied by squats so that you can balance both the lengthening and contracting of the muscles involved.  Otherwise you may have hard rather than strong pelvic floor muscles and may be unable to stop incontinence.

Herballistics -  Leaf Nerve
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Sexual activity is usually helpful unless you have acute pain, spasm or fear of intercourse.  If you are recovering from trauma or an acute pain condition, it can be helpful to start slow:  initially just cuddle in the dark, then the next time massage each other, avoiding the genitals.  Next just touch including genitals but without sexual activity.  Eventually work up to sexual intercourse.  It may help to have an understanding therapist to guide you through this process.

And get acupuncture and herbs prescribed by a trained herbalist for you and your individual condition.  Customized needle prescriptions can reach you at both the physical and emotional levels.  Tailored herbal formulas are worlds away from capsules from the health food store.  Pelvic conditions are far too serious to avoid treating.  Your well-being depends upon it!

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