Do you know someone who struggles with chronic pelvic pain? Unfortunately, you probably do. With roughly one in seven women in the U.S. affected, chronic pelvic pain is as common as migraine headaches, asthma, and chronic back pain. Persistent and often debilitating, it's typically diagnosed after three to six months of discomfort, usually based on your medical history and physical symptoms. 

Despite its enormous prevalence in society, about 50% of cases remain unidentified due to inconclusive imaging and lab tests. In this article, we will discuss pelvic pain disorders, their causes, which lab tests can support patients experiencing this type of chronic pain, as well as integrative approaches to treating these disorders.

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What Are Pelvic Pain Disorders?

Pelvic pain disorders encompass a spectrum of conditions that contribute to discomfort in the pelvic region. Chronic pelvic pain, regarded as a type of chronic regional pain syndrome, is typically diagnosed following a period of three to six months of consistent pelvic pain (1).

The diagnosis is largely contingent on an individual's medical history or physical examinations. Various symptoms or trigger factors can play a crucial role in making the diagnosis. Although imaging and laboratory tests may not definitively diagnose chronic pelvic pain, they are often valuable in identifying co-occurring conditions that may be responsible for the onset of this disorder (1).

One significant aspect of chronic pelvic pain is its classification as a centralized pain disorder. Here, persistent pain over time leads to the body reducing its threshold for pain, leading to conditions like hyperalgesia, where moderate pain is perceived as severe, and allodynia-where normal touch is felt as pain (1).

Often, the roots of chronic pelvic pain are found in previous physical or emotional trauma, leading to a connection with functional somatic pain syndrome. The complexity of chronic pelvic pain and the limited evidence-based treatment options available necessitate a treatment strategy focused on the suspected origin of the pain. This could include managing a comorbid mood disorder, addressing neuropathy, or treating uterine dysfunction (1).

It's worth noting that pelvic pain disorders are not exclusive to women– males can have pelvic pain as well. Such pain may signal an infection or could be a result of discomfort in the pelvic bone or non-reproductive internal organs. In women, pelvic pain can serve as a sign of potential problems with one of the reproductive organs in the pelvic area (2). 

Pelvic Pain Signs & Symptoms

Pelvic pain is a prevalent symptom that arises due to a multitude of underlying conditions. Several conditions can precipitate chronic pain, which includes chronic cystitis, endometriosis, adhesions, or musculoskeletal injury. Strikingly, women experiencing chronic pelvic pain often endure the symptoms for over two years before they seek medical care (1). 

Signs and symptoms associated with pelvic pain may vary but often include (2): 

• Pain in the lower abdomen or pelvis
• Pain during intercourse
• Pain during bowel movements or urination
• Heavy or irregular menstrual periods
• Spotting or bleeding between periods
• Nausea or vomiting
• Fever or chills
• Painful or difficult urination
• Painful or difficult bowel movements
• Pain that worsens during certain activities or movements

Certain symptoms are particularly alarming, indicating the possibility of a systemic disease. These "red flags" include postcoital bleeding, postmenopausal bleeding or onset of pain, unexplained weight loss, the presence of a pelvic mass, and blood in your urine. Red flags often constitute an emergency and should be immediately evaluated (1). 

Possible Causes of Pelvic Pain Disorders 

Pelvic pain disorders are complex due to their varied causes, involving multiple systems and factors.

The reproductive system can contribute to pelvic pain with conditions like endometriosis, ovarian cysts, and pelvic inflammatory disease, as well as pregnancy complications and menstrual cycle symptoms.

Digestive disorders such as irritable bowel syndrome and diverticulitis, urinary system conditions like interstitial cystitis and kidney infections, and musculoskeletal problems, including lower back pain and hernia, can all lead to pelvic pain (2).

Neurological conditions involving nerve entrapment, vascular problems like pelvic congestion syndrome, and psychological factors such as stress disorder and major depressive disorder can also play a part in pelvic pain (1).

Lifestyle factors such as obesity and smoking, along with diet, can further influence the development of pelvic pain. Treatments typically focus on the underlying cause, but symptomatic relief is often prioritized for non-specific pain. Given the multifaceted nature of pelvic pain, a comprehensive approach that includes psychological aspects is essential in management and treatment (1).

Functional Medicine Labs to Test for Root Cause of Pelvic Pain Disorders

When investigating the root cause of pelvic pain disorders using a functional medicine approach, several laboratory tests may be considered. Here are four important labs that can provide valuable insights:

Hormone Testing

This test, by Precision Analytical, analyzes levels of hormones such as estrogen, progesterone, testosterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH), which can pinpoint hormonal imbalances that may be contributing to pelvic pain disorders. Conditions like endometriosis, polycystic ovary syndrome (PCOS), and ovarian cysts all have significant hormonal components that can be evaluated. 

It's also noteworthy that the DUTCH Complete test evaluates hormone metabolites, which can provide additional information on how your body is processing hormones, an aspect critical for conditions like endometriosis. In addition, it also tests for stress and sleep biomarkers, two important aspects for the experience of pain. 

Stool Testing

This test serves as an essential tool for pinpointing digestive complications such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), or infections, all of which could be sources of pelvic pain. 

This test assesses various gut health indicators, including parasites, bacteria, and yeast. Importantly, it also measures zonulin levels, a key marker for detecting "leaky gut." An elevated permeability of the intestine can permit the passage of bacteria and toxins from the gut into the bloodstream, potentially escalating systemic inflammation and pain.

Food Sensitivity Testing 

This test identifies sensitivities or intolerances to certain foods that may be causing inflammation and contributing to conditions such as IBS, which can cause pelvic pain (5). 

Urinalysis

A comprehensive urinalysis can reveal signs of or rule out urinary tract infections, interstitial cystitis, or kidney stones, which are potential causes of pelvic pain.

Additional Labs Tests 

While not a lab test in the traditional sense, a pelvic ultrasound is a key diagnostic tool used to visualize the uterus, fallopian tubes, ovaries, and nearby structures. It can help identify fibroids, ovarian cysts, endometriosis, pelvic inflammatory disease, and other physical abnormalities that might be causing pelvic pain.

Conventional Treatment for Pelvic Pain Disorders 

Conventional treatment for pelvic pain disorders generally encompasses strategies that not only manage symptoms but also address the underlying cause. This approach can involve medication, such as nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation relief, and hormonal medications, like oral contraceptives, to manage conditions linked to hormonal imbalances, such as endometriosis. In some cases, physical therapy, specifically targeting the pelvic floor, might be recommended to improve muscle function and alleviate pain. When specific structural abnormalities or conditions are identified as the cause of pelvic pain, surgical intervention, such as laparoscopy or removal of ovarian cysts, may be considered to relieve the pain and address the core issue (1,2).

Functional Medicine Treatment for Pelvic Pain Disorders

Functional medicine for pelvic pain disorders takes a comprehensive, person-centered approach. Every examination starts with a detailed review of the individual's medical history, lifestyle habits, diet, stress levels, and even environmental influences to focus in on any potential root causes of pelvic pain. The treatment plans are customized, designed around the unique needs of the person in question. These plans can encompass everything from lifestyle modifications and dietary adjustments to the incorporation of supplements, stress management techniques, and specific therapies.

This approach is particularly vital in the context of women's health, where certain types of pelvic pain, often associated with menstruation and pregnancy, are unjustly accepted as a normal part of being a woman. Conditions like severe dysmenorrhea (pain during menstruation) seen in endometriosis and pregnancy-related pelvic girdle pain can significantly affect daily activities, school attendance, and workability.

With increasing evidence that an unhealthy lifestyle is tied to the development and severity of chronic pain, it's clear that lifestyle factors play an essential role in managing pelvic pain. Periods of low physical activity, poor sleep, and stress are common during challenging times in women's lives, such as during menstruation, pregnancy, or the postpartum period, potentially exacerbating pain (15). 

For this reason, functional medicine also emphasizes the importance of balanced hormones and a healthy gut, incorporating testing and treatments to correct any discovered imbalances. Mind-body techniques like mindfulness and meditation might be suggested as part of the treatment plan to help manage the impact of stress on both pain and overall health.

Physical activity and exercise are already supported by current evidence as beneficial for women with pelvic pain (15). 

Nutrition Considerations for Pelvic Pain Disorders

For those dealing with pelvic pain, making changes to your diet could play a significant role in easing discomfort. Here are some of the dietary strategies you might consider:

Embracing a Nutrient-Rich Diet 

Consuming a diet such as the Mediterranean diet, which is rich in various fruits, veggies, whole grains, lean proteins, and beneficial fats, can combat inflammation and improve overall health. Make sure you also get enough probiotics – these have been shown to reduce inflammation, which may, in turn, lower pain. 

Favoring an Anti-Inflammatory Diet 

This diet can mitigate inflammation and related pain by avoiding processed foods, cutting back on refined sugars, and reducing saturated fats. Focus on foods high in omega-3 fatty acids like fatty fish, nuts, and seeds.

Adopting a Low FODMAP Diet 

If you're experiencing pelvic pain associated with IBS, a low FODMAP diet may be beneficial. This diet minimizes the intake of certain carbohydrates that might intensify IBS symptoms like bloating, gas, and abdominal discomfort.

Experimenting with an Elimination Diet 

To pinpoint possible food triggers that could cause inflammation or pain, try an elimination diet. This involves temporarily cutting out potential triggers like gluten, dairy, soy, and triggering vegetables. In a nutshell, an elimination diet involves removing suspected food triggers from your diet for about 30 days to allow your immune system and gut time to recover, followed by methodically reintroducing these foods one by one over three days to observe for any returning or worsening symptoms.

Supplements & Herbs for Pelvic Pain Disorders

In exploring supplements and herbs for pelvic pain disorders, several natural products exhibit potential benefits. For instance, Saw Palmetto, Cemilton, and Quercetin have shown positive effects in men with chronic prostatitis and pelvic pain syndrome. Capsicum frutescens (Cayenne), Harpagophytum procumbens (Devil’s Claw), Salix alba (White Willow Bark), Symphytum officinale L. (Comfrey), Solidago chilensis (Brazilian Arnica), and lavender essential oil also hold promise, primarily for pain management. Furthermore, curcumin and calendula, known for their anti-inflammatory properties, were effective in treating chronic pelvic pain syndrome in clinical trials. Lastly, flavonoids, powerful antioxidants found in fruits and vegetables, showed a statistically significant decrease in pain scores in patients with pelvic pain from pelvic congestion syndrome. 

Complementary and Integrative Medicine for Pelvic Pain Disorders

When it comes to complementary and integrative medicine for pelvic pain disorders, there's a wealth of potential options (24). 

Physical interventions, like pelvic floor physical therapy, have been shown to help with a variety of conditions. Notably, this approach improves relaxation, endurance, and strength of the pelvic floor muscles, benefiting patients dealing with incontinence, pelvic organ prolapses, and other disorders. Manual techniques such as myofascial release and trigger point massage are also getting more attention for their positive results (24).

Acupuncture, a traditional Chinese medicine practice, has shown improvement in chronic pain conditions by balancing the body's qi and blood. It's worth noting that while we need more large-scale studies to fully endorse acupuncture, it's shown some promising results for conditions like chronic prostatitis and pelvic inflammatory disease, among many general pain disorders (24).

Massage, specifically the 'Thiele' technique, has been proven to reduce pelvic pain caused by pelvic floor muscle dysfunctions. Although more robust studies are needed, the existing evidence points to the beneficial role of massage in managing pelvic pain (24).

Osteopathic manipulative treatment, a holistic manual technique, has shown some clinically relevant benefits, particularly for pregnant and postpartum women dealing with lower back pain (24).

Moving to mind-body interventions, yoga and mindfulness-based stress reduction therapies have displayed promising outcomes. Yoga, for instance, has been known to not only improve physical fitness but also improve mood and decrease pain-related disability in chronic conditions (24).

Mindfulness-based stress reduction, along with cognitive behavioral therapy, have been acknowledged for their role in managing the psychological aspects of chronic pelvic pain. These interventions help address the mental health comorbidities often seen in chronic pain patients, and the available research suggests these techniques can make a significant difference in managing pain and improving quality of life (24).

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Summary

Chronic pelvic pain disorders affect a staggering number of individuals, with multifaceted origins making diagnosis and treatment a complex process. However, comprehensive approaches encompassing conventional, functional, and integrative medicine can address these challenges, revealing the root causes of pain and providing individualized treatment plans. Lifestyle modifications, diet changes, and mental health support are essential facets of these approaches, alongside traditional medication or surgery. From functional medicine lab tests to supplement usage, mindfulness practices, and targeted physical therapies, a holistic view of patient care has the potential to not only relieve symptoms but also improve the overall quality of life for those suffering from chronic pelvic pain disorders.