It is one of the most common but least talked about medical conditions. Chronic pelvic pain (CPP)–dull aching, cramping and/or sharp pains in the area between the navel and the hips–is mostly thought of as a woman's disorder. But men account for approximately 20% of the 11 million Americans who suffer from CPP.
It's a tricky condition to diagnose because the symptoms-which in women and men may include painful intercourse, difficulty sleeping, low energy and/or alternating constipation and diarrhea-can be caused by many different conditions, such as endometriosis in women... or prostate enlargement in men. In both women and men, infection of the urethra or bladder and food sensitivities can trigger CPP.
And even though the condition is chronic-that is, lasting for six months or longer-it might wax and wane daily...or you might have a weeklong flare-up after a pain-free month.
Where To Start?
Every woman with CPP symptoms should see a gynecologist, who will perform a thorough pelvic exam to look for such problems as abnormal growths and tension in the pelvic muscles. Men affected by CPP symptoms should be seen by a urologist. Specific testing will depend on what your physician findsor suspects-during the initial exam as the underlying cause of CPP.
Examples: Ultrasound to examine the organs for abnormalities such as ovarian cysts in women and prostate enlargement in men...and laboratory tests to look for infections. In some cases, a woman may also undergo laparoscopy, the insertion of a thin tube into the abdomen to look for endometriosis.
Some patients get relief once the underlying problem is identified and treated, but many patients don't.
Reason: Within just months, CPP can trigger sometimes permanent changes in the spinal cord that allow the persistent passage of pain signals to the brain-even when the underlying cause of the pain has been corrected.
The Next Step
Patients with CPP can improve with conventional treatments (such as the use of painkillers or surgery to remove growths), but these approaches won't necessarily give them the greatest odds of adequately relieving their pain.
Better: Taking a complementary approach that combines conventional and alternative treatments.
Best therapies to try–in addition to mainstream treatments…
- Relax trigger points. Most women and men with CPP have one or more trigger points (areas of knotted muscle) somewhere in the pelvic area-for example, on the lower abdomen or on the upper thighs. Trigger points themselves can be excruciatingly painful and can transmit pain throughout the pelvic region.
Example: Vaginal pain could be caused by a trigger point elsewhere on the pelvis.
Massage therapists are typically trained to identify and treat trigger points. Simply pressing on one of these points for 20 to 30 seconds–and repeating the pressure several times during an hour-long massage–can relax the tension and help ease the pain. Having a weekly massage for several months sometimes can eliminate symptoms of CPP.
To find a massage therapist who specializes in trigger point treatment, go to www.massage therapy.com, click on "Find a Massage Therapist" and select "Trigger Point Therapy."
Drawback: Pressure on a trigger point can be painful. You can get the same relief, with less discomfort, with electroacupuncture. Two or more hair-width acupuncture needles are inserted into the skin above the trigger point. Then, a mild electrical current is administered, which causes the muscle to relax.
Treatment for CPP will typically require about six to 20 sessions of electroacupuncture. Many acupuncturists are trained in electroacupuncture. However, because the technique is less well-studied than standard acupuncture, it may not be covered by your health insurer. Electroacupuncture typically costs about $70 to $100 per session.
Electroacupuncture should not be used on patients who have a history of seizures, epilepsy, heart disease, stroke or a pacemaker.
- Try standard acupuncture. Even if you don't have trigger points, acupuncture is among the most effective treatments for CPP. A study of 67 women who had bacterial cystitis (infection of the bladder wall that commonly causes CPP) found that 85% of them were virtually pain-free after receiving 20-minute acupuncture sessions, twice weekly for four weeks. Reinfection rates were also reduced.
Acupuncture is believed to help block the transmission of pain signals. It's also an effective way to reduce muscular as well as emotional stress, both of which increase all types of chronic pain. Most CPP patients will need 10 to 20 treatments. Acupuncture is often covered by insurance.
- Identify food sensitivities. Many women and men with CPP are sensitive to one or more foods, particularly wheat and dairy. What happens: When these patients eat "problem" foods, they have increased intestinal permeability, also known as "leaky gut" syndrome. Large, undigested food molecules that are normally contained within the intestine pass into the bloodstream, where they trigger the release of inflammatory chemicals that can cause pain throughout the body and in the pelvic region, in particular.
A blood test known as ALCAT (antigen leukocyte cellular antibody test) can identify specific food sensitivities. Although it is reasonably reliable, the test usually isn't covered by insurance because it is considered an “alternative" diagnostic tool. It costs about $400.
Another option: An elimination-challenge diagnostic diet.
What to do: Quit eating wheat, dairy and other likely food triggers, such as soy, wine and sugar, for 21 days. If your symptoms improve, at least one of the foods was a problem. Then, reintroduce the foods, one at a time over a period of weeks, to see which food (or foods) causes symptoms to return.
Patients may get frustrated, initially, because they feel like there are few foods left to eat, but many of the foods that they give up during the test will turn out to be harmless. Foods found to cause problems should be given up indefinitely.
- Take probiotics. Because infections, such as those described earlier, are a common cause of pelvic pain, patients often receive multiple courses of antibiotics. Antibiotics eliminate infection, but they also kill beneficial bacteria in the intestine. This can lead to digestive problems such as irritable bowel syndrome and leaky gut syndrome-both of which are linked to CPP.
Topical Pain Relievers May Cause Burns
Topical pain relievers may cause burns even after just one application. Over-the-counter creams, lotions, ointments and patches for joint and muscle pain often contain menthol, methyl salicylate and/or capsaicin, all of which can irritate skin. Some users reported a burning sensation, swelling, pain and skin blistering within 24 hours of use. Tightly bandaging or applying heat to areas treated with these products may increase risk.
Helpful: A daily probiotic supplement with a mix of at least 10 billion live, beneficial organisms, such as Acidophilus and Lactobacillus. A probiotic supplement should be taken indefinitely.
Also helpful: Glutamine-100 mg to 200 mg, taken twice daily until symptoms improve. It nourishes the cells that line the intestine and can help prevent leaky gut syndrome. People with liver or kidney disease should not take glutamine.
Caution: Do not take a B-complex nutrient if you're suffering from CPP. In my practice, patients who take B vitamins have more CPP symptoms for reasons that aren't clear.
- Learn to relax. Emotional stress doesn't cause CPP, but people who are stressed and anxious tend to be more aware of their pain. Women and men who practice stress-reduction techniques-such as deep breathing and meditation-report about a 50% reduction in CPP symptoms, on average.
Very helpful: Yoga. It is probably the best workout if you have CPP. That's because it relaxes muscle tension as well as trigger points... increases levels of painkilling endorphins...and promotes overall relaxation