Pelvic and Muslcular Pain?

Many patients do not realize that pelvic pain can actually be due to muscle problems in the abdominal wall or even back problems of the spinal discs or bones that are referred or perceived as being in the pelvic area.

This type of pain is broadly categorized as myofascial pain. Some doctors fail to thoroughly evaluate this possibility as a cause of chronic pelvic pain.

How can pain actually be "referred" from another site to the pelvis?

The spinal cord is a complex electrical connection system. The nerve roots of the spinal cord send off neurons that sense pain from skin, muscles, bones, ligaments and internal pelvic organs.

The same spinal nerve roots that innervate the ovaries
may also innervate abdominal wall muscles. Low back pain can
arise from pain in the uterus, bladder, fallopian tubes, and
cervix because the same nerves innervate those organs as well as
the lumbar discs, ligaments and muscles. Conversely, abdominal
wall pain, especially around an incision, may actually feel as if
it is arising from the uterus or deeper in the pelvis when its
origin is from the skin near an incision. Neurologists think that
sometimes the spinal cord just gets confused when there are many
pain impulses coming in and by the time your brain perceives the
pain, it cannot tell whether the source is in the internal organs
or the external muscles.

There are also internal muscles lining the pelvic bone such as the piriformis, puboccocygeus, obturator internus and externus muscles. The muscles can present with cramps and achiness and a patient perceives the pain as uterine or ovarian.

How is musculoskeletal pain differentiated from pain arising in the pelvic organs?

Certain questions help to categorize the pain as more likely to be musculoskeletal in origin rather than urogenital organ in origin if:

* you have a history of musculoskeletal injury to the back, hips or knees.
* your occupation is sedentary or labor intensive.
* you have repetitive musculoskeletal or postural stressors.
* physical activity worsens or lessens the pain.
* positional changes (lying to sitting, sitting to standing) worsen or relieve the pain.
* the pain changes with the time of day.
* there is noticeable muscle weakness or numbness or tingling.
* there is a history of inflammatory or collagen vascular disease such as rheumatoid arthritis or lupus.

On physical exam, what findings suggest musculoskeletal dysfunction?

If there is any abnormal curve in the spinal canal such as a curvature to the right or the left (scoliosis), excessive curve of the thoracic spine like a hunch-back (kyphosis) or increased arching of the small of the back (lordosis), these changes make it more likely for the pain to be musculoskeletal.

The doctor will also have you lie flat on an exam table,
raise your knee and will rotate the knee from side to side
to see if any of the internal and external hip rotators are
tight and cause pain with rotation.

Next you will be asked to bring the one knee up to the
chest. If the straight leg whose knee is not being raised comes
up off the table or gives pain, this means the iliopsoas muscle
and/or the rectus femoris (hip flexor) muscles are tight and may
actually be the source of deep pelvic pain mistaken for internal
organ pain.

The doctor will also check for any pain in the abdominal muscles and touch the skin of the abdomen and back to see if there are places on the skin that "trigger the pain".On pelvic exam the doctor will have you try to tighten the muscles around two fingers placed in the vagina and will palpate the muscles of the interior pelvic wall to see if any of them are exquisitely tender. All of these screening exams can be checked for by you at home to see if they are abnormal.

If pelvic pain is actually coming from the back and spine, how is it treated?

Certain postural problems, especially kyphosis and lordosis,
have been clinically correlated with pelvic pain as have other
muscle weaknesses and spasms. Treatment of those problems
has also been shown to help the pelvic pain.

If there is any suspicion that pelvic pain has a myofascial cause,
a woman should be referred to a physical therapist for a more
in-depth evaluation and plan for treatment. Physical therapy
and muscle exercises can significantly help these problems.

What are trigger point injections and are they helpful?

Trigger points are areas of skin on the abdominal wall that follow along one dermatome, the area of skin innervated by one specific nerve root. When touching them lightly even with a Q-tip, pain is elicited that feels as if it arises deep in the pelvic organs.

Sources: Musculoskeletal factors of chronic pelvic pain.
OBG Management 1999; Feb:10-12,Myers CA

Basic Anatomy - Tissues

There are many different types of cells in the human body. None of these cells function well on there own, they are part of the larger organism that is called - you.

Tissues
Cells group together in the body to form tissues - a collection of similar cells that group together to perform a specialized function. There are 4 primary tissue types in the human body: epithelial tissue, connective tissue, muscle tissue and nerve tissue.

1. Epithelial Tissue - The cells of epithelial tissue pack tightly together and form continuous sheets that serve as linings in different parts of the body. Epithelial tissue serve as membranes lining organs and helping to keep the body's organs separate, in place and protected. Some examples of epithelial tissue are the outer layer of the skin, the inside of the mouth and stomach, and the tissue surrounding the body's organs.

2. Connective Tissue - There are many types of connective tissue in the body. Generally speaking, connective tissue adds support and structure to the body. Most types of connective tissue contain fibrous strands of the protein collagen that add strength to connective tissue. Some examples of connective tissue include the inner layers of skin, tendons, ligaments, cartilage, bone and fat tissue. In addition to these more recognizable forms of connective tissue, blood is also considered a form of connective tissue.

3. Muscle Tissue - Muscle tissue is a specialized tissue that can contract. Muscle tissue contains the specialized proteins actin and myosin that slide past one another and allow movement. Examples of muscle tissue are contained in the muscles throughout your body.

4. Nerve Tissue - Nerve tissue contains two types of cells: neurons and glial cells. Nerve tissue has the ability to generate and conduct electrical signals in the body. These electrical messages are managed by nerve tissue in the brain and transmitted down the spinal cord to the body.

Your body is made up of these 4 different types of tissue and that includes your urinary system, your reproductive organs and the core of your body (pelvic organs).

Why do you need to know this? Understanding what organs are made up of helps you understand the pain as well how equally important exercise and a low fat diet.

It also helps us to realize that the treatments for IC will not resolve your symptoms and in most cases the patient over time sustains more damage to all of the 4 tissues listed above.

I personally have had a dozen surgeries including c-sections, hysterectomy and the Interstim Implant (after 20 years of failed treatments) and all of these cause enormous damage to all 4 tissue types which only added to my pain. If I knew then what I know now I would have never agreed to a surgery that had little to no suscess in resolving my frequency, discomfort, and pain.

Wednesday post will talk about the what damage the tissue sustains when there is damage.

What Are the Elements in the Human Body?

Most of the human body is made up of water, H2O, with cells consisting of 65-90% water by weight. Therefore, it isn't surprising that most of a human body's mass is oxygen. Carbon, the basic unit for organic molecules, comes in second. 99% of the mass of the human body is made up of just six elements: oxygen, carbon, hydrogen, nitrogen, calcium, and phosphorus.

1. Oxygen (65%)
2. Carbon (18%)
3. Hydrogen (10%)
4. Nitrogen (3%)
5. Calcium (1.5%)
6. Phosphorus (1.0%)
7. Potassium (0.35%)
8. Sulfur (0.25%)
9. Sodium (0.15%)
10. Magnesium (0.05%)
11. Copper, Zinc, Selenium, Molybdenum, Fluorine, Chlorine, Iodine, Manganese, Cobalt, Iron (0.70%)
12. Lithium, Strontium, Aluminum, Silicon, Lead, Vanadium, Arsenic, Bromine (trace amounts)

Reference: H. A. Harper, V. W. Rodwell, P. A. Mayes, Review of Physiological Chemistry, 16th ed., Lange Medical Publications, Los Altos, California 1977.

Promote pelvic floor health - through improving the functional use of the pelvic.

Pelvic floor is the common term describing a group of muscles that form a bowl-like shape within the base of your pelvis. In a woman three openings penetrate this band of muscles - the urethra, the vagina and the anus. When people refer to the pelvic floor they are often referring collectively to the muscles of the pelvic diaphragm, the urogenital diaphragm and muscles of the perineal region.

The pelvic floor has several important functions. As the floor of your abdominal cavity it provides support to vital organs including the small and large intestines, stomach, bladder, liver and kidneys. This support also helps to prevent (or reverse) the prolapse of a pelvic organ i.e. When the bladder, rectum or uterus pushes onto or drops through the pelvic diaphragm. Pelvic floor tone is important in the care of your back as it contributes to the internal muscular support for your spine. Your pelvic floor muscles are responsible for your bowel and bladder control. They also help during birth to turn and guide your baby down the birth canal. Then of course there's the sexual function with the pelvic floor muscles being directly responsible for the amount of sensation that women (and their men) feel during intercourse.

All of these factors together make for quite a strong argument that it is worth taking notice of the humble pelvic floor!