Recently, I have been getting to know and love the pelvis: a source for so many chronic problems.
The “true” or “lesser” pelvis lies between the pelvic inlet and the pelvic floor and houses the reproductive organs, the urinary bladder, the sigmoid colon and rectum.
The pelvic inlet is protected by the “greater” pelvis or wings of the ilia, which also hold the ascending and descending colon, so our best access to this area is via the pelvic floor, or via the area superior to the pubic bone and symphesis.
The pelvic floor lines the pelvic outlet and is a muscular partition consisting of the levator ani and coccygeus muscle. The pelvic diaphragm act as a sling, holding viscera in place. We have probably all heard about the importance of pelvic floor exercises in order to maintain pelvic health. However, sometimes it is impossible for some people to engage their pelvic floor either because they have no awareness and control of these muscles, or because the muscles are already chronically tight bilaterally or unilaterally. The pelvic diaphragm is the base of our “core muscles” (along with the respiratory diaphragm, transverse abdominus and multifidus), so inability to engage the pelvic floor fully may affect lumbar stability and breathing patterns.
The Levator Ani muscle (which when combined with the coccygeus muscle forms the pelvic diaphragm) can have a profound effect on the local area if it becomes imbalanced. The Levator Ani is suspended like a hammock from the fascia of another muscle: the Obturator Internus. Therefore one way to help find balance is to assess for a tightened and restricted obturator internus. This can be accessed at the base of the thigh, and once you have found it, you can slowly sink into the deeper layers of pelvic floor muscles. Encouraging your client to gently activate this muscle also can help it release.
Tension in these muscles may cause pelvic torsion/imbalance and may also compress the Pudendal Nerve causing chronic pain, incontinence, genital numbness, and inability to orgasm.
It is interesting to note that the similarities and differences between male and female anatomy.
I have also been getting well acquainted with the uterus recently. Lots of clients have been coming to me with hormonal and menstrual problems, and I’ve found that working to free the uterine ligaments and blood supply has been a great help in both promoting circulation or helping inflammation subside.
The uterus keeps its position suspended in the pelvic cavity by being hung from it’s ligaments. Releasing restrictions of the fascia around these ligaments allows motility to the uterus and may help relieve pain and dysfunction to the area. The main ligaments are the suspensory ligament (which is also important also brings blood to the ovaries), broad ligament, round ligament, cardinal ligament and uterosacral ligament. Also, looking for blockages in the blood supply to the area is very important to help rebalance this crucial area.
Finally, diet is extremely important in order to maintain a healthy pelvic cavity.
The first important problem to counter is inflammation – a byproduct of muscle fibre trauma. Inflammatory mediators are released into the area resulting increased sensitization to pain. While it is possible to take pharmaceutical drugs, there are also dietary measures you can take to support this, as Hippocrates said “Let food be your medicine and let medicine be your food”. Turmeric can suppress expression of COX-2. Nutmeg inhibits TNF-α. Phenolic compounds in olive oil have antioxidant compounds, anti inflammatory properties, prevent hypoperoxidation, induce favourable changes of lipid profile, improve endothelial function and have antithrombotic properties – studies suggesting that 50m (3.5 tblsp) has the same effect as 200mg of ibuprofen. Also weight loss itself is an effective anti-inflammatory strategy.
For endometriosis, oxidative stress can be improved by intake of antioxidant compounds. Antioxidant containing foods also help counter inflammation. Studies have shown the following to be helpful anti-inflammatories: Resveratrol, Carvacrol, pomegranate and blueberry extract, bromelain, and green tea.
Eicosanoids are derived from omega-3 and omega-6 fatty acids. Since we cannot produce these fatty acids, we must consume them, hence their moniker “essential fatty acids”. The main sources of Omega-3 fatty acids are flaxseed oil, walnut oil, krill oil and oily fish. They also can be found in green leafy vegetables, pumpkin seeds, hempseed. It seems that the ratio of omega-6 to omega-3 is crucial, and intake should probably be around 4:1. High intake of trans fats are associated with increased levels endometriosis.
Vitamin D deficiency was noted to be prevalent with women with pelvic disorders.
A great book about this area is “Chronic Pelvic Pain and Dysfunction” by Leon Chaitow and Ruth Lovegrove Jones.