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Female Pelvic Pain_Final

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>> Hi there. And great to see you again today. And in this lecture, we'll be talking about pelvic pain. This is another one of those conditions that's not commonly talked about in the open, but it is important to know about. So let's jump right in and start with the basics. To be called pelvic pain, the sensation that must be felt at somewhere between the vulva and the upper crest of the hips. It's almost always associated with reproductive organs, but can extend to the bladder and rectum as well. There are two types of pelvic pain, acute and chronic. Acute pain that comes on out of nowhere and escalates quickly as a sign of a serious medical condition and it should be evaluated immediately by a trained medical professional. Chronic pelvic pain usually has a slower onset, it can become constant or it may be cyclical. Often times, women with pelvic pain struggle for even a diagnosis, much less, a way to feel better. Chronic pelvic pain can be a debilitating illness, sapping the strength and energy of its sufferers. And it's rarely resolved through traditional methods of western medicine. Let's take a deeper look at the two types of pelvic pain, starting with acute conditions. The causes of acute pelvic pain include pelvic inflammatory disease, tubo-ovarian abscess, ruptured ovarian cyst, and tubal pregnancy. Let's start with pelvic inflammatory disease or PID, which is caused by a sexually transmitted infection. Usually gonorrhea and chlamydia. The infection rather than staying in the vagina affects the pelvic organs, the uterus, fallopian tubes, and ovaries. But it can spread into the abdomen and even as far as the liver. This can be a smoldering low-grade infection or it can be quite severe requiring hospitalization and antibiotic treatment. The most frequent way PID enters the reproductive system is through unprotected sex. Men typically have few symptoms of gonorrhea and chlamydia, and may not be aware they've been infected. Those with multiple partners or whose partner has multiple partners are more susceptible. Women who do sure are also more likely to develop PID. Also, women under 25 are at a higher risk to have the infection spread into the pelvis, possibly due to the immaturity of the cells in the cervix. Symptoms are often at minimal, but can include foul-smelling, vaginal discharge, and low abdominal and back pain, and low-grade fever. If the fever is over 100 degrees Fahrenheit or the abdominal pain is severe, this is a sign that it is a serious infection and requires immediate medical attention. PID can cause scaring which it may partially or completely block the fallopian tubes increasing the risk of ectopic pregnancy. This scaring can also cause chronic pelvic pain and infertility due to the organs of the pelvis sticking together. Next, we have tubo-ovarian abscessed or TOA, which is a form of PID where puss gets walled off in the fallopian tube. The symptoms are usually fever and one-sided pain in the pelvis. It can be mistaken for appendicitis if it's on the right side. This condition requires medical treatment and may ultimately require removal of fallopian tube on that side if not treated quickly enough. There is often significant scaring afterwards which may partially or completely block the tube. The third condition that can cause acute pelvic pain is a ruptured ovarian cyst. Every month, the ovaries create a follicle, but sometimes the ovaries develop a cyst that doesn't go away. A follicular cyst can happen when the follicle doesn't breakdown as it would normally and fills with fluid, instead. These are usually painless and go away on their own, but on the rare occasions that they don't, they can become painful. If the cyst becomes infected or ruptures, the pain can be quite severe and the woman may develop a fever. Another possible complication of ovarian cyst is when it causes the ovary to rotate and twist called an ovarian torsion which can cut off the blood supply to the ovary. Rupture and torsion, both have the potential to become an emergency, requiring medical attention and possibly surgery. Lastly, tubal pregnancy, also called ectopic pregnancy can cause a sudden and severe abdominal pain, as the pregnancy outgrows the tight confines of the fallopian tube. The early signs of tubal pregnancy are achy pelvic pain, the absence of period bleeding, and vaginal bleeding. Risk factors for ectopic pregnancy include previous ectopic pregnancies, surgery, PID, endometriosis, all of which can disrupt the normal anatomy of the fallopian tubes. Many women aren't even aware they're pregnant until the fallopian tube is compromised by the pregnancy. If the tube ruptures, this can result in catastrophic internal bleeding and even damage to or loss of the tube, increasing the risk of a subsequent tubal pregnancy. Tubal pregnancy should always be treated by a physician when discovered because the very high risk of rupture and damage to the tube. To recap what we've covered so far, the four main causes of acute pelvic pain are pelvic inflammatory disease, tubo-ovarian abscess, ruptured ovarian cyst, and tubal pregnancy. Now let's move on to chronic pelvic pain. Chronic pelvic pain is pain that lasts for more than six months, while acute pelvic pain, usually has an obvious cause and a clear solution. It's much harder to diagnose and treat chronic pain. It is often cyclical in nature, making it even harder to pin down. This can be quite frustrating for your clients as they undergo tests after tests without any change in their symptoms. Your support as they go through this is invaluable. Your clients will always benefit from your guidance around eating better, easing their stress, and improving their lifestyle. These steps can never hurt, regardless of the cause of their condition. Causes of chronic pelvic pain include endometriosis, vulvodynia, ovulation pain that known as mittelschmerz, dysmenorrhea, and chronic pain of unknown origin. Let's start with endometriosis. When there is endometrial tissue growing outside of the uterus it's called endometriosis. It's most commonly diagnosed when a woman is in her 30s, although, it sometimes found much earlier. This is because it can take up to 10 years for a woman to get a proper diagnosis of endometriosis. It can range from a few small deposits that cause relatively few problems to extensive, painful, active deposits that cause significant pain and scarring. Endometriosis is usually confined to the pelvic organs. The outside of the uterus, the fallopian tubes, ovaries, and the ligaments that hold the organs in place. Occasionally, it spreads further into the abdomen affecting the intestines, the peritoneum, or the lining of the abdomen, the bladder, and the rectum. Symptoms of endometriosis include pain during sex, extreme cramps that don't go away with anti-inflammatories or impede daily life, bowel and urinary disorders such as painful urination or bowel movements, frequent urge to urinate, or diarrhea. Periods that last longer than seven days, heavy menstrual flow, requiring super pads or tampons, sometimes every hour and nausea or vomiting. Symptoms often cycle with the menstrual cycles since the tissue is estrogen responsive. Similar to the endometrial lining of the uterus, this misplaced tissue is affected by the same hormonal changes that trigger your period to come. The endometrial tissue thickens every month then slows off into the abdomen and the pelvis. Over time, this shedding leads to chronic inflammation and formation of scar tissue. Additionally, these misplaced cells can cause an abnormal immune response resulting in further chronic inflammation and scarring. It's difficult to diagnose usually, requiring exploratory laparoscopic surgery to confirm. It can be a debilitating disease, requiring multiple surgeries to treat the scar tissue. Well, some women may get relief by having the endometriosis removed. Over time, it can reaccumulate if the root cause is not addressed. A natural approach that removes endocrine disruptors and detoxifies excess estrogen has been shown to be helpful. And equally frustrating type of chronic pelvic pain is called vulvodynia. This is basically a fancy word for chronic pain of the vulva. It's frequently described as a burning, aching, or throbbing pain. There may also be itching, but vulvodynia is different from vaginal itching. It's often associated with sexual activity causing pain with penetration. However, for many women, it's constant and frustrating. Vulvodynia may start with a yeast or urinary tract infection, but treatment of the infection that doesn't resolve the discomfort. It tends to get worse over time resisting attempts of treatment. No physical cause for the pain has been identified and it's not associated with cancer. Western medicine has little to offer regarding either diagnosis or treatment. Many women spend a lot of time tracking down a diagnosis only to find there is little relief. Some women do respond to topical creams, but over time, these lose their effectiveness. A functional approach is often much more effective. Say, you have a client who presents with severe vulvar pain, she has a lot of work stress, feeling as though she can't keep up and you'd want to coach her that learning to say no, especially when she is actively having pain can make a big difference to a long-term pelvic health. Additionally, balancing her gastrointestinal flora eliminating toxins working on more stress mitigation techniques and eating a nutrient-dense, blood sugar-balancing diet will go a long way towards calming systemic inflammation and relieving the symptoms of vulvodynia. Third, mittelschmerz or midcycle pain, which can cause a chronic pelvic pain. Up to 20% of women have cramp like abdominal pain in middle of their cycle, often associated with ovulation. It's usually one sided and occurs about 14 to 16 days before a women's period begins. This may be due to a small amount of fluid and blood being released when the follicle ruptures. For most, the pain is bearable and an expected part of the cycle. They may take a hot bath or use a heating pad and feel better in a few hours. However, for others, it is debilitating requiring a day off. Quite often, the prescribed treatment is birth control pills which suppress ovulation. But this is a little like throwing out the baby with the bathwater and it isn't necessary. Since the condition appears to be due to inflammation, a targeted natural approach to decrease inflammation in the body and balanced estrogen and progesterone can be highly effective in minimizing or eliminating the discomfort. Managing blood sugar and maintaining a healthy bacterial flora, just to name a few methods, can help in achieving those goals. Next, we have a dysmenorrhea. Up to 50% of women experience some form of dysmenorrhea or painful periods. The pain may vary from minimal cramps to severe debilitating pain requiring pain medication and time off from daily activities. In fact, it is one of the top causes for women to miss work. There are two types, primary dysmenorrhea, which is related solely to the menstrual period and secondary dysmenorrhea, which is due to another issue such as PID, PCOS, or endometriosis. It's important for your clients that they sort out which type they have because the treatment will depend on the cause. In addition to pelvic pain, other symptoms such as nausea, vomiting, diarrhea, sweating, and headaches can happen just before or during the menstrual cycle. The symptoms may last anywhere from a few hours to two or three days. Thankfully, women have a much more control over this than they think. First of all, there is no question that inflammation contributes to a higher sensitivity to pain. So helping your clients to get their inflammation under control, as well as balancing estrogen and progesterone levels, can make periods much less painful. Stress has been shown to have an impact on dysmenorrhea so working with your client to manage their stress better will also improve pain. Lastly, we'll discuss pain of unknown origin. This can be the hardest pain for your clients to deal with. It can appear out of nowhere, disappear, then reappear, and defy all attempts at diagnosis. The blame for this has been laid on a number of nonspecific issues such as irritable bowel syndrome, a type of chronic bladder infection called interstitial cystitis, endometriosis, and scar tissue. A client with pelvic pain of unknown origin will find that test after test reveals no cause. Treatments that may provide temporary relief, but eventually the pain breaks through again. Even surgery may not reveal a cause for the pain. This type of pain is complex, involving the nerves, muscles, and connective tissue of the pelvis along with psychosocial stress. The cause is unclear, but it may include both nerve and pelvic floor dysfunction. From a functional medicine standpoint, the source of the pain may be a combination of hormone imbalance, physical, and psychological stress, and chronic inflammation of the gut, and sometimes bladder. Supportive care for your clients can be extremely helpful, including working with them to balance their hormones, minimize inflammation, and manage stress. Exercise such as gentle yoga and Pilates can also help to decrease discomfort. Okay, that wraps up our discussion of the types of chronic pelvic pain. To recap, they include endometriosis, vulvodynia, ovulation pain, or mittelschmerz, dysmenorrhea, and chronic pain of unknown origin. Next, we'll talk about solutions because that's what your clients want to know, right? How can you help them feel better and manage their symptoms so they can live a fuller life? Chronic pelvic pain seems to have a common theme of chronic inflammation, gut dysbiosis, high stress, and hormone imbalance. This may look familiar to you as many of the topics we've talked about have similar themes. By now, you have many tools available to you to help these clients with each of these issues. More specifically, recommendations to manage chronic pelvic pain can also include tracking symptoms, elimination diets to reduce inflammation, estrogen/ progesterone balancing, and working with a pelvic pain specialist. First, have your clients keep track of their symptoms, even if they seem unrelated. It's important to document their moods, stress levels, diet, and exercise to see if there is a pattern to their pain. For example, you have a client who presents with monthly period pain that begins a day or so before her period starts and ends in two days. Have her track her pain symptoms, cycles, stress level, sexual activity, exercise, diet, and use of anti-inflammatories like ibuprofen. Sit down with her and look at her records, identify areas that can be improved like exercising less strenuously right before and during her period or scheduling downtime into her calendar, the week leading up to her period. Since almost all of these chronic pain issues are related to systemic inflammation, trying an elimination diet for 21 days can be really helpful. The following foods are the most common foods women with pelvic and sexual pain are allergic to. Gluten, sugar, dairy, soy, corn, eggs, nightshades, citrus fruits, and conventional beef. Organic grass-fed beef is usually okay in modern amounts. Simply, leave these foods out for 21 days and then add one back in per week and watch for symptoms. These include pain, headaches, skin eruptions, sinus congestion, and digestive problems. If you notice any of these symptoms, it's best your client leave that food out of her diet for at least six months while she works with you to support her gut and liver function. Third, an imbalance between estrogen and progesterone particularly when estrogen is dominant over progesterone or progesterone is too low can set a woman up for pelvic pain. High estrogen is connected to endometriosis, so the focus needs to be on estrogen detoxification. We'll talk about estrogen detoxification in another module so don't worry about that just yet. You also want to help your clients raise their progesterone levels by helping them decrease their levels of stress. Remember, stress can decrease progesterone levels, as the body diverts progesterone so more cortisol can be produced. Birth control pills also artificially lower estrogen significantly and may contribute to vaginal tissue dryness and pain during sex. You can educate your clients about the pros of using natural birth control methods over hormonal ones, and encourage them to visit their doctor to discuss alternatives. Finally, when it comes to the various types of pelvic pain conditions, it's strongly recommended that your client seek the help of a pelvic physical therapists who has special training to treat pelvic and sexual pain. Stress management and diet can go a long way, but if there is a joint or muscle injury, a specialist will be able to evaluate your client and use a variety of techniques to help address the problem effectively. Use the link in the Resources section of your homework for this module to find a pelvic physical therapist in your area. That wraps up our discussion on pelvic pain. To summarize, we talked about both acute and chronic causes for pelvic pain and some examples of acute pain that may require immediate medical intervention such as tubal pregnancy or a tubo-ovarian abscess. We also discussed the different types of chronic pelvic pain that include endometriosis, vulvodynia, dysmenorrhea, mittelschmerz, and pain of unknown origin. All of these have some common sources such as hormonal imbalance, systemic inflammation, and ongoing stress. And finally, we covered some key ways you can help your clients that minimize their pain and live their lives more fully. These include tracking symptoms, an elimination diet, correcting the estrogen/progesterone balance, and referring clients to a pelvic pain specialist. You now know how pelvic pain can manifest and how to begin addressing the various conditions from a root cause perspective. Try to pay attention whether any of your clients are exhibiting any telltale signs of pelvic pain conditions, then drop by the Facebook group to join the discussion. Next, be sure to review the handout and take the quiz for this module to test your knowledge on the topics we've covered. Thanks so much for watching. See you soon.

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Duration: 19 minutes and 33 seconds
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Language: English
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Posted by: ninaz on Apr 10, 2018

Female Pelvic Pain_Final

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