Welcome to my blog, discover acupuncture with Dr Maggie Ju

Qualified as a medical doctor in Western medicine in China with a Medical degree from Beijing, China and a PhD degree from the UK. Many year research and clinical experiences. This blog is for information only.

Tuesday, 5 July 2022

Is there a solution to women's pelvic pain?

Pelvis (or pelvic region) is the region between the abdomen and thighs. It includes sacrum and the coccyx at the back, pelvic bone, pelvic cavity, pelvic floor and perineum. Within pelvic cavity there are bladder, reproductive organs, and the rectum. Around the pelvic bone there are skeletal muscles that attach the bone. Pelvic pain is the pain in the pelvic region (lower abdomen). Pelvic pain can be a sign of the problem with one of the organs in the pelvic cavity, such as bladder, lower intestine, rectum and reproductive system (i.e. uterus, ovaries, fallopian tubes etc in women and prostate in men).

Pelvic pain is the pain presented at the low abdomen and very common in women. Here are some common causes:
Pain from the reproductive system:
Period pain and cramps is the pain during the periods. The typical period pain will occur immediately before a woman starts her period or soon after the period starts, as the uterus contracts and sheds its lining. The pain may feel similar to a muscle spasm.
Ovulation pain is the pain at one side of the pelvis in the middle of the menstrual cycle around ovulation time. Ovulation is that the ovary releases an egg, along with some other fluid. The egg will be picked up by a fallopian tube and the fluid can spread within the pelvic area, sometimes, causing irritation and pain in the pelvis.
Endometriosis is that uterine lining shed and the cells grow outside of the uterus causing bleeding, inflammation and pain. Pain severity varies from mild to severe.
Ovary cysts occur when the ovaries fail to release an egg causing bloating, pressure, or pelvic pain on the side of the body with the cyst.
Fibroids are lumps of muscle and fibrous tissue within the uterus. It can cause pain excessive bleeding, period cramps.
Ectopic pregnancy
The embryo implants and grows elsewhere other than uterus. A woman may feel very sharp pain, and cramps in her pelvis on one side of the pelvis. There could be other symptoms associated such as nausea, vaginal bleeding, and dizziness. This is life-threatening condition and needs immediate medical care.

Pain from urinary system
Interstitial cystitis or bladder pain is normally in the middle of the pelvis or low abdomen close to the pubic bone. Other symptoms include painful urination, frequent and urgent urination, and pain during sex.
Urinary stones are from minerals built up and formed crystals in the bladder or kidneys that often cause pain in the pelvis or lower back.


Pain from digestive system
Irritable bowel syndrome (IBS) is inflammable bowel disorder causing low abdominal pain and constipation, diarrhea and bloating.
Appendicitis is inflammation in appendix presenting pain at the right low abdomen.
Pelvic adhesion
Scars in the abdomen from previous inflammation can cause pelvic pain.
Infectious diseases and tumors
Such as urinary tract infections, sexually transmitted infections and pelvic inflammatory disease and various tumors.

Chronic pelvic pain which is continuous or episodic pain in the lower abdomen or pelvis lasting at least six months is one of the most common pain conditions experienced by women. It has great negative impact on women’s quality of life including constant physical and psychological aspects. It depends on what causes the pain and various treatments are available including surgical and non surgical approaches such as hormonal therapy. Improving day-to-day pain management, functioning, and quality of life through multidisciplinary and holistic approaches are also recommended care to women with chronic pelvic pain. The use of complementary health approaches is common for pain conditions. An estimated 35-52% of patients with chronic pain use therapies such as vitamins and mineral supplements, massage therapy or acupuncture for their symptoms. This is applied to chronic pelvic pain. A survey showed that 60% of perimenopausal women with self-reported pelvic pain, and 84% of women with interstitial cystitis used some form of complementary medicine. Recently a study from the US has shown that most women who used acupuncture (91%) had at least some improvement in symptoms based on self-report.

Acupuncture is effective for period pain

Period pain is common. It's usually felt as painful muscle cramps in the tummy, which can spread to the back and thighs. The pain sometimes comes in intense spasms, while at other times it may be dull but more constant. Most women experience it at some point in their lives, but some women can have severe period pain which makes them faint and stays in bed and need to be treated. Primary period pain can be effectively treated with acupuncture. A review analysed data published before December 2017 for effectiveness of acupuncture on primary period pain. They included 49 randomized controlled trials (RCTs) of women with primary dysmenorrhea; these RCTs compared acupuncture to no treatment, placebo, or medications, and measured menstrual pain intensity and its associated symptoms. They found that acupuncture was more effective compared with no treatment or nonsteroidal anti-inflammatory drugs (NSAIDs). The effect of acupuncture stays during short term follow-up.

Acupuncture is effective to treat endometriosis

Endometriosis which cells from lining of uterus grow elsewhere is a common cause of long-lasting pelvic pain in women. The pain could present as painful period, chronic pelvic pain and painful intercourse and increased urinary urgency. The pain is progressing over all their reproductive life. Pain relief is an important aspect of the treatments for endometriosis. Also, women with more advanced degrees of endometriosis showed higher CA-125 levels in both serum and peritoneal fluid.

Much research has shown that acupuncture could be an effective treatment for endometriosis and may relieve pain. Recently a review has analysed the effect of acupuncture on endometriosis. 10 studies involving 589 patients were included in the review. The main outcomes assessed were variation in pain level, variation in peripheral blood CA-125 level, and clinical effective rate. The result has shown that acupuncture has significant effect on pain reduction, lowing blood CA-125 and increased clinical effective rate compared to the control. Current research has suggested that acupuncture could be an effective way to treat endometriosis and help release the pain and decrease the blood CA-125 level.

Acupuncture releases pain by increasing pain thresholds in human subjects, and it would appear to activate analgesic brain mechanisms through the release of neurohumoral factors, including adenosine, γ-aminobutyric acid, opioid peptide, acetylcholine, nitric oxide, noradrenaline, dopamine) and others. Acupuncture also enhances the ability of the immune system to more actively eliminate malignant cells by increasing the ability of NK cells to kill cancer cells.

Acupuncture has better effect than herbs for reducing pain caused by endometriosis

Xiang DF et al investigated the effect of abdominal acupuncture on relieving pain caused by endometriosis and compared the effect with herbs. There were 58 patients with pain and endometriosis. The patients were divided into two groups: 30 patients were in acupuncture group and other 28 patients were in herbs group. The duration of treatment was 3 months. In acupuncture group abdominal acupuncture was performed. The pain reduced by acupuncture treatment was significantly better than that for herbs.

The effectiveness of acupuncture on pain caused by endometriosis was also studied by Rubi-Klein K et al. 10 treatments of acupuncture over 5 weeks (twice a week) were given to patients with pain caused by endometriosis. Significant pain reduction was observed in acupuncture group.

References

Chao et al Pain Med (2015) 16:328-40

Woo HL et al Medicine (Baltimore) (2018) Jun;97(23):e11007. doi: 10.1097/MD.0000000000011007.

Xiang DF et al Zhongguo zhen Jiu (2011) 31:113-6

Rubi-Klein K et al Eur J Obstet Gynecol Reprod Bio (2010) 153:90-3

Xu Y et al Plos One 2017 Oct 27;12(10):e0186616.

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