Many of the patients that I see for pelvic pain come to me very confused and frustrated. Often they have seen 5-10 different healthcare providers for their symptoms. The gynecologist has told them there is nothing wrong with their vagina (females), the urologist has told them there is nothing wrong with their bladder, or prostate (males), the gastroenterologist has told them there is nothing wrong with their colon. Many patients have wondered if it is all in their head, or worse yet, they have been told by a healthcare provider that it may be psychological. Finally, these patients find a knowledgeable provider, who suggest that their symptoms may be muscular….a pelvic floor dysfunction.
Now these patients are even more confused. How could they possibly have a muscle problem when they can’t recall anything that would cause a muscle injury????? They have not had an injury or trauma that could cause the muscles to be injured, especially not there! And besides, it does not feel like a muscle issue, it feels like bladder pain, vaginal pain or testicular pain. Many of my patients will recall, “It started when I had a urinary tract infection”, “I had a yeast infection that just did not get better”, “I had blood in my urine, or in my stool at the same time that it started”, or “it all started when I started/stopped birth control” . This persistent pain may be related to a viscerosomatic reflex.
I first became interested in the concept of viscerosomatic reflex when I studied massage therapy, 15 years ago. We were studying massage techniques based on theories by Anatoli Sherbak, a Russian physician from the 1930’s. He believed organ diseases transmit messages back to a specific spinal segment and are expressed in the form of higher skin density, muscular tension, development of trigger points, high tension and immobility of connective tissue at that same spinal level. He termed this viscero-somatic reflexes. The theory was intriguing, but not really well understood or accepted by the medical establishment in the United States.
In the past few years there has been more basic scientific research that supports this theory. Although ethically, I struggle with the methods of some of these studies (that typically involve inflicting pain in the organs of animal test subjects), the information that they are providing is invaluable to medical fields that treat chronic pain. We are now starting to realize that conditions that affect the organs, can also affect the muscles and connective tissue that share the same spinal cord level. Just like an office with gossiping co-workers, the nerves from an unhappy organ can start to trigger irritation in other nerves that share the same space in the spinal cord. Pretty soon the whole “office” can become disgruntled. Treatments that look at treating only the offending organ can miss the mark if they don’t also address the nerves and the muscles that have been part of that gossiping loop.
Treating chronic pain is like trying to improve morale in an unhappy office. It can be a slow process, and may take many small changes for improvements to be noticeable. Simply appeasing the first complainer does not always make the problem go away. In some cases the initial complainer could appear completely normal, or leave altogether (think hysterectomy). Just like removing one unhappy employee or giving them a sizable raise, does not improve morale of the entire office, simply treating an unhappy organ might not be enough. In addressing chronic pain in the body, we need to evaluate the health of the organs, the nerves, the muscles, the hormones, the blood supply. If we keep in mind that the pelvic organs talk to the pelvic floor muscles through the nervous system, it starts to make a whole lot more sense how chronic pain can develop, and how physical therapy can be helpful for what feels like an organ issue.
Love and Peace,