Pelvic pain has a prevalence of >25% in women and >15% in men, and up to 50% of cases are undiagnosed, demonstrating that there is a definite need for pelvic care awareness among health care practitioners. As holistic practitioners, acupuncturists offer a safe space for clients and are often the practitioners clients seek out when nothing else has worked. Thus, acupuncturists are presented with an opportunity to serve an underserved population.
Pelvic Anatomy
The pelvic floor is a hammock of muscles, extending anteroposteriorly from the pubic bones to the coccyx and laterally between the isichial tuberosities, that provide the foundation for pelvic organs. The pelvis houses vital organs: the bladder, urethra, descending colon and rectum. In those assigned female at birth, it contains the ovaries, fallopian tubes, uterus and vagina. In those assigned male at birth, it holds the prostate. The pelvis is connected via the musculature and fascia to the hips, abdomen, back and sacrum.
Meridian Channels
Many of the body’s energetic channels cross and penetrate the pelvis. The yin meridians that cross the pelvis are the Conception Vessel, Kidney, Stomach, Spleen and Liver through the anterior pelvis. The yang organs, Governing Vessel and Bladder channels run through the posterior pelvis, and the Gallbladder meridian runs on the lateral aspects of the pelvis. The Divergent channels, Extraordinary meridians and the thrusting vessel also run through the pelvic bowl.
The physical anatomy of the pelvis and the trajectory of the Energetic channels leave the pelvis vulnerable to imbalance and dysfunction. The pelvis serves as the foundation or root of the body. When acupuncturists treat the pelvis, we can create a catalyst for healing the whole body.
One study showed that 35% of those with pelvic pain also presented with irritable bowel syndrome. Another showed that 61% of women with bladder pain syndrome and 50% of those with endometriosis also have comorbid pelvic pain. These studies demonstrate some of the obvious comorbidities that exist within the pelvis. Others include orthopedic and postural issues, surgeries, menstrual patterns, pregnancy processes and injuries, prolapses and specific types of cancers.
Assessment
In order to treat pelvic pain and dysfunction, we have to know it exists. In practice, it is vital to gently and professionally include questions about pelvic health in our initial assessment. This topic can be addressed with bladder health, bowel health, reproductive health, women’s or men’s health and/or sexual health.
Assessing the client and acknowledging pain or dysfunction is the first step. From the assessment, as skilled clinicians, we can begin to identify the nature of the dysfunction; where it’s coming from; whether its source is physical, emotional, or spiritual; and the treatment plan that might help the client’s body to create the change it needs to begin the healing process.
Treatments
As acupuncturists, we have a wide variety of needling techniques we can use to impact the pelvis: TCM protocols; Spirit of the Points (and five-element acupuncture); ashi points, sinews, and trigger-point dry needling.
TCM will serve us in treating pathologies that lie deep within the organ and meridian systems and help recalibrate the flow of qi within the system. Using the pulses, tongue and symptom profile, we can identify the pathology that might be affecting the pelvis and the whole body. We can use acupuncture, moxa and Chinese herbal medicine to address the pathology.
Commonly observed TCM pathologies that exist with pelvic pain and dysfunction include kidney yin deficiency, kidney yang deficiency, spleen qi deficiency, damp heat in the bladder or large intestine, cold in the large intestine, and liver qi deficiency and/or stagnation.
Spirit of the Points is extremely useful in treating conditions that exist on the spiritual-emotional level. Both physical and emotional trauma can be present in clients who are experiencing pelvic pain and dysfunction. Utilizing the point spirits will help us identify and repair the root of trauma by moving the stagnation that has built in the system.
A five-element approach grounds the treatment in the client’s constitution or causative factor. We can start to posit from the names of points like BL 53 (Bao Huang, Womb and Heart Diaphragm); Spleen 14 (Fu Jie, Abdomen Knot); Stomach 28 (Shui Dao, Water Path); Kidney 15 (Zhong Zhu, Central Flow); and CV 1 (Hui Yin, Meeting of Yin) that they may have implications for treating conditions of the pelvis.
Utilizing ashi points, sinew treatments, and trigger-point dry needling brings a more physical and musculoskeletal approach to the treatment of the pelvis. These types of treatments are focused in palpation of tender points and bring the client’s objective sensations into focus. Needling these categories of points increases blood flow to the tissue and breaks up chemical imbalances that exist within the tissue.
There are a variety of points on the pelvis, but also in the surrounding structures. These points can also be combined with moxa, cupping or gua sha as indicated.
Clinical Pearls
The complex interplay between pelvic anatomy, Energetic meridians, and the manifestation of pain underscores the significance of holistic pelvic care within the realm of acupuncture. The high prevalence of both diagnosed and undiagnosed pelvic pain in both women and men necessitates a proactive approach to pelvic health awareness among health care providers.
Acupuncturists, positioned uniquely as providers of safe and integrative care with a side variety of treatment approaches, play a crucial role in addressing the need for pelvic care.
Resources
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
When the body is going through a stressful event, the sympathetic system is activated. This activation will help the body with a life-threatening situation. If this state is activated for prolonged periods of time, it starts to consume energy. These traumatic events that generate stressors in the autonomic nervous system (ANS) will eventually become internalized.
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One of the things that makes acupuncture so difficult to measure is that the medicine actually does contain some esoteric aspects. There have been numerous studies that demonstrate the neurochemical reasoning behind why acupuncture points stimulate the autonomic nervous system to enact change However, not all the benefits of TCM can easily be measured by randomized, controlled trials. But does that make them fundamentally and definitively untrue?
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