Getting Oriented
Too often the pelvis is talked about as if it is somehow separate from the rest of the abdomen. The lower pelvic organs – the reproductive system, the bladder, the prostate – are usually classed as pelvic. But the intestines (which touch and function right along with these pelvic organs) are generally talked about as “abdominal.” The truth is, they are all abdominal organs and I have yet to work with anyone who comes to me specifically for pelvic distress that doesn’t also have problems farther “up” in the abdomen. In short, the pelvis is a part of the whole abdomen.
So, to a large extent any of the causes we looked at in Non-Surgical Causes of Abdominal Adhesions apply here. Additionally, the yoga exercises from Yoga and Abdominal Adhesions are very clear in the teachings that they should be used to access all the way to the bottom of the pelvic bowl.
Another tendency I have noticed when thinking of the pelvic area is to think only of the front of the pelvic bowl. But, indeed, the pelvic bowl includes not just the front of the hip bones and the pubic bone but also the sit-bones and the sacrum (the flat bone low in the back that turns into the tailbone). There are very strong lines of connection in the form of muscles, ligaments, tendons that hold these bones and the pelvic bowl in place. When these elements – bones, muscles, tendons, or ligaments – become disturbed, they can create anywhere from a little disturbance in the pelvic area to massive amounts of disturbance all the way up through the abdomen. The pelvic bowl is a very important part of the abdomen.
Now that we have that little bit of orientation as to what the pelvic bowl is, you may have already guessed at some of the non-surgical causes of dysfunction to the area . . .
Non-Surgical Causes
In my previous article about adhesions which are not caused by surgery I talked about dehydration, overwork, sudden (often unexpected) weight bearing, and chronic inflammation as causes of adhesions and all of those apply here. Additionally, here are three more pelvic-specific causes:
♦ Blunt force trauma – We saw this one when we talked about the upper part of the abdomen and those same reasons still apply here, though there is an important addition as we talk specifically about the pelvis. Most of the blunt force trauma I have seen in my practice has come from a very hard fall on the butt or tailbone. Sometimes these falls happen as children, sometimes as adults, but whether or not the tailbone was broken, these types of falls generally give the pelvic area (front and back) a long-term run for its money.
♦ Extreme emotional or physical disturbance – Another primary cause of pelvic distress that I see over and over again in my practice is, sadly, sexual abuse. As I have said elsewhere, our bodies do remarkable things to protect us from harm and sometimes, even without conscious effort, our bodies can lock down in powerful and lasting ways. Of course, in these cases, the physical release of the muscles, tendons, and ligaments will only work if the psychological and emotional pieces of the puzzle are also (or have already been) addressed. I didn’t talk about this as explicitly in the abdominal causes simply because, in my own experience as a practitioner, this kind of emotional/physical disturbance seems to settle in the pelvic bowl rather than further up in the belly. That is not to say that it can’t show up farther up and I’m sure it can, I just haven’t seen it as a practitioner.
♦ Childbirth – Of course, this is a cause that affects the entire abdomen (it is so hard for me not to add “duh” to the end of this sentence). However, I bring it forth here in an article about the pelvic area because in vaginal birth, the muscles, ligaments, and tendons of the pelvic bowl and low back are drastically altered. (Please note, these forces are still at work during a Cesarian birth, just in a different way because of the incision made. I do not in any way mean to discount the effects of a Cesarian as we talk about pelvic bowl health. But just for right now, we’re talking about non-surgical forces at play in the pelvis.) For some women, they experience surprisingly little change in the way their hips function after giving birth. For many women though, there are changes in both the function and the comfort of their pelvic area which can last for many years. In spite of the massive amounts of relaxin that helps to make childbirth possible, the soft tissues can sustain damage during birth that can’t fully self-correct. I have seen any number of times that giving birth is underestimated as a long-term cause of pelvic pain.
Treatment
As always, now that you have some more information about what causes adhesions, you are probably wondering what you can do about it. Again, I harken back to the previous article but also, there are some specific pelvic treatments that, when practiced in conjunction with treatment for your whole belly, can be very useful. One that has come into greater prominence in recent years is internal pelvic work whereby the internal muscles of the pelvic floor are treated by a trained practitioner. This internal tissue is accessed vaginally or rectally.
If that’s not your cup of tea, there are practitioners who are able to effectively and safely address the external pelvic floor. This requires nothing internal and is practiced within the scope of licensed massage or manual therapy. I will say that there are relatively few practitioners who know how to do this work, though if you can find someone who has been trained by a practitioner named Marty Ryan (he’s the one who trained me), then you will likely be in good hands.
As with all of this, just remember that what you are experiencing – adhesions – are as ancient as the human body. And, thankfully, the safe and effective treatments that were marginalized for a while are coming back into our cultural consciousness. In most cases, a trained and compassionate therapist will be able to help you greatly.