New Clues to Chronic Pelvic Pain
Nerve ‘Cross-Talk’ May Explain Coexisting Pelvic Pain Conditions, Researchers Say
By Kathleen Doheny
WebMD Health News
Reviewed by Laura J. Martin, MD
Long Beach, Calif. (Oct. 1, 2010) -- Conditions that cause chronic pelvic pain -- such as irritable bowel syndrome and overactive bladder -- often occur together, and now new research may have uncovered more information on why.
Nerves in the painful organ may ''leak'' information to nerves in an adjacent organ, and as a result the brain isn't sure which organ the pain message originates from, says Tirsit Asfaw, MD, a fellow in the department of obstetrics and gynecology at the University of Pennsylvania. She presented her findings this week at the annual meeting of the American Urogynecologic Society in Long Beach, Calif.
''Before, we couldn't explain why these [conditions] were [often] occurring together," Asfaw tells WebMD. For patients, the finding may be reassuring, she says, as they are now sometimes told after examinations and testing that nothing is wrong functionally in the adjacent organ in which they feel pain.
Chronic pelvic pain conditions are those in which pain has been ongoing, either continuously or intermittently, for six months or longer.
Slideshow: What's Causing Your Pelvic Pain?
Chronic Pelvic Pain: A Closer Look
Patients with chronic pelvic pain often have symptoms from multiple organs, such as bladder and bowel, Asfaw says. Patients diagnosed with irritable bowel syndrome or IBS, for instance, often also have symptoms of bladder urgency, or overactive bladder, in which they get a sudden urge to urinate and may ''leak."
Previously, laboratory studies have found that when the colon is inflamed, the bladder muscle known as the detrusor is affected, with inflammatory markers found. The detrusor helps you empty your bladder by contracting, but when it contracts too much, it can lead to overactive bladder problems.
Asfaw's study took the previous research a step further by looking at an animal model to find out what happens to surrounding organs when the colon becomes inflamed and painful. "We induced colonic inflammation with a chemical," she says, and then tested bladder function.
"We saw a lot of bladder spasms in the animals with colonic inflammation," she says. "The contractions are similar to those in overactive bladder."
Those with the inflamed colons had five times the number of bladder contractions as the control animals.
What's happening? Asfaw believes that nerves from the inflamed organ, in this case the colon, may be communicating with nerves from the bladder, and a ''leakage of information" between nerves may occur.
When the messages reach the brain, "the brain doesn't know if the bladder or the colon is inflamed," she says. So it may send the pain message to both organs. "Pain is perceived as coming from the colon and the bladder," she says, because of this ''cross talk" between nerves, which scientists call ''cross-sensitization."
"Findings from this study support the mechanism that inflammation of one pelvic organ may lead to symptoms in an adjacent organ via cross-sensitization," Asfaw says.
Clues to Chronic Pelvic Pain: Second View
''We know there's a lot of overlap" among pelvic pain conditions, says Rebecca Rogers, MD, professor of obstetrics and gynecology at the University of New Mexico Health Sciences Center, Albuquerque, who reviewed the study findings for WebMD.
Although the finding has no immediate applications, Rogers says that "this is a glimpse into the mechanism.This is a small first step in trying to define the origins of the overlapping problems."
New Clues to Chronic Pelvic Pain
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New Clues to Chronic Pelvic Pain
Interestingly, this article refers to Chronic Pelvic Pain in women, which is supposed to be completely different to IC/PBS and not the same as CP/CPPS either. However, the pain mechanisms described are the same ones under suspicion for IC and CPPS. So is it, as I have always suspected, one big ball of wax?
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Re: New Clues to Chronic Pelvic Pain
There is no doubt that in a subset of patients men and women that their is neural "crosstalk." However, this process is unbelieveably complex. I had a grand rounds done on me awhile back and I brought this up in front of the 30-40 neurologists most looked baffled and others intrigued. The head of neurology spoke up and said I had made a good point but this type of action is still being tested and we are a long way off from a therapeutic resolution.
In my own case I had developed IBS about 3 months prior to CPPS, there is obviously a link, it is almost more frustrating reading this because on the surface it sounds like science is making headway but I am very doubtful we understand this process in the next decade and when we eventually do what treatments will there be for it.
The days of experimenting on humans is long gone, and science often has a hard time converting what happens in mice to what happens in man.
In my own case I had developed IBS about 3 months prior to CPPS, there is obviously a link, it is almost more frustrating reading this because on the surface it sounds like science is making headway but I am very doubtful we understand this process in the next decade and when we eventually do what treatments will there be for it.
The days of experimenting on humans is long gone, and science often has a hard time converting what happens in mice to what happens in man.
Age: | Onset Age: | Symptoms: | Helped By: | Worsened By: | Other comments:
Re: New Clues to Chronic Pelvic Pain
Why bladder symptoms affect the colon and vice versa. Possibly why coffee brings on colon symptoms and what we eat brings on bladder symptoms. The concept the nerves going to many of these structures originate off the same nerve roots (fractions of millimeters from one another is probably pertinent.
Ptns (post tibial nerve stimulation), studied by Dr Stroller is based on crosstalk. They stimulate a nerve (tibial nerve) terminating somewhere around the ankle-bone in an attempt to affect nerves originating around it behind the sacrum. PTNS has been suggested as a alternative to the far more invasive interstim where nerves behind the sacrum need to be accessed. (The tibial nerves terminus near the surface above the anklebone is far easier to access (with a simple tens device) than its origin behind the sacrum)
Colon and bladder and prostate connection and crosstalk:
Ptns (post tibial nerve stimulation), studied by Dr Stroller is based on crosstalk. They stimulate a nerve (tibial nerve) terminating somewhere around the ankle-bone in an attempt to affect nerves originating around it behind the sacrum. PTNS has been suggested as a alternative to the far more invasive interstim where nerves behind the sacrum need to be accessed. (The tibial nerves terminus near the surface above the anklebone is far easier to access (with a simple tens device) than its origin behind the sacrum)
Colon and bladder and prostate connection and crosstalk:
The Pepperoni Pizza Hypothesis
What’s the worst that could happen after eating a slice of pepperoni pizza? A little heartburn, for most people.
But for up to a million women in the U.S., enjoying that piece of pizza has painful consequences. They have a chronic bladder condition that causes pelvic pain. Spicy food — as well as citrus, caffeine, tomatoes and alcohol — can cause a flare in their symptoms and intensify the pain. Researchers had long believed the spike in their symptoms was triggered when digesting the foods produced chemicals in the urine that irritated the bladder.
A surprising new discovery from Northwestern University’s Feinberg School of Medicine reveals the symptoms — pain and an urgent need to frequently urinate — are actually being provoked by a surprise perpetrator. It’s the colon, irritated by the spicy food, that’s responsible. The finding provides an explanation for how the body actually “hears” pelvic pain.
The discovery also opens up new treatment possibilities for “painful bladder syndrome,” or interstitial cystitis, a condition that primarily affects women (only 10 percent of sufferers are men.) During a flare up, the pelvic pain is so intense some women inject anesthetic lidocaine directly into their bladders to get relief. Patients typically also feel an urgent need to urinate up to 50 times a day and are afraid to leave their homes in case they can’t find a bathroom.
“This disease has a devastating effect on people’s lives,” said David Klumpp, principal investigator and assistant professor of urology at the Feinberg School. “It affects people’s relationships with family and friends.” Klumpp said some women who suffer from this become so depressed, they attempt suicide.
Klumpp conducted the study with postdoctoral fellow Charles Rudick. The paper is published in the September issue of Nature Clinical Practice Urology.
The Northwestern researchers discovered the colon’s central role in the pain is caused by the wiring of pelvic organ nerves. Nerves from this region — the bladder, colon and prostate — are bunched together like telephone wires and plug into the same region of the spinal cord near the tailbone.
People with interstitial cystitis have bladder nerves that are constantly transmitting pain signals to the spinal cord: a steady beep, beep, beep.
But when the colon is irritated by pepperoni pizza or another type of food, colon nerves also send a pain signal to the same area on the spinal chord. This new signal is the tipping point. It ratchets up the pain message to a chorus of BEEPEEPBEEPBEEP!
“It was known that there was cross talk between organs, but until now no one had applied the idea to how pain signals affect this real world disease, how the convergence of these two information streams could make these bladder symptoms worse,” said Klumpp, who also is an assistant professor of microbiology-immunology at the Feinberg School.
The findings suggest the bladder pain can be treated rectally with an anesthetic in a suppository or gel. Another possibility is an anesthetic patch applied to pelvic skin. Studies in back pain show anesthetic patches applied to the skin can reduce back pain, Klumpp said.
“We imagine a similar kind of patch might be used to relieve pelvic pain, which might be the best solution of all,” he noted.
HOW THEY “CAUGHT” THE COLON
For the study, Klumpp and Rudnick created a model of a mouse that mimicked an inflamed bladder with pelvic pain. Then they injected lidocaine into the bladder. The pain vanished. Next they injected lidocaine into the uterus. There was no diminishment of the pain. Lastly, they tried lidocaine in the colon.
“In the colon it knocked down pain just as effectively as if we put it in the bladder. We thought if the colon can suppress bladder-associated pain, maybe it can make it worse in the way that foods irritate bladder symptoms,” Klumpp explained.
So, Klumpp injected a small dose of red pepper into the colon of a normal mouse. The injection didn’t provoke any pain. But then he injected a small dose into a mouse with pelvic pain. The pelvic pain worsened.
“We likened it to what happens to humans,” Klumpp said. “Pepperoni pizza does nothing to most people other than heartburn, but when you give it to a person with an inflamed bladder, that will cause their symptoms to flare because the nerves from the bladder and bowel are converging on the same part of the spinal cord.”
MEASURING PELVIC PAIN IN A MOUSE
When pain emanates from a visceral organ, the pain message is delivered to the spinal cord and bounces out to the corresponding skin surface, called the dermatome. To measure pelvic pain in the mice, Kumpp prodded their pelvic skin with nylon filaments of varying thickness and stiffness, beginning with one that was as thin as a human hair. The more pelvic pain the mouse was experiencing, the more sensitive its pelvic skin to even the finest filament.
Source: Marla Paul
Northwestern University
Age:43 | Onset Age:36 | Symptoms: First urinary and backside, golf ball feeling, now ok (no heavy exercise) . Major onset seemed to be with heavy coughing spell , felt "tearing" or nerve pain in rectum/prostate. | Helped By:Hot showers,sleep.Worsened By: Type A obsessiveness ... Stressing, what-if thinking, weights.
Not a doctor. -
The usual... anxiety prone programmer (my case), accountant, lawyer or self employed sitting 50 hrs/week combined with compulsively exercising on a bike,weights or running to compensate for stress. Also aka "graduate student syndrome" New email sigma556@hotmail
Not a doctor. -
The usual... anxiety prone programmer (my case), accountant, lawyer or self employed sitting 50 hrs/week combined with compulsively exercising on a bike,weights or running to compensate for stress. Also aka "graduate student syndrome" New email sigma556@hotmail
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Re: New Clues to Chronic Pelvic Pain
Makes sense, very clearly written. But how are we so sure that the mouse has pelvic pain and how do we know the pelvic pain in the mouse is the same as mine? Same thing with Buffington and his pelvic pain cats. Do they have CPPS or do they have some cat specific urinary condition?
The patch idea seems novel, the lidocaine ones I've tried are weak and address pain only close to the skin in my case, (plus hard to keep on with a tucked in shirt and pants) my discomfort is deep inside my pelvis. Maybe one of the newer opioid based ones but even those have dependency and tolerance issues.
The patch idea seems novel, the lidocaine ones I've tried are weak and address pain only close to the skin in my case, (plus hard to keep on with a tucked in shirt and pants) my discomfort is deep inside my pelvis. Maybe one of the newer opioid based ones but even those have dependency and tolerance issues.
Age: | Onset Age: | Symptoms: | Helped By: | Worsened By: | Other comments:
Re: New Clues to Chronic Pelvic Pain
Age:43 | Onset Age:36 | Symptoms: First urinary and backside, golf ball feeling, now ok (no heavy exercise) . Major onset seemed to be with heavy coughing spell , felt "tearing" or nerve pain in rectum/prostate. | Helped By:Hot showers,sleep.Worsened By: Type A obsessiveness ... Stressing, what-if thinking, weights.
Not a doctor. -
The usual... anxiety prone programmer (my case), accountant, lawyer or self employed sitting 50 hrs/week combined with compulsively exercising on a bike,weights or running to compensate for stress. Also aka "graduate student syndrome" New email sigma556@hotmail
Not a doctor. -
The usual... anxiety prone programmer (my case), accountant, lawyer or self employed sitting 50 hrs/week combined with compulsively exercising on a bike,weights or running to compensate for stress. Also aka "graduate student syndrome" New email sigma556@hotmail