Issue link: https://www.massageandbodyworkdigital.com/i/68178
PATHOLOGY PERSPECTIVES Love Your Guts Marty Ryan of Love Your Guts seminars describes abdominal work in this way: "What does deep pelvic massage mean? I do not work internally or inside the body, as that kind of work is the realm of physical therapists, osteopaths, and providers with other scopes of practice. Many of the important fascial structures are not so 'deep' anyway. The parietal peritoneum is on the belly wall itself, and is continuous with all of the pelvic organs. "One of my big learning curves treating the pre- menopausal uterus was reconciling the differences in shape, size, and density between the anatomy textbook uterus and the uterus found in the cadaver lab. The uterus of the pre-menopausal woman on the treatment table is much larger, softer, and more mobile than the uterus and ovaries tucked back in the pelvic bowl of a post-menopausal woman." Situations that can increase the risk of pelvic adhesions include: Endometriosis. This common condition affects up to 5 million women in the United States. It is identified as a factor in about half of all infertile couples who seek help.5 Endometriosis involves the deposition of endometrial cells in areas outside the uterus: on the bladder, on the colon, or more problematically on the outside of the uterine tubes and/or ovaries. These deposits can stimulate an inflammatory reaction, leading to the creation of scar tissue cysts around them and the mechanical obstruction or strangulation of narrow openings. Infection. Any history of pelvic infection or pelvic inflammatory disease (PID) can lead to scarring of the uterine tubes and a high risk of either infertility or ectopic pregnancy (a situation in which a fertilized egg implants in the uterine tube rather than in the uterus). The most common infectious agents in these situations are sexually transmitted bacteria. Chlamydia and gonorrhea infections are often silent or create only subtle symptoms, but the scar tissue they generate can interfere with fertility, even many years after the infection has subsided.6 surgery. A woman with a history of abdominal or pelvic surgery is at risk for adhesions that may inappropriately link the fascial sheaths of internal organs, leading to poor mobility and interrupted blood, lymphatic, and nerve flow. Open surgeries carry a greater risk for postsurgical adhesions, but laparascopic surgeries can lead to restrictions as well. Injury. Any kind of internal injury, from a ruptured cyst to a bad fall, can lead to the accumulation of scar tissue in the pelvis. HORMONAL IMBALANCES Hormone disorders can impact fertility in ways we are still discovering; some of the links are indirect. Readers of Pathology Perspectives from Massage & Bodywork, January/February 2009 ("Polycystic Ovarian Syndrome and Metabolic Syndrome: A Hidden Link," p. 110–115) may recall that some women with metabolic syndrome or pre- diabetes have had success improving their odds for successful pregnancy by altering their glucose-uptake activity. Improving insulin function seems to change how testosterone, estrogen, and progesterone promote ovarian function. Hormone disorders that contribute to female infertility include: Hypothalamic disruption. The hypothalamus is a gland in the brain that controls endocrine system function by way of the pituitary gland. If the hypothalamus fails to stimulate the pituitary gland to release its cycle- inducing hormones, then ova never have the chance to mature and be released for possible fertilization. Pituitary disruption. The pituitary gland, sometimes called the master gland because many of its secretions control other hormone glands, releases follicle stimulating hormone (FSH) and luteinizing hormone (LH), both of which control the ovaries to create the menstrual cycle. Pituitary tumors— both benign and malignant—can interfere with pituitary secretions. Estrogen/progesterone imbalance. Having an imbalance in estrogen/ progesterone secretions can alter the quality of the mucus in the female reproductive tract, making it more difficult for sperm cells to reach the ovum. 110 massage & bodywork september/october 2009