Could microbiota be the cause of pelvic pain?
Some women suffer from a double blow of chronic pelvic pain and disproportionate pain. Are a few bacteria responsible for making the bladder, vagina, and rectum so sensitive?
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About this article
You may not be aware that all organs which come into contact with the outside world, including the bladder (no, urine is not sterile) and the vagina (dominated by lactobacilli), host a resident microbiota that contributes to the organ’s proper functioning or, in the event of dysbiosis, to disease, including the sensation of pain.
To find out more, researchers examined 30 women suffering from (sidenote: Chronic pelvic pain Persistent, noncyclic pain perceived to be in structures related to the pelvis and lasting more than six months. Often no specific etiology can be identified, and it can be conceptualized as a chronic regional pain syndrome or functional somatic pain syndrome. It is typically associated with other functional somatic pain syndromes (e.g., irritable bowel syndrome, nonspecific chronic fatigue syndrome) and mental health disorders (e.g., posttraumatic stress disorder, depression). ) (CPP), half of whom were (sidenote: Pelvic hypersensitivity Decreased cortical nociceptive thresholds leading to discomfort or pain from stimuli that are not usually painful, such as bladder filling; exaggerated perception of digestive system function; vulvar burning on contact; and abnormally intense pain from stimuli that are usually painful. ) , where pain could be triggered by the mere rubbing of underwear or a full bladder. 1
26% Chronic pelvic pain affects an estimated 26% of the world's female population. ²
3 months Pain is considered chronic when it persists for more than three months. ³
4% to 16% of women are affected by CPP. This is similar to the prevalence of migraine or asthma. ⁴
Unhealthy microbiota
Women suffering from CPP with hypersensitivity have very low pain thresholds: even the slightest pressure on the bladder, for example, is enough to trigger pain. Moreover, the pain experienced is not only more intense but also more prolonged. In other words, their suffering is twofold.
These women have altered gut, urinary (bladder), and vaginal microbiota, with a general decline in beneficial lactobacilli: less Lactobacillus in the gut; a more diverse vaginal microbiota (not a good sign), enriched in Streptococcus and Prevotella, and depleted of other bacterial groups; and a more diverse urinary microbiota (again, not good), with Clostridium sensu stricto 1 predominant.
Specific bacteria that are the signature of pain
Even more troubling: some of these bacteria that are over- or underrepresented in hypersensitive women are directly associated with clinical symptoms. For example, less Akkermansia or Faecalibacterium in the gut means more rectal pain. Less L. jensenii in the vagina means more painful periods and a smaller bladder capacity. Less Lactobacillus in the bladder means impaired functioning.
Is the vaginal microbiota to blame for painful periods?
Rebalance the microbiota to reduce pain?
Ultimately, the researchers managed to establish bacterial signatures of sensitivity based on bacteria from the gut, vaginal, and urinary flora. But are they the cause or consequence of the pain?
At this stage, it is not possible to say. But these findings open up promising avenues for research: probiotics could in the future be a therapeutic solution for these women, as could prebiotics, synbiotics, and nutritional approaches. By acting on the microbiota, it may be possible to relieve certain forms of pain.
Could rebalancing these microbiomes with probiotics not only alleviate pain but also address the root causes of the disease?
