Pelvic pain is a feeling of discomfort or pain in the lower abdomen. It can be acute or chronic, and is often associated with conditions such as endometriosis, irritable bowel syndrome, or urinary tract infections.
The causes of pelvic pain are often multiple, ranging from hormonal imbalances to chronic inflammation. Faced with this complexity, diet becomes a complementary and accessible tool to alleviate symptoms. Several recent studies show that a well-adapted diet can reduce inflammation, modulate nerve sensitivity, and improve digestive function.
Pathophysiology of pelvic pain
The pathophysiological mechanisms underlying pelvic pain often involve a combination of inflammatory, hormonal and nervous factors. Chronic inflammation is one of the main triggers of pelvic pain, particularly in conditions such as endometriosis and irritable bowel syndrome (IBS).
Inflammation: Chronic inflammation in pelvic tissues leads to excessive release of pro-inflammatory cytokines (such as IL-6 and TNF-α) that sensitize peripheral nerves, causing increased pain. For example, in endometriosis, inflammatory lesions can affect pelvic organs and cause disabling pain.
Role of the gut microbiota: Additionally, an imbalance in the gut microbiota, often seen in people with IBS, can lead to increased intestinal permeability (“leaky gut”), allowing toxins and bacteria to enter the bloodstream and worsen systemic inflammation. The gut microbiota is composed of microorganisms that live in our digestive tract. These microorganisms play essential roles in digestion, immunity, and the production of certain neurotransmitters. Recent research shows that gut microbiota imbalance (or dysbiosis) can have direct consequences on pelvic pain through several mechanisms:
Systemic inflammation : An imbalance in the microbiota promotes intestinal permeability, known as “ leaky gut syndrome.” This allows toxins, bacteria, and other pro-inflammatory molecules to enter the bloodstream. These molecules trigger inflammatory immune responses, amplifying pelvic pain.
Gut-Brain Axis Modulation : The microbiota directly influences the gut-brain axis, a bidirectional system that connects the brain and digestive system via the vagus nerve. Dysbioses can alter the production of neurotransmitters such as serotonin (much of which is produced in the gut) and lead to hypersensitivity of the intestinal and pelvic nerves.
Pro-inflammatory cytokines : Pathogenic bacteria or microbial imbalances increase the production of pro-inflammatory cytokines (such as IL-6 and TNF-α), which sensitize nerves and exacerbate pain. This is particularly relevant in conditions such as endometriosis where inflammation plays a major role.
Intestinal microbiota: the case of endometriosis
Recent research suggests that the composition of the microbiota may influence the development and severity of endometriosis. Women with endometriosis have been shown to have marked intestinal dysbiosis and higher levels of intestinal inflammatory markers, associated with an imbalanced microbiota ( Galica An,et al. (2022)). This could accentuate pelvic inflammation and activation of nociceptive receptors in the pelvic region.
To better understand these complex interactions, here is a diagram illustrating the pathophysiology of pelvic pain, with a particular focus on the gut-brain axis, the intestinal microbiota, and systemic inflammation:
This diagram shows:
Intestinal dysbiosis: Disruption of the microbiota promotes intestinal permeability.
Inflammation: Pro-inflammatory molecules enter the bloodstream and trigger inflammatory reactions.
Gut-Brain Axis: Dysbiosis influences communication between the brain and pelvic organs, exacerbating pain.
Dietary support for pelvic pain
Pelvic pain management often relies on conventional medical treatments, but dietary adjustments can provide real relief. Several diets have shown beneficial effects on reducing inflammation and improving digestive and metabolic functions.
1. High fiber diet
A high-fiber diet is beneficial, especially for patients with digestive disorders such as irritable bowel syndrome. Fiber facilitates intestinal transit and feeds the good bacteria in the microbiota, helping to reduce systemic inflammation. A 2022 study showed that increasing soluble fiber intake could reduce the severity of IBS symptoms in women, including decreasing abdominal pain ( Singh P, et al (2022) )
2. FODMAP-free diet
The FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) diet is particularly effective for people with pelvic pain associated with irritable bowel syndrome. This diet involves temporarily avoiding fermented carbohydrates, which are poorly absorbed and cause bloating and pain. More than 70% of patients with IBS and chronic abdominal pain have observed a reduction in symptoms after following a FODMAP-free diet ( İnci Türkoğlu , et al. (2024)) .
3. Mediterranean diet
The Mediterranean diet, rich in vegetables, fruits, fatty fish, and healthy oils like olive oil, has natural anti-inflammatory properties. It is a dietary pattern well-documented for its ability to reduce systemic inflammation, which may improve pelvic pain, particularly that related to endometriosis. A 2019 study in Minerva Ginecol showed that women with endometriosis who followed a Mediterranean diet had reduced levels of inflammation and improved pelvic pain ( De Leo V, et al. (2019) ).
4. Anti-inflammatory diet
An anti-inflammatory diet is rich in foods like fatty fish, nuts, seeds, and spices like turmeric and ginger, which are known to reduce inflammation. This type of diet is beneficial for all chronic pain, including pelvic pain.
Chronic pelvic pain can greatly impact quality of life, but solutions exist beyond medical treatments. Nutrition, as a complementary therapy, has a promising role to play in managing this pain. Whether it’s following a high-fiber, FODMAP-free, Mediterranean, or anti-inflammatory diet, adapting your diet is a valuable strategy to reduce inflammation and improve daily comfort.
The Pain Institute in the 5th arrondissement of Paris now offers personalized nutritional assessments with a nutritionist and a neurologist , to better understand the impact of diet on pelvic pain. Do not hesitate to contact us for advice tailored to your needs.
References:
Galica AN,and al. (2022). Diet, fiber, and probiotics for irritable bowel syndrome. J Med Life.
Singh P, et al (2022). The Role of Food in the Treatment of Bowel Disorders: Focus on Irritable Bowel Syndrome and Functional Constipation. . Am J Gastroenterol.
İnci Türkoğlu , and al. (2024). Eating for Optimization: Unraveling the Dietary Patterns and Nutritional Strategies in Endometriosis Management . Nutr Rev
By Leo V, et al. (2019). Role of a natural integrator based on lipoic acid, palmitoiletanolamide and myrrh in the treatment of chronic pelvic pain and endometriosis . Minerva Ginecol.