A case of persistent abdominal pain explores craniosacral therapy, chronic stress, body image, and self-compassion as interconnected elements of whole-person healing.
Initial Presentation
As luck would have it, this patient was never supposed to see me. But I’m so glad she did. An opening in my schedule, coupled with the severity of her pain, led her to my care.
During our first appointment, she described waking in the night with stabbing abdominal pain at a severity of 8/10 and the sensation of knots in her lower abdomen. The pain was always below the belly button, bilateral, and waking her one to two times a night. There was occasionally the sensation of heaviness and an “entity” there, along with bloating.
Outside of the abdominal pain itself, her digestive presentation was remarkably unremarkable and she otherwise appeared healthy. She had a history of depression, alcoholism, Polyendocrine Metabolic Ovarian Syndrome (PMOS), and struggled with stress management.
So far, nothing had brought her any relief. She reluctantly mentioned recent weight gain in the lower abdomen with a sense of embarrassment.
She mentioned the onset of abdominal pain with significant stressors a few months earlier regarding familial relationships but could not elaborate further. She knew stressors were present, but she felt disconnected from the stress itself. This left me very curious.
Initial Evaluation and Treatment
I ordered an abdominal Computed Tomography (CT) with contrast and recommended dietary changes, prioritizing whole foods over processed and pre-made foods, with emphasis on centering her meals around plants instead of heavy meats. Stress management in the form of calming nervine teas and a craniosacral session were recommended.
The results of the CT were unremarkable with the exception of a cyst on the right ovary. A follow-up ultrasound showed a benign simple cyst with no required follow-up.
We followed up with cranio-sacral therapy (CST) one week later. The abdominal pain had gotten worse in the past week, with intense cramping now occurring during the day instead of solely at night. The patient pointed to a broad area of the lower abdomen stating the pain was everywhere.
The listening during my cranio-sacral session led me to both sides of her lower abdomen. While I laid my hands on the areas causing her significant pain, I put my intention towards her healing, listening and unwinding the tightness within her, and including a mantra of love towards the body.
“Was it the dietary changes? The physical therapies? Or could the most significant change have been the one that could not be seen on a scan, the patient’s changing thoughts, beliefs, and relationship with her own body?”
The Wisdom of The Body
Cranio-sacral is a specialized training, although the practice can be highly variable from provider to provider. My individual approach consists of feeling where tension is being held in the body, moving with the body, releasing those areas of congestion or tightness, and incorporating concepts from the oldest forms of medicine, including Traditional Chinese Medicine (TCM). I listen to the body and follow where it leads, rather than being guided by the patient’s expectations or perceived limitations. When tension presents in an area associated with the large intestines, as it did with this patient, I evaluate both the physical and emotional aspects of what may be present, including grief, sadness and the struggle to let go, emotions that TCM traditionally associates with the large intestine.
The session itself is not simply the laying of hands on a patient. It is also the intention set towards the patient, the meditative moments created for them, the reconnection to breath, the reminder to let go and return to the present moment. It is an opportunity to become aware of the body and what we are truly feeling. I see myself as a steward of the process while the patient, remaining in control of their own body and mind, gently relaxes, unwinds, and returns to a parasympathetic state, the physiological condition where the body prioritizes healing.
At the end of each session, I reflect back to the patient what I experienced and felt during the treatment. This discussion provides another space for healing by exploring what the body has been holding and what this means for them.
What I experienced during this patient’s CST session was a sense of suffocation towards her inner self, which manifested as an intense tug-of-war within body. There was resistance to unwinding, as the body had been tight, knotted, and accustomed to a prolonged state of protection. It seemed unable to fully trust the process of relaxing and unwinding. Slowly, with gentle reminders of love and safety, the body began to release.
She felt better in-office immediately following the session, but could not state specifically how so. A few days later, another moment of release surfaced. She sent me a message, finally opening up about how she truly felt about her body:
“I really want to get rid of the HUGE belly fat that I have, I know it’s unhealthy and it makes me feel so gross. Maybe my fat belly will get reduced with nervous system support and my new commitment to plant based diet & starting the [fitness] classes, thanks to your suggestion! Maybe you have more ideas on belly fat?!”
I encouraged her towards consistency with the current treatment plan, and working with the body’s pace. I emphasized the potency of the stress management support and re-connecting with her body, bringing calm and a sense of security from within.
The Area Beneath the Pain
The belly fat that she was referring to was her lower abdomen, the same area she pointed to for her pain in the first CST session. The area that she disliked and thought was gross was the same area that was causing her stabbing pain, and disrupting her sleep on an almost nightly basis.
This stood out to me most about her case.
With significant structural pathology ruled out, I returned to her fixation with that particular area of her body. Her distinct distaste for her lower belly continued to echo in my head with each interaction, highlighting another potential root-cause and bringing an important element of her healing into focus: the mind-body connection.
The mind-body connection is remarkably potent, capable of either supporting or undermining health for each individual. The brain communicates with every system in the body, allowing our psychological experiences to influence our immune system activation, endocrine function, sympathetic vs parasympathetic state, proper digestion, and optimal health. Prolonged or dysregulated stress can contribute to changes at a functional level bringing more inflammation, changes in mood, and overall impaired health.1
Stress has been studied immensely with connection to our body. Although some acute stressors provide benefits to the body, chronic stress broadly suppresses physiological functioning, especially the immune system. And most interestingly, the type of stressor creates different outcomes in the body. Research has found that the body responds differently to experiences of trauma and loss, both emotionally and physiologically.2
This raises a broader consideration of how our health is influenced as we navigate the ever-shifting landscape of life, with its stressors, work, finances, relationships, inevitable changes, and unexpected turns. If the body can respond so distinctly to trauma and loss, what other emotions, thoughts, and beliefs does it interpret and respond to in such a nuanced way?
Furthermore, if the body can respond so profoundly to what happens within us, what happens when we consider what happens between us? The profound influence of internal experiences represents a single layer of our overall well-being; external factors add another dimension to our health.
Simple intentionality between provider and recipient continues to be studied, with emerging research suggesting that the intentional connection between two individuals has measurable physiological effects. In one fMRI study, healers directed distant healing intentions toward recipients who were isolated in an MRI scanner and unaware of the randomly assigned periods in which the intention was being sent. Significant differences in brain activation were observed between the “send” and “no-send” periods.3
This information invites us to look beyond the physical treatment itself. If intention can be associated with measurable changes in brain activity, then what happens in the sacred moments of silent work between provider and patient may also become part of the medicine.
The Follow-Up
After the cranio-sacral session, I didn’t hear from or see the patient for one month until her next CST session. When asked about her intense abdominal pain, she expressed that it stopped suddenly, and had never returned. She hadn’t even thought about it since her last CST visit one month ago.
The biggest change I saw in the patient was the confidence she radiated in herself. She no longer held disdain toward any particular part of her body. As she developed a renewed sense of acceptance and compassion towards herself, her body seemed to respond in kind.
The final result leaves room for interpretation. Was it the dietary changes? The physical therapies? Or could the most significant change have been the one that could not be seen on a scan, the patient’s changing thoughts, beliefs, and relationship with her own body?
To date, she remains pain-free and continues to receive craniosacral therapy.
