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At least 1 in 10 women have endometriosis. Up to 50% of women with infertility have endometriosis. So, what is Endometriosis?

by SRC Health

Endometriosis is a common long-term condition where the tissue that is similar to the lining of tissue that grows inside the uterus, grows outside of the uterus. Endometriosis can be found anywhere in the abdominal cavity, so it is common to find it on the pelvis, the bladder and bowel. In some cases, endometriosis can also be found outside the pelvis such as the lungs, the skin, the brain and even the diaphragm.

Because of the different locations where the tissue can grow and the severity of the symptoms, everyone that has endometriosis present slight differences. It is also known that the stage of endometriosis (that is determined by the quantity and location of the endometriosis tissue found in surgery) doesn’t coincide with the severity of symptoms. So, there is still a lot that we don’t understand about endometriosis.

Studies have shown that in the general population, about 5-10% of women (up to 1 in 10 women) are affected by endometriosis, with symptoms typically presenting in women of child-bearing age.

Treatment of endometriosis is a case-by-case basis and requires a good team care involving the GP, Gynaecologist specialised in endometriosis, pain specialist, psychologist, dietician and women’s health physiotherapist.

5 ways Pelvic floor physiotherapist can help if you have endometriosis

1. Painful periods and abdominal pain

One of the most common symptoms of endometriosis is painful periods and abdominal pain. Did you know exercise can be the best tool for pain management for painful periods? We are aware that this may be a hard thing to take especially because pain can give you tremendous fatigue. However, whenever you feel slightly better, try to go for a walk or to the gym. Do something you really love or enjoy (like dancing, yoga, etc) and research is clear that pain levels can improve significantly. It is hard however, to occasionally do exercise when everything seems to flare your pain and this is where Pelvic physiotherapists can help you! The goal is to choose what works for you and this requires some bravery to try and some trial and error. Sometimes you may flare but the goal is to find a routine that can help you find the best exercise routine that can help you manage your symptoms.

2. Pain during and after sex

1 in 4 women have painful penetrative intercourse. Endometriosis is linked with an increase in the muscular tension of the abdominal muscles and pelvic floor muscles. It is therefore another very common symptom for those who have endometriosis, to report pain during or after penetrative intercourse. If you have endometriosis, it is common to also describe some bleeding and spotting after intercourse. None of these is normal but pelvic physiotherapy can help! Pelvic physiotherapists are not only trained to help you increase awareness of pelvic floor and therefore decrease your pain, but they are also trained to give you tips about how to optimise intercourse with positioning and how to improve foreplay. When you have pain during or after intercourse, pelvic floor awareness is the key.

3. Difficulties in emptying bladder and bowel

As mentioned in point 2, Endometriosis is linked with an increase in the muscular tension of the abdominal muscles and pelvic floor muscles. As a result, because the pelvic floor is responsible for the control of the urethral and anal sphincter, those with endometriosis commonly describe difficulties in starting to empty the bladder and bowel as well as difficulty in fully emptying them. Pelvic physiotherapy can help you regain control of the anal and urethral sphincter by improving pelvic floor control and giving you strategies to improve relaxation during bladder and bowel emptying.

4. Anal pain

Following on points 2 and 3, due to the increased muscular tension in the pelvic floor and lower abdomen, often those with endometriosis report pain before, during and after emptying their bowel. Although this may result from the presence of endometriosis tissue in the rectum or adenomyosis (another common condition that can provoke severe pelvic pain), an increase in pelvic floor tension and lack of control can exacerbate the pain. It is therefore in these situations it is vital to improve the anal sphincter control, to improve the strategies during defecation (emptying the bowel) and, whenever necessary, improve stool consistency. Pelvic physiotherapists are the best to help you how to achieve all these

5. Stress and pain management

People with endometriosis often report high levels of pain during and outside their periods. Chronic pain can have an impact in several systems and it is therefore understandable why people with endo also report higher incidence of irritable bowel syndrome, fibromyalgia, migraines, autoimmune conditions, chronic fatigue, among other conditions. Pelvic Physiotherapists can help you with providing stress management strategies and pain management skills to help you cope better with pain, stress and anxiety that is linked with living with pain.

Seeing a pelvic floor physiotherapist who specialises in pelvic pain is an excellent first step in managing increased muscular tension in pelvic floor due to endometriosis. An important part of the treatment involves in helping you to regain control of your pelvic muscles so they can get back their full range of motion of contraction and relaxation.

Physiotherapy treatment methods for overactive pelvic floor muscles are many and mainly depend on one’s symptoms, but could include a combination of:

  • Education, Desensitisation of the nervous system with movement, manual therapy and breathing exercises
  • Pelvic floor down training with relaxation and stretching of the pelvic floor muscles
  • Body scanning techniques, graded imagery, neural dynamics
  • Using feedback devices like EMG biofeedback and real time ultrasound to help relax pelvic floor
  • Graduated dilator therapy
  • Strategies to improve bladder and bowel emptying by adjusting posture.

No treatment is the same as your pelvic floor physio will treat your symptoms and address the underlying changes that have occurred in the pelvis. Your treatment plan will be developed to help you achieve your goals and improve your quality of life.

Living with Endometriosis isn’t easy but, with the right team, the burden can be eased.

References

  1. Del Forno, S., Arena, A., Alessandrini, M., Pellizzone, V., Lenzi, J., Raimondo, D., Casadio, P., Youssef, A., Paradisi, R. and Seracchioli, R., 2020. Transperineal ultrasound visual feedback assisted pelvic floor muscle physiotherapy in women with deep infiltrating endometriosis and dyspareunia: a pilot study. Journal of Sex & Marital Therapy46(7), pp.603-611.
  2. Wurn, B.F., Wurn, L.J., Patterson, K., King, C.R. and Scharf, E.S., 2011. Decreasing dyspareunia and dysmenorrhea in women with endometriosis via a manual physical therapy: Results from two independent studies. Journal of Endometriosis3(4), pp.188-196.
  3. Aredo JV, Heyrana KJ, Karp BI, Shah JP, Stratton P. Relating Chronic Pelvic Pain and Endometriosis to Signs of Sensitization and Myofascial Pain and Dysfunction. Semin Reprod Med. 2017 Jan;35(1):88-97. doi: 10.1055/s-0036-1597123. Epub 2017 Jan 3. PMID: 28049214; PMCID: PMC5585080.
  4. Orr NL, Noga H, Williams C, Allaire C, Bedaiwy MA, Lisonkova S, Smith KB, Yong PJ. Deep Dyspareunia in Endometriosis: Role of the Bladder and Pelvic Floor. J Sex Med. 2018 Aug;15(8):1158-1166. doi: 10.1016/j.jsxm.2018.06.007. PMID: 30078464.
  5. HILTON, S. & VANDYKEN, C. 2011. The Puzzle of Pelvic Pain—A Rehabilitation Framework for Balancing Tissue Dysfunction and Central Sensitization, I: Pain Physiology and Evaluation for the Physical Therapist. Journal of Women’s Health Physical Therapy, 35, 103–113.
  6. Dos Bispo AP, Ploger C, Loureiro AF, Sato H, Kolpeman A, Girão MJ, Schor E. Assessment of pelvic floor muscles in women with deep endometriosis. Arch Gynecol Obstet. 2016 Sep;294(3):519-23. doi: 10.1007/s00404-016-4025-x. Epub 2016 Feb 5. PMID: 26848858.
  7. Allaire C, Aksoy T, Bedaiwy M, et al. An Interdisciplinary Approach to Endometriosis-associated Persistent Pelvic Pain. Journal of Endometriosis and Pelvic Pain Disorders. 2017;9(2):77-86. doi:5301/jeppd.5000284
  8. Awad, E., Ahmed, H., Yousef, A., & Abbas, R. (2017). Efficacy of exercise on pelvic pain and posture associated with endometriosis: within subject design. Journal of physical therapy science29(12), 2112–2115. https://doi.org/10.1589/jpts.29.2112

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