Endometriosis: How Pelvic Physiotherapy Can Help

Endometriosis affects an estimated 1 in 10 individuals assigned female at birth, making it a prevalent and often debilitating condition. Despite its high incidence, there remains a lack of comprehensive understanding surrounding the condition, leading to delays in diagnosis that can extend for over 7 years.

This blog post delves into the world of endometriosis, discusses common signs and symptoms, and explores how pelvic physiotherapy can help with symptom management and improve your quality of life.

Understanding Endometriosis:

Endometriosis is a complex condition where tissue similar to the uterine lining grows outside the uterus, leading to pain, inflammation, and potential complications. It can grow on the ovaries, fallopian tubes, intestines, bladder, and lining of the pelvis, and has been identified in almost every organ of the body. Its effects are far-reaching, impacting physical, emotional, and psychological well-being. However, despite its prevalence, the lack of awareness and knowledge surrounding endometriosis often results in delays in the development of an appropriate treatment plan.

Recognizing the Signs of Endometriosis:

Endometriosis manifests through various signs and symptoms, which can differ from person to person. Common indicators include:

• Painful Periods: Pain that is so severe it significantly impacts daily activities is a hallmark symptom. This pain often occurs around or during menstruation.

• Heavy or Irregular Bleeding: Excessive bleeding or irregular menstrual cycles can be indicative of endometriosis.

• Pelvic and Low Back Pain: Pain in the pelvic region and lower back, which may radiate down into the legs, is another frequent symptom.

• Pain During or After Sex: Pain during sexual intercourse (dyspareunia) or lingering discomfort afterward can be related to endometriosis.

• Fatigue: Chronic fatigue is a common complaint among individuals with endometriosis due to the physical and emotional toll of the condition.

• Bladder and Bowel Symptoms: Endometriosis can affect the urinary and gastrointestinal systems, leading to bladder urgency, frequency, and pain with filling or emptying. Painful bowel movements are also reported.

• Ovulation-Related Pain: Pain occurring during or around ovulation can be a sign of endometriosis.

Common Surgical Treatments for Endometriosis:

While there is no known cure for endometriosis, there are many different treatment options to consider. When it comes to managing endometriosis with surgery, there are two main types, both done laparoscopically: ablation and excision. Understanding the differences between these approaches is crucial for making informed decisions about your health.

1. Ablation: is the removal of tissue by an erosive process such as scraping or burning. While this method offers relief from symptoms for some, it's important to note that it doesn't address the root cause of endometriosis.

2. Excision: recognized as the gold standard for treating endometriosis, which is the removal of the entire endometriosis lesion by cutting.

It is important to acknowledge that although surgeons can skilfully remove endometriosis through laparoscopy, there is no guarantee that this will improve pelvic pain, especially if pain has become persistent and widespread sensitivity is present. The surgeon may decide to refer their patient for multidisciplinary treatment to calm the nervous system first before considering surgery.

The Role of Pelvic Health Physiotherapy:

Pelvic physiotherapy offers a holistic approach to managing endometriosis symptoms. This specialized form of physical therapy focuses on restoring optimal function and improve your quality of life. Here's how it can help:

1. Pain Management: Persistent pelvic pain (which can often go hand in hand with Endometriosis) is complex and multifactorial in nature. Pelvic pain is often influenced not only by biomechanical factors, but also by central mechanisms, like your emotions, level of stress, beliefs, and past experiences. Pelvic physiotherapy aims to address both the all aspects through a biopsychosocial approach to guide you towards positive outcomes. Our collaboration frequently extends to other healthcare team members, including psychologists, specialists, and general practitioners, ensuring a well-rounded approach to your care.

2. Manual Therapy: Pelvic physiotherapists use a variety of techniques to alleviate pain, such as manual therapy, and myofascial release to reduce muscle tension and improve mobility.

3. Pelvic Floor Rehabilitation: Dysfunction in the pelvic floor muscles is common in endometriosis. Pelvic physiotherapy includes exercises to strengthen, relax, and improve coordination of your pelvic floor muscles.

4. Education and Self-Care: Our biggest tool is education, so you should expect plenty of knowledge to empower you, as you navigate treatment for your endometriosis. This can include: healthy bladder and bowel habits, developing a pain toolkit for flares, learning how to function with pain, and create a supportive environment for healing.

5. Scar Tissue Management: Post-surgical scar tissue and adhesions can contribute to pain. Pelvic physiotherapy techniques help manage your scar tissue and promote optimal healing.

6: Coaching on Lifestyle Interventions: Research has demonstrated the profound influence of lifestyle on pelvic pain. Pelvic floor physiotherapy integrates evidence-based lifestyle interventions. This might include guidance on stress management, nutrition, sleep hygiene, and relaxation techniques, all of which can contribute to your well-being and pain management.

Online Resources & Websites:

• https://endometriosisnetwork.com/educational-resources

• https://www.yourperiod.ca/endometriosis/

• https://gynqi.com

• https://endoact.ca

• https://tapmipain.ca/patient/managing-my-pain/pain-u-online/pain-education.html

• https://portal.poweroverpain.ca

• https://pelvichealthsolutions.ca/knowledge-base/endometriosis

• https://www.belowthebelt.film

• https://www.tamethebeast.org

Bottom Line:

Endometriosis is a challenging condition that affects countless individuals, often leading to significant pain and poor quality of life. Our team of pelvic physiotherapist offer a holistic and empowering approach to managing endometriosis symptoms, aiming to alleviate pain, improve physical function, and enhance overall well-being.

If you or someone you know has endometriosis or endometriosis-like symptoms, don’t delay, and book a pelvic physiotherapy appointment at Raise the Bar Physiotherapy to take steps toward a more comfortable and fulfilling life. We can help.

References:

1. Rogers PA, et al. Priorities for endometriosis research: recommendations from an international consensus workshop. Reprod Sci 2009;16(4):335-46.

2. Adamson GD, et al. Creating solutions in endometriosis: global collaboration through the World Endometriosis Research Foundation. J of Endometriosis 2010;2(1):3-6.

3. Nnoaham KE, et al. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril 2011;96(2):366-373.

4. Johnson NP and Hummelshoj L, et al. Consensus on the current management of endometriosis. Hum Reprod 2013;28:1552-1568.

5. Leyland et al. Endometriosis: Diagnosis and Management. J Obstet Gynaecol Can 2010;32(7):S1-S3.

6. Azzolino et al.Musculoskeletal Changes Across the Lifespan: Nutrition and the Life-Course Approach to Prevention. Front Med 2021;8:697954.

7. 2023. The Endometriosis Network Canada. Accessed Aug 17, 2023.

8. Philippa Bridge-Cook, PhD. Endometriosis: a team approach to healing. Alive, January 2017. Endometriosis – alive magazine

9. Chopin et al. Operative management of deeply infiltrating endometriosis: results on pelvic pain symptoms according to a surgical classification. J Minim Invasive Gynecol. 2005;12:106–112

10. Ghaderi et al. Pelvic floor rehabilitation in the treatment of women with dyspareunia: a randomized controlled clinical trial Int Urogynecol J. 2019; 30(11): 1849–1855.

11. Berghmans et al. Physiotherapy for pelvic pain and female sexual dysfunction: an untapped resource. Int Urogynecol J. 2018 May;29(5):631-638.Armour et al.

12. Dietary Practices of Women with Endometriosis: A Cross-Sectional Survey. The Journal of Alternative and Complimentary Medicine Volume 27, Number 9, 2021, pp. 771-777