Endometriosis & Pelvic Health Physiotherapy
What is it?
Endometriosis is a condition thought to affect 10-15% of women worldwide. Endometrial tissue which is usually only found in the uterus spreads to other areas of the body (usually around the abdomen and pelvis). The displaced tissue behaves in the same way it would usually behave during your menstrual cycle, thickening, breaking down and bleeding with each cycle. Since it has no way of leaving the body it becomes trapped, irritating tissues around it and eventually causing scar tissue and creating adhesions, causing pelvic tissues and organs to stick together.
Diagnosis
Symptoms can be very variable and wide-spread which is one of the reasons it currently takes between 5-12 years on average for women to be given an accurate diagnosis. In fact, the only Gold Standard way of diagnosing this condition is via a laparoscopic surgical procedure. This requires a specialist consultant with significant experience with Endometriosis to go in and look for Endometriosis. It requires meticulous work from the surgeon, checking all surfaces of the tissue in the area.
Often a general Gynaecological Consultant is not a specialist in Endometriosis, and so it is worth considering finding a specialist to undertake your investigation and any following procedures because it is such a misunderstood condition. It is also important to be aware that Endometriosis can not be ruled out with any other medical investigation such as ultrasounds or MRI. If you suffer with the following symptoms and feel you have not been properly investigated for Endometriosis then it's worth having further conversations with your GP or seek the advice of a Specialist Consultant in your area.
Pain in your lower tummy or back or pelvis which often worsens during your period
Period pain that stops you from doing your usual activities
Very heavy periods
Pain during or after sex
Pain when going to the toilet (often worse during your period)
Feeling sick, constipation, diarrhoea or blood in your urine during your period
Difficulty getting pregnant
Recurrent bloating
Excessive fatigue
Treatment
If Endometriosis is found following a Laparoscopic investigation, the only Gold Standard form of surgical treatment is called a Laparoscopic Excision, in which a surgeon will remove the Endometrial tissue from the affected areas. This usually requires a few small incisions around the pelvis and abdomen.
Why seek Physiotherapy Treatment?
While studies do show an overall improvement of period pain, pain associated with sex and improved quality of life following Laparoscopic Excision, we also know that the longer-term effects of living with the condition must also be treated in order to improve further. This is where Pelvic Health or Women's Health Physiotherapy has an important role. Pelvic rehab addresses pelvic floor dysfunction and abdominal guarding, both common physical responses to a long history of pain. The body adapts to pain by 'protecting' or guarding the painful area but eventually this causes tightening, tension and poor function of the muscles in the area, which itself can cause pain.
Physiotherapists are highly skilled at managing and teaching skills to cope with and overcome chronic pain. This can be applied to Endometriosis clients too, helping them to understand the effect of lifestyle, stress, sleep, and negative thoughts will affect their experience of pain.
Given the length of a typical physiotherapy appointment, compared to that of a GP appointment, your Physiotherapist is also able to spend more time getting to know you and how your condition affects your daily life. They are more focused on enabling you to restore full function and recognise that this means more than just being able to do simple daily tasks, but instead lead a full, active life. This usually also means guiding you towards regular exercise that will complement and aid your recovery.
You will benefit more from exercise that lengthens and strengthens your muscles (called eccentric exercise), rather than lots of shortening and tightening movements.
Stretching and mobility is also very important, in order to regain some of the mobility lost through years of guarding and adhesions.
Often clients require a lot of practice at downtraining their pelvic floor muscles which can be very tight and uncomfortable, leading to symptoms such as bladder pain, urinary incontinence, constipation and painful sex.
Slower work, such as yoga and pilates can be very effective at regaining control and help to address the common 'dissociation' with the abdomen and pelvic region that Endo clients experience.
As you progress, it's important also to introduce CV exercise to improve heart health and fitness.
Lifestyle Advice
Endometriosis is a hormonally driven condition, usually caused by elevated levels of oestrogen. For this reason it is often managed with long-term birth control medication and in some extreme cases a hysterectomy is offered. However, it is now recognised that the endometriosis adhesions and growths can produce their own oestrogen supply, and therefore these treatment options are likely to be simply masking the symptoms rather than solving them. The side effects of reducing oestrogen supply long-term or a hysterectomy include early menopause, decreased bone strength and health and increased risk of a cardiovascular event.
Instead, consider how you can affect hormone regulation with diet and lifestyle. Seek the input of an experienced nutritionist to recommend specific dietary plans, but ultimately aim for a low inflammatory diet such as a Mediterranean diet with lots of fruit and vegetables. Many women with Endo find gluten and dairy exacerbate symptoms or lead to 'Endo Belly' so this could also be something to consider. Without question, good digestion and bowel health is vital for managing Endo symptoms, mainly because this is the most effective way of removing excess oestrogen and waste products from the body. Better pelvic floor function is also proven to improve bowel transit times. Reducing stress, anxiety and fatigue so as to maintain a better energy balance is also an effective way of achieving better hormonal stability, reducing the symptoms of Endo.
Summary
A Women's Health Physio has the skills and knowledge to be able to address all of the areas discussed above, and identify areas that may need more specific input and refer you to an appropriate clinician. Alongside this they are also qualified to assess and treat the internal pelvic floor muscles which can make a significant difference to their function and how they affect the rest of the system. Often your treatment plan will include some manual therapy, soft tissue massage or Acupuncture to provide relief from pain and tension, aid relaxation and improve mobility, resulting in improved symptoms. You'll be guided towards self-management tools to continue your progress at home and alter the way you cope and respond to pain. Your physio will introduce safe and effective exercise to make long-term changes to the way your body moves and performs. It is for all of these reasons that Pelvic Physiotherapy is recommended as Gold Standard treatment for all women with Endometriosis, so if you've not yet tried it, seek an appointment.
Thanks to Lori Forner & Michelle Lyons for inspiring this post via 'The Pelvic Health Podcast'.
Recommended reading: 'Beating Endo' by Amy Stein