One in 10 women of reproductive age have endometriosis. It is often dismissed as ’period pain’ which means that diagnosis can take as many as 7 years.
Endometriosis is a common condition that affects the pelvic organs. It occurs when the tissue similar to the tissue that lines the uterus grows outside of the uterus (womb), usually within the pelvic cavity, but potentially anywhere in the body.
You may have been told you also have Adenomyosis. In this condition, the tissue that lines the uterus grows into the uterine muscle wall. This can cause the uterus to become enlarged, tender, and painful during menstruation, and the flow will be heavy, usually with clots. Adenomyosis is very common in women who have endometriosis, and it may contribute to infertility.
Symptoms of endometriosis and adenomyosis can be similar and include:
- Heavy or prolonged menstrual bleeding
- Severe menstrual cramps often causing you to miss school or work
- Pelvic pain (stabbing pains inside the hip bones and aching pain in the back or across the belly are common, but it can also be felt in the tailbone). These may occur throughout the month, not only during your period
- Painful intercourse
- Painful bowel movements or painful urination
- Abdominal bloating and abdominal tenderness
While there is currently no cure for endometriosis or adenomyosis, pelvic health physiotherapists often play a crucial role in managing symptoms and improving your overall quality of life.
Often, after years of pain, the pain system can become very sensitive. Your women’s health physiotherapist can help you reduce the sensitivity of your nervous system by using techniques such as manual therapy, nerve glides, relaxation and visualisation, pain education, TENS (a type of electrical stimulation), and special exercises. Pain is treatable even if it has been present for many years!
There is a great explanation of how the pelvis can become sensitised over time in this brochure from Mercy Heath in Victoria.
Pelvic floor Rehabilitation
Endometriosis can cause altered pelvic floor muscle function, which commonly contributes to painful sex, pain when emptying the bladder or bowel, or incomplete bladder or bowel emptying. Women’s health physiotherapy can help to rehabilitate the pelvic floor muscles through pelvic floor muscle downtraining, manual muscle release, and biofeedback. With more relaxed, lengthened, and co-ordinated pelvic floor muscles, your symptoms could improve. You can hear more about how endometriosis affects the pelvic floor muscles here:
When you have been in pain for years there will have been some degree of subconscious protective muscle clenching response, probably in multiple muscle groups throughout the body, not just in the pelvis. Prolonged increased tone in muscle and fascia will add another layer to your pain. Your pelvic health physiotherapist can help you identify which other muscle groups need releasing, relaxing, and lengthening, thereby reducing your pain.
Nerve and Connective Tissue mobilisation
To function normally, your pelvic organs need to move freely, sliding and gliding over each other without friction. The bladder needs to stretch to hold 600mls, then it needs to contract down to empty fully. The rectum should be able to expand to hold 250mls of stool, and then contract to empty completely. The uterus changes position over the course of a normal menstrual cycle, reaching its highest point at ovulation and during sexual arousal, and its lowest point just before your period. Endometriosis lesions can cause adhesion between organs, sticking them to each other so they can’t move like they are supposed to. Intra-pelvic ligaments and fascia can become contracted and shortened. Nerves can get caught up in the tangle too. Sometimes endometriosis lesions form on the nerves. Mobility exercises, visceral manipulation techniques, connective tissue release, and nerve glides can make a big difference to your pain.
Every woman will have a different presentation. The main driver for one woman’s pain might be tight pelvic floor muscles, but for another woman the driver might be sensitised fascia and altered posture. For this reason, each woman needs an individual assessment and treatment plan.
You might find some general information on the pelvic pain foundation website useful: https://www.pelvicpain.org.au/learn/download/
Education and support
Your women’s health physiotherapist can provide education and support if you are living with endometriosis. Physiotherapists can help women to understand their condition better and provide advice on lifestyle changes that can help manage their symptoms, such as changes to exercise, diet, and stress management. We can also offer emotional support and help you cope with the challenges of living with endometriosis.
Surgery preparation and recovery
A definitive diagnosis of endometriosis requires laparoscopic (keyhole) surgery. During the surgery, endometriosis lesions can be removed. It is not uncommon for pain to return 1-2yrs after surgery, or for surgery to sometimes not even help the pain, because of the multiple drivers of pain.
For women who require surgery for endometriosis, women’s health physiotherapy can play a vital role in preparing for the procedure and recovering afterward. We can prescribe pre-operative exercises to prepare your body for surgery. We can also offer post-operative rehabilitation to help you recover quickly and effectively.
If you are living with endometriosis, consider a consultation with one of our women’s health physiotherapists and start taking charge of your pain.