How Pelvic Floor Therapy Can Help Those With Endometriosis
Endometriosis, a condition where uterine-like tissue grows outside the uterus, affects millions of women, causing debilitating pain and impacting daily life.
In this blog, we delve into how endometriosis affects pelvic health and discuss how pelvic floor therapy can help manage its symptoms. Join us as we share more about the complexities of endometriosis and explore how pelvic floor therapy can provide relief.
What is Endometriosis?
Endometriosis is a medical condition in which cells similar to the lining of the uterus (endometrium) grow outside the uterus in the pelvic or abdomen. The presence of endometrial tissue outside of the uterus can cause inflammation in the pelvic region, leading to painful symptoms, cysts, scarring, and even infertility. Endometriosis is estimated to affect about 10% of women between the ages of 15 and 44.
Many women suffer silently with endometriosis. Since many healthcare professionals still continue to lack awareness about this condition, it can take 10 years on average for an individual struggling with these symptoms to get diagnosed with endometriosis.
How is Endometriosis Diagnosed?
Generally, endometriosis can only be definitively diagnosed by biopsy taken during laparoscopic surgery. Since this is rather invasive, most diagnoses are arrived at based on history, physical exam, and in some cases, ultrasound and/or MRI can be used to narrow the possibilities of conditions down to endometriosis.
The most common symptoms associated with endometriosis are pain, particularly pain during and around a menstrual period, and infertility. Endometriosis patients often describe painful cramping pain that originates in the lower abdomen and radiates down their lower back and legs as well as pain during and after sex.
Other symptoms may include:
Diarrhea
Constipation
Fatigue
Heavy and/or irregular periods
Pain with urination and/or bowel movements during a menstrual period
Spotting or bleeding between menstrual periods.
Endometriosis is classified as stage 1, 2, 3, or 4. The stage is defined as how far the endometrial tissue has spread throughout the body and how much endometrial tissue is growing in these distant regions. A woman’s symptoms are not necessarily reflective of the stage they may be diagnosed with–a woman with stage 1 endometriosis may have more symptoms or experience more pain than a woman with stage 4.
Treatment for Endometriosis
There is no cure for endometriosis at this time but there are both surgical and nonsurgical treatments available to help manage growth of the endometrial tissue and symptoms.
Because endometrial tissue both inside and outside the uterus is affected by fluctuating hormone levels, one of the nonsurgical treatments for endometriosis includes hormone therapy such as:
Oral contraceptives with estrogen and progesterone to control hormones
Progestins to stop menstrual periods and endometrial tissue growth
Gonadotropin-releasing hormone antagonist to limit ovarian hormones
Gonadotropin-releasing hormone agonist to stop ovarian hormones
Excision surgery may be necessary for patients with more advanced endometriosis, enduring pain despite less invasive interventions, and/or those who may be trying to conceive. Surgery to remove or ablate endometrial tissue can be done via laparoscopy and during the procedure, the surgeon can often remove scar tissue that remains from endometrial growth as well.
Some women may be recommended a hysterectomy (removal of the uterus) to treat the endometriosis and/or an oophorectomy (removal of the ovaries) to lower estrogen levels, thereby decreasing the growth of endometrial tissue.
How Endometriosis Affects The Pelvic Floor
Patients with endometriosis often find that they also experience pelvic floor dysfunction.
As an inflammatory chronic pain condition, endometriosis can affect the structures of the pelvis including the muscles, ligaments, and nerves of the pelvic region. This inflammation from the endometriosis itself and surgery can cause scar tissue, adhesions, trigger points and tension making it difficult for the pelvic floor muscles to contract and relax effectively leading to pelvic floor dysfunction.. The symptoms of pelvic floor dysfunction that those with endometriosis often face include but are not limited to:
Painful penetrative sex
Pain with a gynecologic exam or with inserting a speculum
Having to urinate often
Burning pain with urination
Difficulty emptying the bladder
Pain in the back and hips
Constipation
Pain with a bowel movement
Painful cramping and bloating
Pelvic Floor Physical Therapy can help to treat all these symptoms, relieve pain, and improve muscle function to be able to have better sex, better bladder and bowel emptying, less cramping and pain, and decrease urinary frequency and urgency.
Ways Pelvic Floor Therapy Can Help
Pelvic floor therapists treat the myofascial trigger points often found in the abdominal wall, back, hips and pelvic floor in those with endometriosis. These trigger points may also cause spasming and thickening of the muscular tissue and referred pain. They help to elongate this tissue, internally and surrounding the pelvis, through soft tissue mobilization and trigger point release.
An internal pelvic exam allows the pelvic floor therapist to assess and treat muscle tension held in the pelvic floor. This involves one gloved finger with lube inside the vaginal canal, and does not require a speculum.
Additionally, the muscles tense due to a nervous system protective response against endometriosis and inflammation which may also cause bloating. The hands on manual therapy a pelvic floor therapist can provide can help to relax the protective response, improve lymphatic drainage and venous return, and reduce bloating.
During pelvic floor therapy sessions, individuals can expect a comprehensive assessment of their symptoms and physical condition. Through exercises, stretches, manual techniques, and behavior modification, pelvic floor therapists work closely with patients to improve quality of life. Each session is personalized to address the individual's unique needs and goals.
Many patients find relief of their pain with pelvic floor therapy and are surprised to find how much treating the musculoskeletal system affects their everyday lives. Learning how endometriosis and the pelvic floor are connected and knowing that there is effective treatment for endometriosis symptoms can be empowering and life changing!
Resources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9740037/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5890212/
