Endometriosis

Chances are you’ve heard of endometriosis, which affects up to 1 in 10 women globally. Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside the uterus. This can lead to inflammation, pain and pelvic floor dysfunction, which can significantly impact a woman’s quality of life. Learn more about this condition and the role of Pelvic Physiotherapy.

What is Endometriosis?

Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside the uterus (called extrauterine sites). These sites may include the ovaries, bladder, bowel and recto-vaginal septum (the thin structure separating the vagina and the rectum). This abnormal tissue growth can lead to inflammation and the formation of scar tissue called adhesions in the pelvic area. There are 3 main types of endometriosis:

• Superficial endometriosis (found mainly on the pelvic peritoneum)

• Ovarian endometrioma (found in the ovaries)

• Deep endometriosis (found in the recto-vaginal septum, bladder and bowel)

Endometriosis symptoms are highly variable, so every woman’s experience is unique. Common symptoms include:

• Chronic pelvic/low back pain

• Dysmenorrhea (painful periods)

• Dyspareunia (painful intercourse)

• Bowel or bladder dysfunction (pain when urinating or defecating)

• Fatigue

• Infertility

Because the symptoms of endometriosis can be confused with other conditions, diagnosis can be challenging. In fact, may women may not even be aware that they have endometriosis. If you’re feeling troublesome symptoms like the ones above, talk to your healthcare professional. They will gather your medical history, do a physical exam, and use a number of methods to diagnose endometriosis, including (some or all of the following):

• Laparoscopy. This is a minimally invasive procedure in which a camera is used to visualize inside the pelvis so that suspected tissues can be removed and tested to confirm the presence of endometriosis. It is considered the gold standard for diagnosing endometriosis.

• Pelvic exam. Your doctor manually feels (palpates) areas in your pelvis for abnormalities, such as scars behind your uterus.

• Imaging (e.g., transvaginal/abdominal ultrasound, MRI). Imaging allows your doctor to see inside your body and assess your organs and tissue in more detail.

Endometriosis is a fairly common condition, occurring in 10-15% of women worldwide.

Who Is At Risk of Endometriosis?

The exact cause(s) of endometriosis is not known, but it is known to be linked to estrogen levels. Studies show that women are at higher risk for endometriosis if they:1

• Have a mother, sister, or daughter with endometriosis

• Started their periods at an early age (before age 11)

• Have short monthly cycles (less than 27 days)

• Have heavy menstrual periods that last more than 7 days

• Are infertile

What Is The Role of The Pelvic Floor in Endometriosis?

The pelvic floor is a group of muscles, ligaments, and connective tissue that are located at the bottom of the pelvic bones. The pelvic floor is our body’s foundational core, providing:

• Support to the pelvic organs

• Stability for the low back and hip joints

• Support for the bowel and bladder

• The framework for sexual sensation and arousal

Women suffering from endometriosis often experience dysfunction in their pelvic floor. This is because chronic inflammation and adhesions can cause the surrounding pelvic muscles to protectively contract to guard the area of pain. Over time, this can create areas of muscle tightness, weakness, and a lack of coordination. Pelvic floor dysfunction can lead to significant pelvic pain (including the back – which often stems from pelvic floor muscles), which can interfere with activities requiring these muscles, like sex, urinating and exercise.

How Can Pelvic Health Physiotherapy Help Me?

If you are suffering from pelvic pain due to endometriosis, know that you have treatment options. One such option is Pelvic Health Physiotherapy (also called Pelvic Floor Physiotherapy). Pelvic floor physiotherapists help “re-train” your pelvic muscles so they’re able to relax, gain strength and flexibility, and properly coordinate contractions. This can help reduce spasms and improve symptoms like pelvic or lower back pain, panful intercourse and painful urination. Techniques may include manual therapy and exercises for pain management (that you can also do at home). Keep in mind that Pelvic Physiotherapy will not cure your endometriosis, but it may provide needed pain relief. It is recommended that a number of strategies (see below) be used to manage endometriosis and its associated pain.

An important tool in managing pelvic health is “period tracking” or menstrual charting. Charting can help women better connect to their bodies. For women experiencing endometriosis, in particular, connecting to their cycle can provide insights into how to treat and manage symptoms. Learn more here

How Do We Approach Treatment For Endometriosis?

At Proactive Pelvic Health Centre, we are committed to providing a safe and comfortable place where clients can access multi-disciplinary pelvic care to help improve their quality of life.

Our approach to treating any type of pelvic dysfunction, including that from endometriosis, is evidence-based and holistic. Before pelvic floor treatment begins, your Pelvic Health Physiotherapist will take your full medical history and thoroughly discuss your current symptoms. With informed consent, your Pelvic Health Physiotherapist will perform a complete physical assessment of the joints and tissues affecting this area. Based on the assessment, a personalized treatment plan will be developed to help you both identify and manage your symptoms. They may also suggest a referral to another healthcare practitioner depending on your assessment.