Endometriosis is a debilitating and painful, often helped with surgery. But once the diagnoses is reached, then what?
As a condition, endometriosis can be quite invasive, it can be focused on your pelvic region, as well as it could spread on other areas, and create this inflammatory tissue, that’s painful and hard to manage. But, let’s go over the basics.
What is Endometriosis?
“Endometriosis (en-doe-me-tree-O-sis) is an often-painful condition in which tissue that is similar to the inner lining of the uterus grows outside the uterus.”… “(This) tissue acts as the lining inside the uterus would — it thickens, breaks down and bleeds with each menstrual cycle. But it grows in places where it doesn’t belong, and it doesn’t leave the body.”
Due to this, the tissue surrounding the area could also become irritated, and create its own set of scar tissue. This condition usually affects ovaries, fallopian tubes, and the tissue that lines the pelvis region; however, these growths can rarely be found beyond the pelvic organs, and take place in other parts of the body.
Outside of the scar tissue, adhesions may also form, and they may cause the pelvic organs and lining to fuse together, which can be incredibly painful.
Symptoms for Endometriosis
There’s a variety of symptoms that can alert you to head over to a Gynecologist to make sure the condition can be treated and kept under control.
Common symptoms include:
- Dysmenorrhea: also known as painful periods, or pain with menstruation. This can be pelvic pain, and cramping that may start before a period and last for days; it can also come with lower back pain and stomach aches.
- Pain with sex: during or after, pain with sex is very common with endometriosis, as there could be tissue surrounding the areas. If you’re experiencing pain with sex, please seek the help of a professional.
- Pain going to the bathroom: whether it’s from bowel movements or urination, pain may be present before or during a menstrual period.
- Heavy bleeding: you may experience a higher-than-normal menstrual flow.
- Bleeding between menstrual periods
- Infertility: if you have been trying for sometime to conceive, endometriosis could be the cause, and it can be detected during tests for infertility treatment.
- Other common symptoms before or during menstrual periods:
- Fatigue
- Diarrhea
- Constipation
- Bloating
- Nausea
These are some symptoms to look out for, however, know that there are some who get diagnosed with no symptoms, so it’s always important to go to your yearly Gynecologist appointment to ensure everything’s right as rain.
However, know that pain always has a cause, it could simply be painful periods, but it could also be cause for other conditions, if you feel the pain is too much before or during a period, speak with your Primary care physician. You should not have to live in pain, if it can be helped.
Treatments available for Endometriosis
There’s a variety of treatment options that depend on the degree of damage this condition has created on the pelvic region, let’s go over some of them:
- Pain Relieve Medication: these may be recommended by your health care team, and they can be over the counter medication like Ibuprofen as in advil, motrin IB, and others similar to it, or Naproxen sodium, like Aleve, as they can help with painful periods.
- Exercise: anyone struggling with endometriosis can use exercise as a part of their pain management, as yoga, pilates, and other cardiovascular exercises can be helpful with inflammation and decreasing pain, as well as a rush of endorphins, or feel good hormones.
- Hormone Therapy: because they can help manage the menstrual cycle, they can help with both growth of tissue, and pain management, it’s not a permanent fix, but it can help. These can be hormonal contraception, Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists, progestin therapy, and aromatase inhibitors. Your Health care team will over each one, and decide which one will be the most helpful for you.
- Conservative surgery: usually done laparoscopically, this surgery is to help take away endometriosis tissue, while preserving the uterus and ovaries, to help with potential pregnancies; however, with this surgery, there’s a chance of return of pain and endometriosis tissue overtime.
- Fertility treatment: if you’re looking to conceive, you may be referred to a reproductive endocrinologist, and they may work with you to help you with a series of treatments including increasing egg production, and IVF, depending on your situation.
- Hysterectomy with removal of ovaries: considered a last resort for pain management on patients with endometriosis. The lack of hormones will have a similar effect in the management of pain as birth control, however, it’s not a guarantee, and it comes with its own set of complications and lifestyle changes.
Pelvic PT and Endometriosis
A holistic approach to pain management when it comes to Endometriosis can be incredibly beneficial to endometriosis patients. There are a series of treatments we can apply that will have a huge improvement in your lifestyle, as well as a general better understanding and connection with your pelvic floor.
Proper pelvic floor physical therapy can help with techniques like manual therapy, myofascial release, trigger point massage, and in some cases even specific movements, you will be able to reduce pelvic pain, low back pain, bowel, bladder and pain during and after intercourse, which are all symptoms associated with endometriosis like previously mentioned.
There are a ton of exercises that we can include in your treatment plans to help you improve blood flow, and target specific muscles, that can promote healing, and learning how your body works and manage your symptoms better.
- Among the other benefits, you can also experience:
- Reducing pain and discomfort in your pelvic area
- Reduced inflammation
- Improved function and mobility
- Improved blood circulation, which in turn, promotes healing
Let’s do a deeper analysis on how pelvic floor physical therapist can be beneficial for the treatment and management of endometriosis.
Tailored planning
Whenever you go in to a Pelvic Floor Physical Therapist, the very first consultation includes a deep review of your medical history, an assessment of pelvic floor muscle function, and this is the perfect time to go over any and all symptoms you are currently experiencing from your endometriosis, such as symptoms relating to bowel, bladder and sexual function.
For example, if you are having pain with bowel movements, or having a difficulty evacuating with no other GI symptoms. Facing issues with bladder function can look like both incontinence, and retention of urine; and when it comes to sexual function, if its painful, if its uncomfortable, this can be helped with pelvic floor physical therapy.
With this information, we can create a detailed plan for your particular treatment, and how it can be incorporated into your lifestyle as well.
Myofascial release
Considering that endometriosis can cause scar tissue to form in the pelvic region, this treatment is incredibly important, and a big part of your treatment.
You may think this type of treatment can only be done in other parts of the body, but you’ll be surprised by how incredibly useful it can be for pelvic pain. But, let’s go over first what it is:
“Myofascial release therapy is a hands-on technique used to manage myofascial pain. “Myo” means muscle. “Fascial” refers to the connective tissue that covers and supports the muscles throughout your entire body. During myofascial release therapy, your therapist doesn’t focus specifically on your muscles. They focus on releasing tension in your fascial tissues.”
With this in mind, remember the anatomy, for the pelvic floor you have pelvic floor muscles and connective tissue. Key muscles include the levator ani (pubococcygeus, puborectalis, iliococcygeus) and the smaller coccygeus, which together form the pelvic diaphragm.
Superficial muscles like the bulbocavernosus and ischiocavernosus also contribute, assisting with sexual function, these muscles can be affected by the endometriosis, as well as just regular pelvic dysfunction, and causing to increase pelvic pain related issues.
When it comes to myofascial release for endometriosis, it uses manual techniques for external and internal muscles, and connective tissues like the ones mentioned before, as well as scar tissue management, which could be the cause for the pelvic pain and limited pelvic floor muscle function.
It’s a very holistic approach to the symptoms, and the results can be incredibly favorable, as you’ll start to feel relief session by session as we work the muscles and scar tissue into a more manageable one, and it can increase pelvic floor muscle function, especially when it’s used alongside other treatment options.
Internal trigger point release
This treatment usually works alongside with the myofascial release, this however, has a deeper focus on targeting specific trigger or pressure points in those muscles in order to release the tightness, and help with the muscles that affect your urinary, bowel and sexual function, or simply producing any pain symptoms.
Patient education and exercise
For patient education, the moment you enter a pelvic floor physical therapist consultation, you should be learning the proper function of your pelvic floor, how it is supposed to be, the level you are at, and what habits you can pick up to go towards recovery quicker, on your own, outside of the consultation.
In this line, this is mostly where exercises come in. During appointments, you’ll practice certain movements and exercises to ensure you’re doing them correctly, as well as an exercise prescription to do on your own.
There are however, a few exercises and trainings you can help, but there are some that can hurt as well, and this is where your physical therapist will guide you towards creating a program that will fit your unique needs, and keep in mind your endometriosis symptoms, as to not aggravate them, but instead help them.
There are many factors to consider when you are creating the plan, such as:
- Endometriosis adhesions: these can cause a huge disruption in the orientation of your pelvic organs, and in your abdominal muscles, so certain exercises might cause more pain.
- Laparoscopic surgery and scar tissue: this surgery, even if it’s less invasive than other abdominal surgeries, it can still result in scar tissue in the abdomen and pelvic area, this in turn, has an effect in the length, tension, and tone of abdominal muscles, so you could create a more difficult situation if the wrong exercises are prescribed.
The way we work out how to best help your situation, we think of what benefit you, and your pelvic floor in the long term, and the best way to do that is to retrain your muscles, and pelvic floor, remind them how to work, and in some cases, finding new techniques to help it to function depending on what damage the endometriosis has created. This is important to provide stability to the body through strengthening the core muscles.
This stability is incredibly important for functional movements of your daily life. Think of it this way, your trunk holds your organs, yes, but realistically, it’s like an accordion, what holds them in perfect accordance is your diaphragm and pelvic floor, in combination with one another, and for your accordion to produce perfect melody, it also needs to be held at a specific angle, like the abdominals and deep back muscles do in your body.
Without this perfect angle, and pressure of your abdominals and deep back muscles, you cannot experience effective breathing, and it can have an effect on your pelvic floor function as well. Having your abdominal muscles work in a perfect symphony between your diaphragm and your pelvic floor muscles, as well as the smaller muscles in the spine, these will all create that stability in your trunk, that will in turn promote effective breathing, and the right amount of intra-abdominal pressure.
There are some breathing techniques, as well as mild exercises you can do to retrain the core muscles, teach them how to properly contract, and relax, and strengthen the area.
If you are currently struggling with Endometriosis, having a Pelvic Floor Physical Therapist at your side is incredibly important. If you are in the Westchester Area, feel free to reach out, we’d love to help you, give us a call 914-273-0800.
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