Endometriosis, or "Endo", is a condition that affects 1 in 9 people who menstruate. It occurs when tissue that is similar to the lining of the uterus (endometrium) grows outside of the
uterus. This typically happens in the pelvis and abdomen, but endometriosis has been found in the liver, the diaphragm, and in a rare case it was found in someone's brain!
Common symptoms of Endometriosis include:
Painful and Heavy Periods
Pelvic/Abdominal/Groin/Buttock Pain
Fatigue
Depression and Anxiety
Pain with sex
Bladder pain
Pain in the rectum
Bloating (often called "Endo Belly")
Fatigue
Infertility
60% of endo sufferers started noticing their symptoms in their teenage years. Pain and other symptoms often can get worse around ovulation or periods but can happen outside of these times as well. The wide range of symptoms means that endometriosis can impact all aspects of someone's life - work/study productivity, social activities, romantic relationships, exercise/leisure, and even sleep quality. Some researchers have found that when you add up the cost of healthcare/treatments, and the lost income, lost work time, and other costs relating to childcare and housework, they found having endometriosis can cost a woman up to $30,000 per year! That is a huge impact!
On top of that, new research has found a genetic link between endometriosis and ovarian cancer! The overall risk is still low, so don't panic, but this highlights why recognition and diagnosis is so important so that the right people can then be screened for things like ovarian cancer.
At the moment, endometriosis requires a medical diagnosis. Large endometriosis lesions and cysts (called endometriomas) can be found on specialised ultrasounds from specially trained Gynecologists. But not all endometriosis can be seen on a scan. Smaller or surface lesions, and adhesions (where different tissues stick together because of scarring) won't show on ultrasounds and other scans, but can be seen during a laparoscopy (exploratory keyhole surgery).
Once you have a diagnosis, your Gynaecologist will talk you through your medical and surgical treatment options. These treatments make a world of difference to the vast majority of endo sufferers, but this condition is one that does not have a cure. This means that there are often still symptoms to manage in the long term, which is where other healthcare professionals come into the picture.
For people who suffer "Endo Belly" (bloating and distension of the abdomen around your period) or constipation/diarrhea that gets worse around the menstrual cycle we highly recommend seeing a Dietician who works with endometriosis and other reproductive issues. A Psychologist who is experienced in chronic pain can be very helpful for helpful strategies for stress, depression, and pain. Then there is us, Pelvic Health Physio!
How might Physio help?
Pelvic Health Physio can offer help in a few domains. Physio is not just one treatment (like pelvic floor exercises) and everybody's treatment plan should look a little different because each person's needs are different. So here are some of the things we can offer for people with endometriosis:
Pelvic Floor Exercise:
In our experience, most people with endo have pelvic floor muscles that tend to tense and have difficulty relaxing, so we can teach exercises to relax the pelvic floor. A tense pelvic floor can be tender and sore, but can also make penetration, passing urine and passing stool difficult or painful. Learning to let go of the muscles in the moment can help. In cases where there are weaker muscles, we can also teach you strengthening exercises.
Stretches:
Often with pain comes muscle tension, which can sometimes aggravate pain and become a vicious cycle. Based on your Physio's assessment, the best stretches for you can be added to your plan. This might include stretches for the hips, back, inner thigh, tummy or pelvic floor. A great starting point for stretches that can help pain around the pelvis can be
found at the Pelvic Pain Foundation.
Breathing:
This often sounds more airy-fairy than it actually is. We teach Breathing for a few reasons.
First of all your diaphragm, which is a muscle you use to take deep belly breaths, works with your pelvic floor. Good diaphragm breathing can help to relax the pelvic floor and tummy muscles, so it's good for muscle-related pain. Second, stress and pain go hand in hand because pain is stressful. But stress also can make pain worse. Deep breathing reduces the stress hormones in the body which helps both with stress and pain sensitivity.
TENS:
TENS stands for Transcutaneous Electrical Nerve Stimulation. It uses a low-level electrical
current to give different sensations to the nerve endings and can help with pain. For the right person, TENS can help with pain while the machine is running. Some research suggests it can also help to desensitise over time which can help with pain in the long term. Your physio can help you determine if TENS is right for you, how to safely use it, and where is best for you to place the electrodes.
Exercise:
Exercise is a tricky one. We know from experience (and the research backs this up too) that exercise helps reduce pain for some people, but for others can make it worse. This can come down to the type of exercise, when in your cycle you exercise, and how much you do in one session. Most people who tell us they get worse with exercise find more vigorous exercise or too much exercise all at once is a problem. For most people with endo, lighter exercise (such as swimming, yoga or gentle walking) for shorter sessions (starting 10-15 minutes at a time) can have multiple benefits on health and pain without aggravating it.
So why exercise? Besides the general health benefits, regular exercise can help reduce pain sensitivity, reduce stress (which can help pain) and improve sleep quality (which also helps pain).
Vaginal Trainers or Pelvic Wands:
Vaginal trainers (also call dilators) come in a kit with 3-6 cylinders in increasing size. We
recommend these as part of the treatment if you're having issues with painful sex. Your physio can teach you how to insert first the smallest trainer, which using your breathing and muscle relaxation strategies to reduce your pain during insertion. Once you can comfortably insert one, you progress to the next size, and so on, to reduce your pain with intercourse.
Pelvic wands can be used for the same purpose as trainers, to insert
something while controlling your pain, but they can also be used for people who respond well to trigger point release or internal stretching of the pelvic floor, The wand allows you to do the trigger point release or pelvic floor stretching yourself on a regular basis. Your physio can teach you how to correctly use it.
Managing Bladder and Bowels
Endometriosis and pelvic floor pain can also start to impact bladder and bowel function. We see difficulty passing urine, constipation, loose urgent bowels, bladder or bowel pain and incontinence in different people with endomtetriosis. How we can help you manage each of these is a blog article in istelf!
Conclusion:
We hope this has given you an overview of things that can help you with your endometriosis. Each person's picture and therefore management will look different, so this is just a rough guide. For more information you can contact our team, or you can go to one of the sites below:
Endometriosis Australia https://www.endometriosisaustralia.org/about-endo
Pelvic Pain Foundation https://www.pelvicpain.org.au/learn/for-women/
EndoActive https://endoactive.org.au/resources/
References
Lara-Ramos, A., Álvarez-Salvago, F., Fernández-Lao, C., Galiano-Castillo, N., Ocón-Hernández, O., Mazheika, M., Artacho-Cordón, F. (2021). Widespread pain hypersensitivity and lumbopelvic impairments in women diagnosed with endometriosis. Pain Medicine, 22(9), 1970-1981. doi:https://doi.org/10.1093/pm/pnaa463
Merete, K. T., Gabrielsen, R., & Tellum, T. (2021). Effect of physical activity and exercise on endometriosis-associated symptoms: A systematic review. BMC Women's Health, 21, 1-10. doi:https://doi.org/10.1186/s12905-021-01500-4
Mińko, A., Turoń-Skrzypińska, A., Rył, A., Bargiel, P., Hilicka, Z., Michalczyk, K., Cymbaluk-Płoska, A. (2021). Endometriosis—A multifaceted problem of a modern woman. International Journal of Environmental Research and Public Health, 18(15), 8177. doi:https://doi.org/10.3390/ijerph18158177
Omero Benedicto Poli-Neto, Arthur Marques, Z. O., Mariana, C. S., Rosa-e-Silva, J. C., Dalmo Roberto, L. M., Candido-dos-Reis, F. J., & Nogueira, A. A. (2020). Strength exercise has different effects on pressure pain thresholds in women with endometriosis-related symptoms and healthy controls: A quasi-experimental study. Pain Medicine, 21(10), 2280-2287. doi:https://doi.org/10.1093/pm/pnz310
Mechsner, S. (2022). Endometriosis, an ongoing Pain—Step-by-step treatment. Journal of Clinical Medicine, 11(2), 467. doi:https://doi.org/10.3390/jcm11020467
Kannan P, Claydon LS. Some physiotherapy treatments may relieve menstrual pain in women with primary dysmenorrhea: a systematic review. J Physiother. 2014 Mar;60(1):13-21. doi: 10.1016/j.jphys.2013.12.003. Epub 2014 Apr 24. PMID: 24856936.