Endometriosis: What is it? How does pelvic therapy help endo symptoms?

Endometriosis symptoms?

Join us in celebrating endometriosis awareness month throughout March as we raise awareness surrounding this invisible condition. There is an abundance of medical gaslighting when it comes to pelvic pain, especially with endometriosis, or “endo.” Many women go years and years before their concerns are taken seriously, they are finally heard, and a diagnosis paves the way for proper treatment and care. According to the book Beating Endo (which we highly recommend checking out), it often takes 7-12 years from when someone with endo starts experiencing symptoms and when they finally get a proper diagnosis. This is extremely frustrating and often leads to numerous doctor’s visits, playing trial-and-error with different treatment approaches and medications, several rounds of diet changes, and so on.

What is endometriosis?

Endometriosis is diagnosed when cells or tissue that is similar to (yet slightly different from) those of the uterine lining begin to grow outside of the uterus. When this process occurs, inflammation throughout the body is triggered in response. Every month the endometrial-like tissue is stimulated but cannot escape, unlike the cells within your uterine lining which find their way out during a menstrual period. This tissue continues to accumulate and thicken, sometimes altering the anatomy wherever it is located. This can lead to organs being stuck to one another, often impacting bodily functions such as urinary, bowel, and sexual health, and lead to the most reported symptom – pain.

How is endometriosis diagnosed?

A common misconception is that endometriosis can be diagnosed by a blood draw, ultrasound, or even an MRI. Unfortunately, this is not the case. Endometriosis is invisible to the naked eye and requires excision and examination for a true diagnosis. In other words, it requires removing tissue to truly confirm the presence of endo.

What are common symptoms?

The #1 most reported symptom when it comes to endometriosis is pain. Symptoms of endometriosis, as well as location and description of pain, can be very different depending on the person and can make the diagnosis and experience quite puzzling. Some people living with endo may describe the pain to come and go while others describe the pain as persistent. Believe it or not, symptoms do not always match the severity of the disease. For example, someone could be completely asymptomatic yet find that they have endo lesions during an unrelated procedure.

Is there a cure for endometriosis?

While there is not currently a cure for endometriosis, there are treatment options that include rehabilitation (pelvic floor therapy), medication management, and surgical interventions. It is important to discuss your unique experience with your medical team to ensure you are presented with options that may be the most suitable for you.

Does pelvic floor therapy help endometriosis?

Yes! Pelvic floor physical therapists and occupational therapists are known for championing the care of their patients with endo (or suspected endo), minimizing symptoms, and getting people back to living their fullest lives. Pelvic floor therapists are specialists in treating the pelvic floor and pelvic pain related conditions, such as endo. Your pelvic floor muscles connect at the bottom of your pelvis to support your organs, work as a key player of your core, pump fluids throughout the body, and facilitate bladder, bowel, and sexual functions. These muscles contract to maintain continence and relax for sexual participation, as well as to permit urine and stool to pass through the muscles. You can visualize your bladder, uterus, and rectum sitting right on top of these muscles and the pelvic floor muscles being the gatekeeper to what goes in and what goes out.

Pelvic floor therapists can help restore the function of these muscles when someone is experiencing any related issues. They may consider if there is tightness in the muscles contributing to pain, constipation, or urinary urgency, for instance. They may help to strengthen these muscles if they are not “keeping the gates closed” when perhaps there is urinary leakage with coughing, sneezing, or laughing. They may also help release the muscles when there are trigger points or overactivity in the muscles, which is common with women experiencing pelvic pain or endo. It is important to note that pelvic floor therapists also work with the entire person (and the entire body!) not just the pelvic floor.

Strategies are tailored to the individual person and their needs while often including:

• Nervous system retraining and breathwork for pain relief

• Exercise recommendations to restore and promote pain-free movement

• Daily lifestyle modifications

• Manual techniques externally and internally

What is internal pelvic therapy?

If you are wondering what “internally” means when it comes to the manual techniques, this is when a pelvic floor therapist uses a skilled intravaginal or rectal approach for myofascial and trigger point release to ultimately relieve pain. This is something the pelvic floor therapist will discuss with each person if it is clinically indicated. This can be a beneficial treatment strategy for pain relief if there is a high amount of tension within the muscles of the pelvic floor, which is common for individuals with endo. The pelvic therapist will move slowly and clearly communicate every step of the way to ease any discomforts or worries when it comes to internal treatment approaches. This is, of course, something that can always be deferred but will likely be a beneficial treatment, especially when followed with movements and exercise to restore appropriate function of the pelvic floor muscles.

What doctor do I see for endometriosis?

Pelvic floor therapists will help you to reduce pain and related symptoms, navigate the medical system for accurate diagnosis, and support your coordination of care across providers. It is common for individuals experiencing symptoms of endo to get “lost in the shuffle” as they try to identify which medical providers to reach out to for their care. For example, should they schedule with a gastrointestinal doctor for their bloating and concern with constipation? Should they schedule an appointment with their gynecologist for imaging or managing painful periods? Should they call their primary care physician to get them in the loop? What about an endo specialist to see if excision surgery is needed? The list goes on… Pelvic floor therapists are skilled in helping you to understand how many of your symptoms are connected, manage your symptoms and pain, and help you get the answers and support that you deserve.

For more information on pelvic health, related concerns, and other helpful tips we wrote a large blog “The Complete Guide to Everything to Know about Your Pelvic Floor Health and Pelvic Floor Therapy”

References:
Kerin Orbuch, I., & Stein, A. (2019). Beating Endo. Harper Wave.