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Endo What?

    It’s Endometriosis Awareness Month! Although many women experience the symptoms of endometriosis, they may not be aware of how non-invasive, conservative care strategies like pelvic health physiotherapy can help them. So, let’s change that!

    What is endometriosis?

    Endometriosis is a gynaecological condition where tissue similar to the lining of the uterus (endometrium) grows within and outside of the pelvic cavity. This tissue can take various forms such as ovarian cysts (endometriomas) or deep-infiltrating lesions that can affect organ functioning. The Endometriosis Network Canada estimates it affects 1 in 10 women, with almost 50% of teenage girls experiencing severe pain with menstruation and pelvic pain. Unfortunately, many individuals experience delays in their diagnoses where it can take an average of 2 years for adolescents and 5 years for adults to be diagnosed.

    What are the symptoms of endometriosis?

    Pelvic pain is a cardinal sign of endometriosis and can manifest throughout different parts of your cycle. These are some examples of when you may experience pain:

    • Before/during/after menstruation
    • During ovulation
    • With bowel movements during menstruation
    • When passing urine
    • During or after sexual intercourse

    Other symptoms may include:

    • Diarrhea or constipation (particularly with menstruation)
    • Abdominal bloating (particularly with menstruation)
    • Heavy or irregular bleeding
    • Fatigue

    How does physiotherapy help with endometriosis?

    When it comes to treatment and management of endometriosis, most healthcare providers give you education on surgical and pharmacological interventions. We know through research that excision surgery is the most effective option that can remove the affected tissue and improve pain. However, some women may not be ready to undergo surgery or continue to experience pain postoperatively. Pelvic health physiotherapy by no means eradicates or cures endometriosis, but it can certainly help with any myofascial pain and nervous system hypersensitivity associated with the condition. The most recent Guideline for Chronic Pelvic Pain state that any condition that may have a myofascial component needs to be addressed through a multidisciplinary approach with the inclusion of physiotherapy to restore function. Now you may be wondering, what exactly do pelvic health physiotherapists do with our endometriosis patients? Here are some things we address in our assessment and treatment sessions:

    Relaxation & desensitization techniques

    • For many women, they’ve been dealing with this pain for years and their central nervous system (brain and spinal cord) become very good at producing pain in a dysfunctional manner. This can sometimes continue even AFTER endometriosis has been surgically removed. You can think of this as being analogous to phantom-limb pain in amputees. Although what you are sensing isn’t there, your brain and nervous system still believe it is there. So, how can we change this? By re-training your body and nervous system to re-think pain. And we do this through relaxation and manual therapy to desensitize the hypersensitive tissue. We have to let your body learn that there is no danger and there is no need for this heightened response. Your pelvic health physiotherapist will teach you how to use these techniques and you’ll be able to use them when you need them. Remember that it takes time for your body to make adjustments.

    Reconnecting mind and body

    • This alteration in your nervous system sensitivity doesn’t just affect your pain. It can also affect your thoughts, cognition and emotions. Especially if your pain has impacted your work, relationships, and ability to be intimate. One of our jobs as pelvic health physiotherapists is to recognize when other members of the healthcare team should be involved to further progress your rehabilitation. This may include speaking with someone about how your pain has affected you. Pain does not just affect your physical health, but also your mental and emotional health. And it’s important to have these aspects of your health addressed as well.

    Graded exposure & restoration of function

    • Now, we’ve done all this work to address your pain and mental health and you’re feeling great! So, you get back to running or have sex again and… pain again. This is something that I see often in my practice, where patients go from 1 to 100 too quickly. You have to slowly re-introduce your body to activity. Whether your goal is to engage in pain-free sex or go for a 30 minute walk or be able to get through your work day, you have to gradually expose yourself to these activities without allowing your body to feel threatened. This is done in a number of ways, but the key is having good management strategies that you can use on a daily basis. Physiotherapy will help you gain those management strategies, but you will be the one implementing them.

    Hopefully that provides you an idea of what pelvic health physiotherapists do, but stay tuned for more information! I will be posting an in depth video on our Facebook Page discussing endometriosis and pelvic health physiotherapy later this month!

    Until next time,

    Grecia

    Grecia Alaniz PT, MScPT