Endometriosis is a female reproductive disorder, which affects the lining of the uterus and the endometrial cells. This oestrogen dependent disorder is defined by the presence of endometrial tissue outside the uterus and the tissue grows to form lesions that leak fluid in response to the change in hormones at the time of the period.
This leads to inflammation and is linked to ongoing pelvic pain. Three out of four women with endometriosis experience pain, and this pain can occur immediately before your period, during your period, or during or after sex.
Pain can be felt in the pelvis, stomach, back, when passing wind, urine or stool (poo), or when you ovulate. Pain is a key symptom of endometriosis. The pain is not related to how severe the disease is, but rather to the location of endometrial tissue. Each woman with endometriosis will experience a different range of symptoms.
How can physiotherapy help women with endometriosis pain treatment?
Research has shown that women with endometriosis also develop tension in the lower abdominal, hip, pelvic floor muscles, which may further contribute to pain and tension throughout the body. Increased pelvic floor muscle tension can lead to bladder or bowel problems, difficulties with sex, and reduced ability to exercise. However, endometriosis pain treatment is possible.
What is pelvic pain?
Pelvic pain is a term that relates to a pain problem in structures related to the pelvis. Pain may be felt in the lower abdominal region (below the belly button), inside or outside the vagina, the perineum (region between the vagina and anus), anus, coccyx or clitoris. Pain may be associated with bladder filling or urinating and urinary symptoms such as urgency and frequency commonly coexist. Similarly, pain may be aggravated with a full bowel or opening the bowels and can be aggravated by either irritable bowel syndrome or constipation. Pelvic pain can vary throughout the menstrual cycle. Women with persistent pelvic pain often describe painful intercourse. Many people experience more than one pelvic pain condition. Chronic or persistent pain can be very distressing, exhausting and disrupt many important aspects of a person’s life.
How common is it?
Three out of four women with endometriosis experience pelvic pain and for some women this is severe and significantly affects their quality of life. Pelvic pain is termed persistent or chronic when it lasts for more than 6 months.
Pelvic floor muscle tension and difficulty relaxing the pelvic floor muscles is found in 80% of women with persistent pelvic pain and/or pain with intercourse. Research shows that physiotherapy management strategies to restore normal function of the muscles around the abdomen, hips and also the pelvic floor muscles can help to reduce pain.
✖ Pelvic pain is something you have to just live with
✖ Pain with period is normal and you just have to put up with it
✖ Pain in the bladder and bowel cannot be helped
✖ Pelvic pain means you cannot go back to having pleasurable sex
✖ Pelvic pain means you can’t exercise
✖ Pelvic pain means you should just lay down and rest
✖ Pelvic pain can only be helped by surgery or injections
✔ Pelvic pain is complex, linked to sensitivity of the pelvic organs and muscles in the pelvis
✔ Pelvic pain often worsens when things get out of balance in our lives
✔ Pelvic pain is linked to many things like increased stress, low mood, poor sleep, fatigue, poor exercise habits and in some cases a history of trauma
✔ Pelvic pain is often linked to too much pelvic floor muscle tension
✔ Pelvic pain is often linked to reversible muscle changes and may not need surgery
Risk factors for developing pelvic pain
In many cases, pelvic pain and pelvic floor muscle dysfunction may emerge at a time of increased stress, emotional distress, poor sleep and fatigue causing sensitisation of the pelvic structures.
A person’s response to pain such as fear of pain, depressed mood, activity and movement avoidance, can set up a vicious cycle of distress and ongoing sensitisation.
Treatment of endometriosis and associated pelvic pain and bladder, bowel and sexual dysfunction
It’s important to understand that the pain associated with endometriosis is complex and often multiple factors need to be considered to seek endometriosis treatment.
At Body Logic Physiotherapy, our Pelvic Health physiotherapists have completed postgraduate advanced training in the treatment of pelvic pain, bladder, bowel and sexual problems.
To understand each individual, it is important to understand all the factors that are involved in your presentation and the impact that your endometriosis symptoms are having on your life. Our Pelvic Health physiotherapists will take a thorough history, screen for factors that could be influencing your problem, and establish your goals for endometriosis pain treatment.
Following this, we will conduct a comprehensive assessment of your condition including assessment of all the muscles around the lower abdomen, hips, pelvis and pelvic floor muscles.
Assessment of endometriosis
Assessment of the pelvic floor muscles can be done fully clothed using real-time ultrasound. For a more comprehensive assessment of pelvic floor muscles a direct assessment can be performed via a vaginal assessment. This method is recommended for an accurate assessment of the pelvic floor muscles if you have pain and sexual dysfunction. The method of assessing your pelvic floor muscles is always your choice and will be thoroughly explained and based on your consent.
Following the assessment, we will explain to you in simple terms the factors that may be impacting on your problem and design a collaborative endometriosis treatment plan to help you achieve your goals.
Physiotherapy management includes bladder or bowel habit retraining, pelvic floor and abdominal muscle retraining, most women with pelvic pain and pelvic floor muscle dysfunction need to learn to relax their pelvic floor muscles fully. Any management program includes identifying the key factors linked to your symptoms, coaching you in body relaxation, breathing techniques, relaxed fearless movement, graded activity and sleep rehabilitation.
A long-term plan is the key to managing your endometriosis pain and it may take up to 3-6 months to make this plan work. We also work with your doctor and or a clinical psychologist if additional care is needed.
If you have any issues with endometriosis pain and symptoms, or further questions, get in touch with us today!