Endometriosis
Condition Overview
Endometriosis is typically a painful condition in which endometrial cells (similar to the cells that line the uterine wall) are found outside of the uterus. These cells behave like the endometrial cells that line the uterine wall and are affected by hormonal changes that typically occur throughout the menstrual cycle.
During the menstrual cycle, endometrial cells thicken, break down, and bleed as the body goes through menses. However, there is no way for these cells to exit the body (like endometrial cells should do during the period of bleeding during menstruation) and over time can cause scarring and adhesions to surrounding tissues. This scarring can cause organs and pelvic tissues to stick together leading to inflammation and pain.
Symptoms of endometriosis
The primary symptom of endometriosis is pelvic pain that is associated with the menstrual cycle. Many women may have slight cramping and discomfort during menstruation. With endometriosis, cramping can be severe and limits their ability to perform their typical activities.
The pain can also last longer and affect other systems such as urination, sex, and defecation.
People with endometriosis also have several other common symptoms including
pain with intercourse (dyspareunia)
pain with bowel movements or urination
excessive bleeding during menstruation
spotting between menstruation
digestive issues
infertility
What Causes Endometriosis?
Unfortunately, the jury is still out on what causes endometriosis, but through research there are a variety of theories that may contribute to someone having endometriosis.
Retrograde menstrual flow - tissue that is shed during a normal period flows through the fallopian tubes and out into pelvic tissue rather than down through the vagina and out of the body.
Surgery: endometrial cells are transplanted to other areas of the body following an abdominal surgery such as a cesarean delivery or hysterectomy
Genetics: endometriosis affects certain families more than others
Hormones: there is a possible link between increased estrogen and endometriosis growth that research is still looking into
Blood or lymph system transport: endometrial tissues are transported to other areas of the body through blood flow or the lymphatic system.
What are Treatment Options for Endometriosis?
Birth control: these have been used for long periods of time to block estrogen; however, they may not fix the root of the problem and just hide the symptoms.
Surgery: there are two common types of conservative surgical treatment
Excision: this type of surgery excises the extra-uterine endometrial cells using surgical scissors and a CO2 laser. This is a more precise procedure, minimizing the damage to the surrounding tissue and there is a lower rate of recurrence. This is the gold standard of treatment when performed by an Endometriosis Specialist
Ablative: this is the most common type of surgery a gynecologist will perform and it is where the extra-uterine endometrial cells are removed with a scalpel. Unfortunately, an ablation surgery has a high rate of reoccurrence and can lead to further scar tissue and damage to adjacent tissue.
Hysterectomy: this has historically been thought of as an effective treatment option, however is often only necessary when adenomyosis is a diagnosis in conjunction with endometriosis.
How Can Physical Therapy Help?
Physical therapy cannot affect the disease process itself; however, it can help with reduction of pain and symptoms affecting urination, bowels, and sexual activity.
In physical therapy, we will discuss your symptoms and go over each of the systems of the pelvic floor (bladder, bowel, sexual health, and gynecological health) in order to diagnose your symptoms appropriately.
With your consent we will perform an external and internal pelvic floor muscle assessment. We will assess your abdominal wall, low back/hips, adductors, and superficial and deeper pelvic floor muscles. We will determine your muscle function, strength, endurance, and coordination.
From our findings we will set-up a treatment plan depending on your pelvic floor characteristics!
Manual treatment can include but is not limited to dry needling, myofascial release, cupping, and connective tissue mobilization especially through the abdominal wall since this is where a lot of adhesions will occur.
With each session we will progress as able and learn new activities to include in your daily routine to manage and prevent worsening symptoms!