Endometriosis is a debilitating disease that impairs the quality of life in adolescent and adult females. Sorry – not exactly the best news of the day. But March is endometriosis awareness month, and it’s important to discuss a condition that affects females across the lifespan. Endometriosis occurs when the inner lining of the uterus implants outside of the uterus and cervix, causing scarring, adhesions, and pain within the abdominal and/or pelvic cavity. It has been known to affect 10-15% of all women of reproductive age, with the age of 13 being the median age for onset of initial symptoms. Commonly reported symptoms include dysmenorrhea (painful periods), pelvic pain between periods, dyspareunia (painful intercourse), dysuria (painful urination), and GI complaints (including chronic constipation and IBS-type symptoms). These symptoms closely mimic other conditions, making the diagnosis of endometriosis difficult. It is known as an “invisible illness,” as there is currently no minimally-invasive testing to determine the presence of the disease. The only definitive and most accurate assessment available is laparoscopic surgery.
While rehabilitation cannot stop or cure the disease process, rest assured rehabilitation can help patients in managing symptoms in hopes of improving their quality of life. Here a few ways a pelvic health physical therapist can help with conservative management:
1. Embrace a team approach: ensure the patient has the right medical providers on board, including but not limited to a primary care physician, gynecologist, acupuncturist, and especially a reproductive endocrinologist. Hormone and medical management are vital to promote reproductive health and fertility. PTs are happy to connect patients with the right provider.
2. Pain management: soft tissue work done by the therapist can help reduce pain and tension holding patterns within the muscles of the abdomen, low back, and pelvic floor. Teaching home techniques for the patient to use independently is important for long term benefits. After all, empowering the patient is the gift that keeps on giving.
3. Down training pelvic floor muscles: often with endometriosis the pelvic floor muscles (PFM) tighten up, which facilitates pain patterns. The PFM rarely go off duty when there’s pain. Pelvic health PTs help patients with being able to more successfully lengthen and relax their tightened, painful PFM. It’s almost like helping the pelvis breathe again.
4. Exercise: get the body moving! Keeping the abdomen gliding, moving, and grooving via various stretches and deep breathing techniques can help maintain mobility and reduce pain. Also, encouraging the patient to be successful in basic exercise is helpful, especially when pain is a limiting factor. As the saying goes, “motion is lotion” and all parts of the body require healthy movement.
5. Patient education: the pain and fatigue associated with endometriosis combined with the high demands of current lifestyles can cause further stress. Providing ways for the patient to be consistent with self-care and energy conservation techniques is important for regulating healing for the body. In addition, educating the patient about the disease process is helpful in order to maintain realistic outcomes and goals. Understanding the disease process helps the patient become an active participant in their medical management. As a wise man once said, knowledge is power!
References:
1. ACOG fact sheet: https://www.acog.org/about_acog/news_room/~/media/newsroom/millionwomanmarchendometriosisfactsheet.pdf
2. Endometriosis: epidemiology, diagnosis, and clinical management. Parasar P., Ozcan P., Terry K. (2017) Curr Obstet Gynecol Rep. March; 6(1): 34–41.
