Endometriosis Q&A

What is Endometriosis?

Endometriosis is an invisible, incurable disease when tissue that is similar to the lining of the uterus (endometrium) grows in other parts of the body and causes chronic inflammation or scarring (definition from International Pelvic Pain Society).

How does it impact/relate to the pelvic floor?

A women with Endometriosis often has secondary Pelvic Floor Muscle Dysfunction. The bodies protective response to pain is for muscles to tighten, causing dysfunction. A tight and tense muscle, overtime can develop trigger points, or tender areas, that can refer pain into the lower abdomen, lower back, gluteals, hips and thighs. This pain can mimic endometriosis symptoms.

What signs are there that your pelvic floor might be impacted?

Those who have Pelvic Floor Dysfunction & Endometriosis may suffer from the following symptoms;

• Pelvic Pain

• Dyspareunia (pain with sex)

• Bladder Urgency

• Frequent Urination

• Urinary Incontinence

• Dysuria (pain emptying your bladder)

• Constipation

• Bowel Urgency

Are these signs commonly understood, or might women put these signs down to something else?

As a society we do not talk about pelvic floor enough. I believe that women still think Pelvic Floor Dysfunction is something they worry about when pregnant or postpartum. Even with the growing number of Pelvic Floor Physiotherapists in Australia women still do not know we exist. So yes, women believe their symptoms need to be investigated further, with surgery. Often women with endometriosis have no signs of endometriosis when investigated but still suffer from immense pain. This is very typical of someone with chronic pain. These women should be seeing a Pelvic Floor Physiotherapist for functional re-training and desensitization. I do my best to review all my endometriosis patients both pre and post op to address any pelvic floor muscle pain, bladder and bowel dysfunction, in the hope this may make their surgery more successful.

How can Physiotherapy assist?

As a Pelvic Floor Physiotherapist we can help women with endometriosis by;

• Treating muscular dysfunction

• Functional retraining for biomechanics, posture and muscle guarding

• Establishing good Bladder and Bowel Habits

• Exercise program

• Pain education

At what point should a woman visit a Pelvic Floor Physio?

Women with endometriosis should see a Physiotherapist when they feel ready. Physiotherapy is not a passive treatment, it requires patients to invest time and energy into home programs to retrain habits. However, the earlier someone see’s a physiotherapist the sooner they can commence treatment to decrease symptoms and pain.

Is more awareness required? 

Absolutely. We need to be educating teenagers about periods, period pain, endometriosis, PCOS etc. If we can identify women at a younger age that have endometriosis the more effective our treatment may be in preventing chronic pain. There is a fantastic program running in South Australia called Periods, Pain and Endometriosis Program (PPEP Talk). How fantastic would it be if this was run in all schools!!  Social media has also been a fantastic resource to educate women.

 Can all Physiotherapists treat this condition?

All Physiotherapists have a role in identifying Pelvic Floor Dysfunction and endometriosis symptoms. However a Pelvic Floor Physiotherapist, or a Physiotherapist with post-graduate qualifications to treat the Pelvic Floor is more suitable. The gold standard way to assessing ones pelvic floor is to perform an internal examination which requires further training. All physiotherapists are equip with exercise and rehab knowledge so could definitely help with exercise, functional retraining and pain desensitisation. It is important physiotherapists without these extra qualifications refer to someone who does to co-treat together.

What questions should patients ask?

 I encourage all patients to ask physiotherapists and all other  health professionals many questions. Understanding why they are in pain is so important. Chronic pain can be very complex and it is important patients are equip with knowledge. I also recommend you ask your health professional if they treat patients with endometriosis. Like anything, if you don’t see it regularly you aren’t as skilled in treating it. As a patient, if you are not happy with your health professional or want another opinion, you have every right to seek further advice.

How can Physio’s ensure they have the skills to understand, treat this type of condition?

 Professional development! We are constantly learning in the Women’s health and Pelvic Floor space. There is always new research coming out about these conditions. It is important to stay up to date with all the information both from a Physiotherapy perspective but also from a medical perspective. Endometriosis is better treated with a multi-disciplinary approach. Develop relationships with local acupuncturist’s, naturopath’s, dieticians, pain specialist, psychologist’s, gynaecologists,

Other comments, thoughts, opinions!

Endometriosis is a complex pain condition. Not one person will ‘cure’ your symptoms. You need a good multi-disciplinary team to work together and case mange you to ensure treatment goals align to achieve the best outcome.

 If you would like to learn more follow Rachel @physioforwomen_ or visit QENDO