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Endometriosis: How It Affects The Pelvic Floor

Physio&SoleClinic Pelvic Floor, Physiotherapy September 23 2022

What Is Endometriosis?

Endometriosis is a benign and chronic condition in which endometrial tissue that normally lines the inner surface of the womb is abnormally located in the other parts of the pelvis such as the ovaries, fallopian tubes, bladder, bowels, as well as in the abdomen.

Is Endometriosis Common?

It affects about 1 in 10 women of childbearing age. It has been reported that half of the affected women have chronic pelvic pain whilst 70% of them experience pain during menstruation.

How Do I Know If I Have Endometriosis?

Complaints of pain or cramps during menses are common for women with endometriosis.  The severity of symptoms may vary. Other symptoms associated with endometriosis include the following:

  • Abdominal pain
  • Pain during sexual intercourse
  • Pain during bowel movements
  • Painful urination
  • Migraine
  • Fatigue
  • Loss of quality of life

How Is Endometriosis Diagnosed?

Endometriosis is diagnosed through biopsy of the tissue taken during laparoscopic (keyhole) surgery.

It is unfortunately common to have a delay in diagnosis, with reports highlighting it takes about 8.7 years on average for an accurate diagnosis to be made. During this time, however, the affected woman may have developed musculoskeletal disorder, which worsens the pelvic pain and will affect her quality of life.

The Medical Treatment Options

Unfortunately, there is no cure for endometriosis. Management is focused towards alleviating endometriosis associated symptoms. A combination of hormonal therapy, non-steroidal anti-inflammatory drugs, surgery amongst other treatment modalities can be applied depending on the severity your condition.

How Does Endometriosis Affect The Pelvic Floor?

The pelvic floor muscles are like a hammock that slings from the pubic bone to the tailbone. They keep the pelvic organs such as the bladder, womb, and rectum in place. The pelvic floor helps in controlling urine, bowel movements and it plays an important role in pleasurable and pain-free sex.

Chronic pain from endometriosis will affect the ability of pelvic floor function. It may become weak, tight and potentially develop trigger points that may amplify pain.  In some cases, it can also affect one’s posture with constant tension in the back and hip muscles. If left untreated, the pain will worsen and could greatly affect your wellbeing. Endometriosis is also associated with infertility.

The Role Of A Women’s Health Physiotherapist In The Management Of Endometriosis?

A women’s health physiotherapist will examine the state of your pelvic floor muscles as well as assess the muscles and joints possibly affected by endometriosis. Research has shown that pelvic floor physical therapy can help women relieve pelvic pain, increase body flexibility and strength, as well as improve quality of life.

What Are The Treatments Available In A Physiotherapy Session?

A women’s health physiotherapist will apply a combination of the following treatment modalities:

  1. Manual therapy techniques such as pelvic floor massage
  2. Down training of pelvic floor muscles
  3. Relaxation techniques
  4. Therapeutic exercises
  5. Electrotherapy

Sources:

  • Awad E, Ahmed HAH, Yousef A, Abbas R. Efficacy of exercise on pelvic pain and posture associated with endometriosis: within subject design. J Phys Ther Sci. 2017;29(12):2112-2115. doi:10.1589/jpts.29.2112
  • Bontempo AC, Mikesell L. Patient perceptions of misdiagnosis of endometriosis: results from an online national survey. Diagnosis (Berl). 2020 May 26;7(2):97-106. doi: 10.1515/dx-2019-0020. PMID: 32007945.
  • Rafique S, Decherney AH. Medical Management of Endometriosis. Clin Obstet Gynecol. 2017;60(3):485-496. doi:10.1097/GRF.0000000000000292
  • Tennfjord, M.K., Gabrielsen, R. & Tellum, T. Effect of physical activity and exercise on endometriosis-associated symptoms: a systematic review. BMC Women’s Health 21, 355 (2021). https://doi.org/10.1186/s12905-021-01500-4

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