Endometriosis is a condition which causes pelvic pain in women and can start as early as a girl’s first period. Some women they know something is wrong due to severely painful periods. Others are surprised to find later in life that they have had endometriosis but never knew.
It is a condition which causes the tissue similar to the lining of the uterus (womb) to grow outside of the uterus. The lining of the uterus is called the “endometrium” hence the term “endometriosis”. The endometriosis is found outside of the uterus which might be on the ovaries, on the wall between the rectum and vagina or on the bowel which lies above the uterus. The tissue causes an area of chronic inflammation and this can leave scar tissue. Inflammation is painful.
Who is affected?
Endometriosis affects an estimated 1 in 10 women. It only affects women in the reproductive years i.e. that is women who have started their periods and women who have not gone through to menopause (when periods stop). Once a women’s periods stop, sometimes problems continue due to the scar tissue that is left from the original endometriosis. Or there might be secondary muscular problems that have developed over time in response to persistent pain.
It is thought that there is a genetic link so if a there are family members with endometriosis, it is even more important to be checked out.
How do I know if I have endometriosis?
If young girls have persistently heavy, painful periods that cause them to take time off school or not to be able to participate in normal activities, they should be seen by a Doctor to find out if Endometriosis is perhaps the cause. Many young girls miss out on help because those around tell them that painful periods are normal. “Period pain” is a usual thing, but the pain of endometriosis is not “normal” and girls and women should seek help initially from their G.P.
Endometriosis causes painful periods, painful ovulation (mid cycle), pain during or after sexual intercourse, heavy bleeding, persistent pelvic pain, sometimes difficulty having children.
What treatment is available?
Endometriosis can be treated with medications which inhibit periods. If women don’t get periods, the pain is hopefully managed. The endometriosis itself can’t be treated, but it can be managed so that debilitating pain does not occur.
Surgery can be carried out to remove the endometriosis and scar tissue.
Can I become pregnant if I have endometriosis?
Yes. For some women it is difficult and it is known to affect the ease with which some women become pregnant. Some women have children and only find out later that they have had endometriosis. Pregnancy is likely to ease the symptoms but not to cure the diseases since there is no known definitive cure.
Can Physiotherapy help?
Physiotherapy can help. But Physiotherapy cannot help with the actual management of the endometriosis itself. This is for the Medical Team: your G.P and your Gynaecologist.
However Physiotherapy can help with the management of the secondary issues of pelvic pain and tight painful muscles.
We know that muscles around the uterus ie the pelvic floor muscles and the abdominal muscles can both become tight and painful in response to the pain.
When the pelvic floor becomes tight, sex often becomes painful. Women start to associate sex with pain and so there is a guarding reaction from the muscles: they become tighter to protect from the pain. This unfortunately makes the pain worse. Often the sexual pain of endometriosis is a deep pain due to inflation deep around the uterus which ]is situated deep at the top of the vagina and above the bladder. Eventually, as muscles tighten, pain can develop with initial penetration.
Physiotherapist can teach you how to relax the pelvic floor and release muscle tension generally. Physios can also apply manual therapy techniques which are massage techniques very similar to those used anywhere else in the body,. Aim is to help muscles start to release, relax and move out of pain.
As those with endometriosis often know, the pain of endometriosis prevents women being able to do their usual exercise and prevents normal freedom of movement which can lead also to low back pain and external pelvic muscle pain. As mentioned above, the rectus abdominis i.e. “the six pack muscles” is notorious for becoming tight and painful and worsening abdominal pain.
Your assessment with Physio is about learning what muscles are contributing to your pain. We want to help you find out what to do to help yourself. There is usually a short trial of manual therapy so that you find out how much is from external muscles and how much directly from the endometriosis. We aim to help you on your pathway of self-management.
Information for this blog has been taken from the World Endometriosis Society:
Further Useful information can be gained from http://www.endometriosisaustralia.org/