There can be many factors as to why someone might experience pelvic pain. Injury, scar tissue, past surgeries, or even overly contracted pelvic floor musculature may be the culprit. Endometriosis is also a diagnosis that can sometimes be overlooked as a factor in pelvic pain and pelvic floor dysfunction. Endometriosis is a condition where the inside lining of the uterus, the endometrium, be found on other areas of the abdominal cavity outside of the uterus. Endometrial tissue has been found in some women to be on the ovaries, fallopian tubes, peritoneum, bladder, bowels, rectum, and in some studies even in the eye! Now, how did it get there, you ask? Researchers and still investigating how this might be the case, but a working theory is that this tissue gets displaced during fetal development, or the activation of certain genes, a science called epigenetics, later on in child or adulthood.
Endometrial tissue is unique in that it is receptive to normal cyclical hormonal changes of the menstrual cycle and bleeds and sheds every month. This process works just as designed when this tissue is inside of the uterus and has a way to exit our body through the vagina. When endometrial tissue is found in areas outside the uterus, however, it cannot be eliminated which can create irritation and inflammation to the surrounding tissues or organs. Over time, this can create scar tissue or adhesions throughout the abdominal cavity, causing pain and inflammation.
Common symptoms of endometriosis include painful, debilitating periods. Not just gentle cramping that makes you reach for a heating pad or your nearest ibuprofen, but unable to get out of bed, go to work, or engage with family or friends type of pain. Heavy bleeding or clotting, fatigue, excessive abdominal bloating, painful bowel movements, constipation, painful sex or bladder urgency and frequency or infertility are also potential symptoms for endometriosis.
Women who have endometriosis may wait anywhere on average from 6-11 years from first symptoms to final diagnosis. Diagnosis can be challenging as surgery is currently considered the gold standard, meaning physicians must look at the tissue via small cameras inserted through the abdomen in order to be diagnosed. Current treatments to assist in reducing symptoms for endometriosis include hormonal birth control and surgery via excision or ablation. Other treatment modalities such as acupuncture, modifications to diet and exercise, yoga, meditation and mindfulness practice, self care routines, and pelvic floor PT may be helpful in management of pelvic pain from endometriosis. Communicating with your doctor and other providers of your health care team allow for the best plan to be created based on what your specific needs are.