We’re currently in Endometriosis Awareness Month, so let’s talk about it. Endometriosis is a condition during which tissue that normally lines the uterus grows outside of the uterus in the pelvic cavity. Endometrial tissue can be found on the ovaries, fallopian tubes, rectum, bladder, bowels and more. Furthermore, it’s common. Endometriosis is present in roughly 10% of women in the United States, and 176 million women worldwide, most frequently diagnosed in their 20s-40s.1
While not all women with endometriosis experience pain, this is the most common symptom of the condition. Women suffering from symptomatic endometriosis may complain of abnormally painful periods of time throughout their menstrual cycle, starting from a young age. This may not always be during menstruation, but can appear during ovulation, or the weeks preceding or following her period. Women may also complain of low back or pelvic pain. Other common symptoms include painful intercourse, painful bowel movements and gastrointestinal discomfort leading to constipation, diarrhea, bloating and nausea. Most pains and symptoms caused by endometriosis are cyclic in nature, triggered at times throughout a woman’s cycle. Unfortunately, up to 30-50% of women suffering from endometriosis experience infertility.1
One frustrating aspect of this diagnosis is that while it is a common condition, the average time to diagnosis is frequently over 10 years with 68% of women experiencing misdiagnosis.1 It is believed that, in part, the extended time frame for diagnosis is due to symptoms being misconstrued as normal period pain. An additional factor includes the average time it takes for women to seek help for this condition, estimated at 4.67 years. This is even longer for younger girls and women as well as more severe cases.1
Diagnosis is often multi-step including pelvic exams with your physician feeling for adhesions, followed by imaging and ultrasounds to assess for cysts and other structural abnormalities. However, the only way to officially diagnosis endometriosis is with a laparoscopic procedure. Laparoscopy is a minimally invasive surgery that allows your physician to see what is happening at your tissue level. It allows them to visualize the adhesions that may be causing your pain and it allows them to take samples, or excise and remove them.
Another frustration surrounding endometriosis for the medical community and patients alike is that we do not know the cause of the condition. While theories exist, there is no one accepted truth. Potential causes include: retrograde menstrual flow, genetic factors, immune system malfunctions, surgical history and hormones.
While there is no cure for endometriosis there are a number of treatments available to help manage symptoms. The first line of treatment is frequently hormonal birth control, with surgical intervention being another common choice. Pelvic floor physical therapy is another underutilized, in my opinion, resource for those with endometriosis.
While pelvic floor physical therapy will not treat your endometriosis, it will treat your pain to make you more comfortable. Pelvic floor physical therapists can use manual therapy techniques and exercise to help ease your pain with intercourse, improve your bladder and bowel emptying, decrease pain with bowel movements and urination, improve your tolerance to gynecological exams and tampon use and even decrease your cramping.
Muscular guarding may not be the cause of your endometriosis, but it can be a major contributing factor. Pelvic floor physical therapy can help teach your muscles how to relax and teach you how to manage your pain.
If you need help finding a pelvic floor specialist in your area, let us know! With questions or concerns, feel free to reach me at firstname.lastname@example.org or comment below.
-Rebecca Maidansky, PT, DPT