Endometriosis. What can be done?

Endometriosis is a medical condition that has recently gained more awareness and funding for research into diagnosing and managing it. It is a chronic condition where the endometrial lining is found outside of the uterus, typically within the pelvic cavity. So thus with every cycle, these tissues also respond to the hormonal fluctuations, leading to inflammation, scarring, pain, and sometimes infertility.
Unfortunately, endometriosis is a silent disease that can be quite debilitating for some females. Endometriosis can affect women of all ages but is most commonly diagnosed in women between the ages of 25 and 35. The exact cause of endometriosis is unknown, It affects 1 in 9 women in Australia and the average length of time to reach a diagnosis is roughly 6.5 years. Endometriosis Australia [1] estimates that it costs Australia $9.7 billion dollars a year in health related costs and work productivity losses.

There are a wide range of symptoms and each person’s symptoms are different to the next person. The major symptoms of endometriosis are:

  • Pelvic pain. Pain can present as lower abdominal pain, vulval, anal pain. It can refer to other areas around the pelvis such as the lower back and hips. In some women her pain can refer down the legs or sometimes up into the chest
  • Pain can occur with vaginal penetration such as with intercourse and using tampons, pain with bladder and/or bowel function
  • Ovulation pain
  • Painful and/or heavy periods and abdominal cramping
  • Abdominal bloating
  • Urinary frequency and/or urgency
  • Bowel changes either constipation or diarrhea. It can sometimes be mistaken for IBS
  • Fatigue and mood changes are also quite prevalent
  • Infertility

Unfortunately, a diagnosis still requires a laparoscopic procedure and biopsy to confirm endometriosis. Surgery removes the endometriosis, and in some cases, it helps with one’s pain. However, there are some women where pain still persists after surgery. It’s not that surgery was a failure, but sometimes there are other underlying factors contributing to pain. So does this mean that you need to have another surgery soon? Health professionals are aware that with each surgery you have, this increases scar tissue and adhesions developing, which can also play a role with pain. We definitely do not want to increase your pain!

Research shows management of endometriosis is best when multiple health professionals are involved. The team can have a GP, gynaecologist, gastroenterologist, pain specialist, dietician, psychologist, and a pelvic floor physiotherapist. Unfortunately as endometriosis is a chronic condition, the goal is to manage your pain. It’s finding out what strategies work for you.

As a pelvic floor physiotherapist, we can play a role in assessment and management of pain. The pelvic floor is likely to develop tension as a consequence to try to manage the pelvic pain and any other associated symptoms. So what is one of the main key things we are hoping your pelvic floor to do? It’s to teach it how to relax. So for example if you ball your hand into a fist and it stays that way 24/7 it’s going to hurt at some point. So imagine that being your pelvic floor.

Other treatments may include stretches and tailored exercise ideas, encouragement of relaxation through positioning, general advice on meditation, usage of vaginal trainers and optimising bladder and bowel habits. Some women may not get the desired result, some get significant reductions in pain. Our goal though is not to cure endometriosis, as it is a chronic condition, but more so to manage the symptoms.

Each person’s experience with endometriosis is unique and there is no one-size-fits-all approach to management. However, with the right support and team and tailored strategies, it is possible to manage the symptoms and improve one’s quality of life.
1. Endometriosis Australia, Endometriosis Australiahttps://www.endometriosisaustralia.org/

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