Understanding Endometriosis: Treatment and Support

March is Endometriosis Awareness Month. Do you know that one in ten women of reproductive age are affected by endometriosis? Endometriosis is a debilitating condition that is characterized by abnormal growth of uterine tissue outside of the uterus that is affected by hormonal changes each month. The growth of endometrial tissue can develop adhesions, fibrous tissue that can cause pelvic organs and connective tissue to stick together. This can result in pelvic pain, infertility, bowel and/or bladder dysfunction, sexual dysfunction, menstrual cramps and more. Muscle function can be altered affecting the entire core system. Symptoms can be mild or severe and do not necessarily coincide with the extent of endometrial lesions. Endometriosis is diagnosed by symptoms and via laparscopic surgery.

If you suspect you have endometriosis, we recommend a multidisciplinary approach beginning with an evaluation by a urogynecologist, a specialized urogynecologist. Medical treatment can range from hormonal therapy to surgical excision of endometrial tissue. Your doctor or provider might refer you to a pelvic floor therapist although you don't need a referral to see a physical therapist in most states, like Ohio. In extreme cases, a total hysterectomy might be recommended, although endometrial lesions can exist after surgery. There is evidence that movement and exercise improves symptoms. Physical therapists are movement experts and can design a program specific to your individual needs, while empowering you in managing symptoms of endometriosis.

Some strategies to manage symptoms of endometriosis include:

Visceral Mobilization - a form of myofascial release performed by a skilled practitioner to address restrictions around deep pelvic structures and organs (viscera). Manual therapy is especially beneficial for women suffering with dysmennorhea (painful menstruation) and dyspareunia (painful penetration). Visceral mobilization promotes the natural glide of pelvic structures to improve digestion, breathing capacity, neural gliding, muscle function and organ motility. Visceral mobilization also improves nervous system regulation through stimulation of the vagus nerve, promoting healing and restoration.

Nutitional Support - There is increasing evidence that diet affects the immune response, altering organ and muscle function via the viscerosomatic reflex and contributes to a leaky gut. Leaky gut increases intestinal permeability and can trigger an autoimmune response. The intestinal lining is one cell layer thick and is weakened by a leaky gut, causing large particles of food and bacteria that are not meant to pass through the gut wall to enter the blood stream and create an inflammatory reaction. This alters hormonal function through the connection with the endocrine system. In addition, nerves from the organs and pelvic floor muscles share a pathway to the spinal cord, creating "cross-talk" between the nervous and musculoskeletal systems. It is no coincidence that women with pelvic pain are commonly diagnosed with Irritable Bowel Syndrome (IBS), constipation, Small Intestinal Bacterial Overgrowth (SIBO) or Celiac Disease. Read our blog Reduce Inflammation With Nutrition For a Healthy Core Part 1 and Part 2 for more information on nutritional support to reduce pelvic pain.

Mindfulness and Meditation - Advances in pain science continue to show that diaphragm breathing improves pain perception, promotes movement of lymph drainage to aid the body's detoxification process, improves digestion and gut motility through the pulsing of the intestines and promotes the rest and digest mode for a full body relaxation effect. Additionally, pelvic floor muscle relaxation is encouraged with each breath via the piston relationship to the diaphragm. Mindfulness is an evidence-based strategy for improving nervous system regulation. Since nervous system regulation is anti-inflammatory, incorporating mindfulness strategies into your regular routine can reduce inflammation that is contributing to symptoms of endometriosis. The caveat is that it is hard to breathe correctly when you have nervous system dysregulation.

At Healthy Core, our core experts are trained in evaluating and managing symptoms of endometriosis using an evidence-based approach. Many women get significant relief from symptoms to improve quality of life and learn strategies to breathe better, improve nervous sytem regulation and manage pain. Call our office at (330) 528-0034 to ask questions and schedule an evaluation with one of our pelvic floor physical therapists.

Resources:

George S, Clinton S & Borello-France D. (2013). Physical Therapy Management of Female Chronic Pelvic Pain: Anatomic Considerations. Clinical Anatomy. 26(1). 77-88.

Montenegro M, Vasconcelso

Wurn et all. Decreasing dyspareunia and dysmenorrhea in women with endometriosis via manual therapy. 2011.

written by: Janine Laughlin, PT