How Endometriosis can cause or contribute to chronic pelvic pain and what pelvic floor therapy can do to help alleviate it.
Endometriosis is a condition where endometrial-like tissue grows outside of the uterus(endometrial tissue is tissue that usually grows inside of the uterus and sheds each month). The most common area for it to grow is in the abdominal cavity, where it can implant of the surface of other structures including the ovaries, bladder, rectum, and along the walls of the abdomen and pelvis.
The true prevalence of endometriosis is unknown, since it takes a laparoscopic procedure to confirm the diagnosis and others are either have no symptoms or seek no treatment (Signorello, Harlow, Cramer, Spiegelman, & Hill, 1997). However, up to 78% of women undergoing laparoscopic investigation for infertility and up to 82% of women investigated for pelvic pain were found to have endometriosis in one study (Schenken, 1996; Wellbery).
Actress Lena Dunham has been vocal about her experiences with endometriosis, most recently publishing an essay in American Vogue on electing to have a total hysterectomy after years of chronic pain due to the condition.
Pain, fatigue, and other symptoms associated with endometriosis can affect quality of life, including sexual health and happiness. In fact, a study published last year found that patients with endometriosis have more than twice the sexual dysfunction as compared to women without the disease (Fairbanks, Abdo, Baracat & Podgaec, 2017). Below is a list of common sexual health problems associated with endo and some strategies to help:
Some people with endometriosis report that pain and fatigue can be better or worse at certain times of the month. Keeping a diary can help identify patterns of pain associated with the cycle. Estrogen levels peak during ovulation, usually day 12-15 of the cycle, leading to higher pain levels for some with endometriosis. Knowing how your body feels during different parts of the cycle can help you make decisions about when to engage or avoid in sex to manage your pain.
As we continue our series about endometriosis, today we address how endo might affect fertility and pregnancy.
Having endometriosis does not automatically mean that you will never have children. What it does mean is that you might have more trouble getting pregnant. About 30% of those with endometriosis have trouble with fertility and struggle to get pregnant. Others with endometriosis have no difficulty getting pregnant, or eventually get pregnant after utilizing medical interventions including surgery to remove endometrial growths, or reproductive technologies like in vitro fertilization to help with conception.
March kicks off Endometriosis Awareness Month, and we'll be posting a series of articles to educate women and their loved ones on this debilitating disease. Many women are uninformed about the benefits of pelvic floor physical therapy and complementary care on restoring and maintaining function, reducing pain and ultimately guide you towards a better quality of life.
Worse yet, their pain and dysfunction may be dismissed by their providers, only causing further debilitating pain and disability. Our goal this month is to support women, educate providers, and get the word out! Women should not be passed around from provider to provider, and should instead be given a treatment plan as early in the process as possible. Women should not have to wait several years to get their pain addressed. Delays in care only cause detriment to the physical and emotional well-being of these women.
Endometriosis affects 1 in 10 women and girls. The delay for diagnosis averages 7 years! How early should you start the discussion about this debilitating condition? As a pelvic health physical therapist, I believe this conversation should start not long after your daughter begins menstruating. As moms, we need to be aware about what is “normal” versus “abnormal”. We only know if we ask them questions. It can be a scary time for girls when they first get their periods, and it can be devastating if there is a lot of pain. We need to be a strong support system for our daughters, but also educate them on the norms.
Is it normal to have cramping? Yes. It’s the uterus contracting to shed the lining of the uterus. Mild to moderate cramping can often be helped with Motrin, heating pads, gentle exercise and adequate hydration. Be careful to not dismiss her if she comes to you complaining of severe cramping during her cycle. If her pain is so severe she is vomiting, please do not accuse her of being “too dramatic”. I’ve heard these stories in my office from my patients as they relay their history and how long they complained of severe pain, only to be accused of playing up their pain too much. It only delayed their treatments and added psychological factors as they were made to feel that their pain wasn’t that bad or worse…not real at all.
1 in 10 women have endometriosis and experience different forms of pain—pain with urination, pain with bowel movements, painful periods, pelvic pain, ovulation pain, painful sex, abdominal pain, and nerve pain. The Office on Women’s Health of the U.S. Department of Health and Human Services estimates 5 million American women are affected by endometriosis.
As we covered in a previous blog post, endometriosis is a condition where endometrial tissue (tissue that usually grows inside of the uterus) grows outside of the uterus. Endometrial tissue can implant on the surface of organs and structures including the ovaries, bladder, rectum, and along the walls of the abdomen and pelvis. These tissues can cause inflammation and pain to develop throughout the abdomen and pelvic cavity.