March 1, 2019
Endometriosis occurs in an estimated 10% of the female population. It is a condition in reproductive-aged women who have tissue similar to that of the uterine lining growing outside of the uterus. This tissue can appear in the pelvic cavity, and in more severe cases, outside the pelvic cavity. Common locations of endometrial tissue deposits are on the ovaries, fallopian tubes, utero-sacral ligaments and on the uterine or pelvic cavity wall.
What does this mean for the women who suffer from endometriosis? The most common symptom of endometriosis is pelvic pain. This can be described as cramping, achy, heavy/dull pain in the lower abdomen and pelvic area. The laying down of endometrial tissue outside of the uterus causes an inflammatory response which can often result in the production of fibrous bands of scar tissue called adhesions. Adhesions, when severe, can fuse organs together, and further increase the pain associated with endometriosis. Adhesion pain presents itself as sharp, stabbing, nauseating and sickening pains. It is also thought that women with endometriosis are more likely to suffer from infertility or may have a harder time getting pregnant.
There are many theories as to what may cause endometriosis including retrograde menstruation, genetic disposition, immune system dysfunction and environmental factors. None of these theories have been proven to date and are unable to explain all the mechanisms involved in the condition. It is agreed upon that estrogen plays a role in the exacerbation of endometriosis. Thus treatments are often based around regulating the production of estrogen in the body, and therefore help to reduce the symptoms experienced. Studies have found a genetic correlation with endometriosis. If a first-degree relative suffers from the condition, you are more likely to have it, and if there is indeed a hereditary link, later generations typically experience a harsher version of the condition.
The diagnosis of endometriosis is often delayed as most women don’t even realize they are having symptoms and mistake endometriosis pain for intense menstrual cramps. The gold standard for diagnosis of endometriosis is a laparoscopic surgery with biopsy of the excised tissue. This must be performed by a knowledgeable physician specializing in endometriosis, as the endometrial tissue can easily be missed, leading to a false-negative result. Unfortunately, at present there is no reliable, conservative method to diagnose the condition, making it increasingly frustrating to deal with.
There is currently no treatment to cure endometriosis. However, other treatments that can help alleviate symptoms and improve quality of life are available. These include hormonal therapies to regulate estrogen production, and surgical excision of endometrial tissue. In addition to these treatments, physical therapy with a pelvic health specialist can be beneficial. Physical therapy will not by any means change the endometrial tissue itself, but it can help with pain by decreasing muscle guarding in the pelvic and lower abdominal area. A physical therapist can do this by teaching you how to relax the pelvic floor muscles, as well as with numerous abdominal, core, and proximal hip stretches. These techniques can also help with painful intercourse, urinary urgency/frequency as well as constipation and bloating.
It’s important to know that though being labelled with endometriosis may be daunting and depressing, with the help of an interdisciplinary team including a pelvic health PT you can feel empowered and in control. Knowledge of your condition and knowing how to manage it independently can allow you to continue to do the things you love.
For more information about endometriosis, check out http://endometriosis.org/