Endometriosis and Physical Therapy

Endometriosis is a condition that can affect 10-15% of women between the ages of 15 to 49. It can start as early as the onset of menses and may not even resolve with menopause. In this condition, endometrial-like tissue grows outside of the uterus. This includes places such as the ovaries, intestines, and in the tissues lining the pelvis. In some cases endometrial tissue may grow outside of the pelvis as well. 

Causes and Risk Factors

The cause of endometriosis is unknown, but it can be linked to high levels of estrogen, which can result in the endometrial-like tissue growing and thickening. This leads to adhesion formation. It is highly likely that women can have a genetic predisposition in developing endometriosis if their mother and/or sister(s) are also affected. Age when the menstrual period starts, other gynecologic factors, and environmental toxins may also influence whether a woman is affected. Some studies have also linked the presence of endometriosis with the development of ovarian cancer; however, the association is not definitive and the risk is exceedingly low.

Symptoms

Endometriosis symptoms include:

• pelvic pain
• painful periods
• low back and/or abdominal pain
• pain after sex
• discomfort with bowel movements
• abdominal bloating
• diarrhea or constipation
• fatigue

Diagnosis

The “gold standard” to diagnose endometriosis is via laparoscopy to take a biopsy of the tissue, which is a pretty invasive procedure. Tests such as ultrasound, MRI, CT scans, CA125, and gynecological exams can be performed. Results of these tests can be suggestive of endometriosis, but does not definitively rule in or out the disease. 

How Can PT Help?

Pelvic physical Therapy can help to decrease pain and reduce tightness in the abdomen and low back. The pelvic floor muscles will also be evaluated and treated to improve bowel, bladder, and sexual function.

Physical therapy treatment options may include: 

• Myofascial manual therapy
• Visceral Manipulation 
• Pelvic floor muscle lengthening through internal trigger point release 
• Stretching and Flexibility exercises
• Relaxation exercises

References:

1. https://www.healthline.com/health/endometriosis
2. http://endometriosis.org/endometriosis/ 
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5890212/pdf/jpts-29-2112.pdf
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3895811/
5. https://journals.lww.com/greenjournal/fulltext/2019/10000/optimal_management_of_endometriosis_and_pain.25.aspx