March is Endometriosis Awareness Month

By Dr. Brooke Meinema, DPT, FAFS

What is endometriosis?

Endometriosis is a condition where endometrial-type tissue (endometrial tissue is the tissue lining the inside of the uterus) begins to grow outside of the uterus. These tissues may begin implanting on different structures and organs, commonly within the abdomen (ovaries, bladder, rectum, abdominal walls, and beyond). There are different stages for endometriosis depending on the amount and location of the endometrial-type tissue formation ranging from stage 1 (minimal) to stage 4 (severe).

What is endometrial tissue?

The endometrial tissue is the lining within the uterus. This tissue responds to hormones (estrogen) during our cycle allowing us to shed the tissue during our cycles. However, with endometriosis, the tissue growing outside of the uterus doesn’t have a way to be shed and continue laying down, becoming inflamed, and potentially leading to issues.

Why is this a problem?

Normally, the organs within our abdomen are able to slide and glide along one another as well as expand or contract depending on what is needed. If the bladder fills, things shift around and expand; if the bowels fill, things shift around and expand; during pregnancy and menstruation, things shift around and expand. Moral of the story: our organs need the freedom to shift and glide along one another and room for expansion. Now, imagine these new implanting tissues forming adhesions between these organs causing them to stick together and no longer allowing them to glide smoothly locking them down. This (among other things) is what can happen with endo, so you can see how this would be a problem and lead to discomfort!

Symptoms

Symptoms can vary for those suffering from endometriosis. Some of the common symptoms may include:

• Pelvic pain
• Abdominal pain
• Abdominal bloating/distention (“endo belly”)
• Painful periods
• Irregular/heavy periods or prolonged bleeding
• Pain with sex (dyspareunia)
• Constipation and/or diarrhea
• Difficulty conceiving/infertility
• Decreased quality of life

Why the delay in diagnosis?

Endometriosis is estimated to affect 10% of women in the U.S., but this number is considered to be under-reporting the true number of cases. The average time from onset to diagnosis is over 7 years.

If it is so common, why on earth is it taking so long to get a diagnosis?! For starters, some women see their symptoms as being normal (other people have pain with their periods, too, so it must be normal, right?!). They may not think to mention it to providers to avoid being stigmatized as weak or dramatic. While it may be normal to have some cramping during our periods, having it impact our lives in such a way should not be considered normal and should be mentioned to our providers. Similarly, when women mention the symptoms they are experiencing to their providers, it is not always well understood and can sometimes be minimized, so some women just accept it and deal with it. It can also be difficult for providers to confidently diagnose endometriosis due to difficulty being seen in imaging (ultrasound, MRI, etc.), so some cases require a laparoscopy (a surgical procedure to view inside the abdomen) to get a confident diagnosis. Understandably, this sounds less than ideal but may be a necessary step to take towards finding relief in some cases.

Many women end up seeing multiple doctors and specialists before getting a proper diagnosis. On top of the discomfort from the endometriosis itself, this is exhausting! Advocating for yourself can be a struggle, but continuing to speak up and look for answers is so important to improving your health and quality of life.

What can therapy do?

While physical therapy is not going to cure endometriosis, it is able to help manage the symptoms often associated with it. Each session is specific to the needs of the individual and will be modified to fit the needs of each patient. This may include:

• Reducing pelvic floor muscle tension and encouraging the muscles to relax
• Desensitization of the pelvic floor to improve tolerance to penetration
• Education on safe positions to avoid discomfort during sex
• Therapy to treat issues with urination or bowel movements
• Stretching and exercises to alleviate low back, abdominal, and hip pain that are often associated with endo flares
• Manual therapy
• Education on self-help tips to manage symptoms

If you are curious if physical therapy can help your case but aren’t sure where to start, give us a call! We offer free 10-minute phone consultations with one of our women’s health specialized therapists to help determine your next steps. Call us at 616.847.1280 ext 0.