Endometriosis, the hidden disease
What is Endometriosis
Endometriosis is when the inner lining of the uterus, called the endometrium, grows outside of the uterus. The areas most affected are the ovaries, fallopian tubes, and soft tissues lining the pelvis. However, endometriosis can occur in other areas throughout the abdomen such as the diaphragm, bowels, and bladder. Like the inner lining of the uterus, the endometrium thickens and then sheds and bleeds with the menstrual cycle which can be problematic when located throughout the abdomen. When this happens, surrounding tissues can develop scar tissue and very painful adhesions.
Symptoms:
• Painful periods that spread into the back legs or abdomen
• Painful Intercourse
• Pain with urination
• Pain with bowel movements
• Passing of large clots during periods
• Diarrhea or constipation during periods
• Fatigue
• Heavy periods
• Spotting or bleeding between periods
• Infertility
• May have other symptoms based on where endometriosis is found.
Risk Factors:
• Immediate female family member with endometriosis
• Abnormal uterus
• Menstruation starting before age 11
• Short menstrual cycle (less than 27 days)
• Heavy periods lasting >7 days
Treatment for Endometriosis
Unfortunately, there is limited knowledge and options about the treatment of endometriosis. However, current evidence suggests that laparoscopic excision surgery has better outcomes and lesser recurrence rates. Excision is when they go in with cameras and cut out the areas with endometriosis. Ablation, which is the other surgical option, goes in burns the tissue. There is a much higher rate of recurrence with this method.
There is also much controversy regarding the use of progestin-based birth controls for the management of symptoms (or what other providers may call treatment). Some will say that endometriosis would still be growing, and the symptoms are suppressed. Others say that endometriosis does not grow. Overall, the level of evidence for this is low. The most evidence for its use was to use progestin-based birth control after excision surgery to prevent recurrence.
Role of Pelvic Physical Therapy
Physical therapists at Revive Physical Therapy can see patients with endometriosis in a few different stages. First, the physical therapist may be the first to identify that a patient has endometriosis and direct them to the proper care. Second, the physical therapist can prepare the patient for excision surgery. They may address muscle tension, fascial tension, or any other things they find in their assessment. Not every patient has the same symptoms with endometriosis, so it is important for the PT to do a thorough assessment to find the things that need to be worked on. Finally, the PT will help with rehabilitation after excision surgery. Surgery can lead to scar tissue, decreased bowel motility and other impairments that need to be addressed. Again, every patient is different, but any time someone has surgery, it is a good idea to have PT afterward to return to all activities as safely as possible.
Sources
https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656
https://www.hopkinsmedicine.org/health/conditions-and-diseases/endometriosis
Pundir J, Omanwa K, Kovoor E, Pundir V, Lancaster G, Barton-Smith P. Laparoscopic Excision Versus Ablation for Endometriosis-associated Pain: An Updated Systematic Review and Meta-analysis. J Minim Invasive Gynecol. 2017;24(5):747-756. doi: 10.1016/j.jmig.2017.04.008
Peng C, Huang Y, Zhou Y. Dydrogesterone in the treatment of endometriosis: evidence mapping and meta-analysis. Arch Gynecol Obstet. 2021;304(1):231-252. doi:10.1007/s00404-020-05900-z
Wójcik M, Szczepaniak R, Placek K. Physiotherapy Management in Endometriosis. Int J Environ Res Public Health. 2022;19(23):16148. Published 2022 Dec 2. doi:10.3390/ijerph192316148