Endometriosis: How can Physiotherapy help?

What is Endometriosis?

Endometriosis is a condition in which cells similar to those that line the uterus are found in other parts of the body. These endometrial cells can deposit anywhere in the body however are most commonly found in the pelvic area. 

The endometrial cells:

  • May start to grow and form patches or nodules on pelvic organs or on the inside lining of the abdomen and pelvis (known as the peritoneum) 
  • Have the same cyclical + hormonal response as inside the uterus and may bleed at the same time as your period (menstruation).
  • Found outside the uterus grow to form lesions or patches that bleed. This leads to inflammation and scarring.


Facts about endometriosis 

  • Endometriosis affects an estimated 1 in 10 women during their reproductive years (ie. usually between the ages of 15 to 49)
  • Teenagers are NOT too young to have endometriosis 
  • Period pain is NOT normal 
  • There is no known cause of endometriosis but it is highly likely that certain genes predispose women to develop the disease. Women have a higher risk of developing endometriosis if their mother and/or sisters are also affected


Symptoms of endometriosis

The symptoms of endometriosis vary from woman to woman. Some women have mild symptoms while others have severe symptoms. Symptom severity does not necessarily reflect the severity of the condition. 

Common symptoms of endometriosis include: 

  • Painful periods (pain that last > 1-2 days that does not settle with over the counter pain relief) 
  • Painful ovulation
  • Pain during or after sexual intercourse 
  • Heavy bleeding (with or without clots) 
  • Chronic pelvic pain
  • Severe pain that means you can’t participate in work, school or sporting activities.
  • Fatigue
  • Infertility
  • Pain with bowel movements or urination.
  • Bladder urgency/frequency 
  • Bleeding from the bladder or bowel.
  • Change in the pattern of bowel habits, such as constipation, diarrhoea.
  • Increased abdominal bloating (With or without pain at the time of the period) 

Always seek help when your pain and symptoms are stopping you from doing day to day activities. Period pain should never be so severe that you have to miss school, work or leisure activities. 

How is endometriosis diagnosed?

The only way to diagnose endometriosis is via  laparoscopy. A laparoscopy is an operation, performed under a general anaesthetic. It allows the gynaecologist to see if there is any endometrial tissue present. 

How can Physiotherapy help with endometriosis?

Physiotherapy can play a major role in educating you about endometriosis and treating your symptoms. A Physiotherapist trained in women’s health can properly assess your pelvic floor, and get a really good understanding of how all of your symptoms are related. Physiotherapy can assist in managing and treating the impact that the musculoskeletal system has on your endometriosis. 

Common musculoskeletal changes with endometriosis includes:

  • Spasm of the pelvic floor muscles in response to pain 
  • Apical breathing with a braced abdominal wall 
  • Myofascial trigger points in the pelvic floor, abdominal muscles, hip and low back muscles 
  • Pelvic floor muscle hypertonicity or overactive (which can contribute to bladder and bowel dysfunction including increased urinary frequency/urgency and difficulty emptying the bladder or bowel) 

Understanding and improving pelvic floor muscle function is essential for good bladder, bowel and sexual function. Addressing pelvic floor function can help to improve your bladder, bowel and sexual function because they are all connected and related. 

Physiotherapy treatment can help address: 

  • Pelvic pain
  • Low back pain
  • Pelvic floor muscle spasm and tightness
  • Pelvic floor weakness
  • Sexual dysfunction and pain with intercourse 
  • Difficulty emptying the bladder or bowel 
  • Increased urinary frequency or urgency 
  • Pain levels 

Treatment options may include (depending on your assessment findings):

  • Pelvic floor strengthening 
  • Pelvic floor down training and relaxation techniques
  • Dilator therapy 
  • Pain modulation and pain management techniques
  • Exercise therapy 
  • Acupuncture and dry needling 
  • Education on understanding endometriosis and pain cycles

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