Pelvic Floor Dysfunction: What is Endometriosis?

What Is Endometriosis?

Endometriosis is a condition where the endometrial tissue grows outside the uterus. Endometrial tissue lines the uterus but with endometriosis, it can grow outside the uterus, ovaries, fallopian tubes, and less commonly outside the pelvis. Endometrial tissue thickens, breaks down and bleeds during each menstrual cycle. This works well when it is lining the inside of the uterus but on the outside it can cause a lot of pain. This tissue being outside of the uterus has nowhere to go and can become blocked thereby causing pain.  Endometriomas (cysts on the ovaries) may form and may cause adhesions between the pelvic organs.

Signs and Symptoms of Endometriosis

  • Dysmenorrhea, or painful periods
  • Pain during intercourse
  • Pain with urination and/or bowel movements
  • Bloating, constipation
  • Infertility
  • Excessive bleeding during or between periods

Causes of Endometriosis

Nothing is know for certain but some possibilities are:

  • Retrograde (backwards) menstruation

This is when the menstrual blood, containing endometrial cells,  travels back through the fallopian tubes instead of exiting the body through the vagina. Where these cells settle, they may grow and thicken

  • Hormone influences may change other cells into endometrial cells
  • The lymphatic system may transport endometrial cells to other parts of the body
  • An immune system disorder where the body is unable to recognize and destroy endometrial cells lying outside of the pelvic cavity   

Risk Factors for Endometriosis

  • Never giving birth
  • Early age menstruation
  • Later age menopause
  • Shorter menstrual cycles that are less than 27 days
  • Higher estrogen levels
  • Lower body mass index
  • Alcohol consumption
  • One of more relatives with endometriosis (mother, aunt, sister)
  • Uterine abnormalities

Complications of Endometriosis

  • Pain
  • Infertility

Because endometriosis may block the egg or sperm travelling through the fallopian tubes, becoming pregnant may be more difficult

Diagnosis of Endometriosis

  • Ultrasound, either abdominal or trans vaginal. This is used to try and identify any cysts
  • Laparoscopy – making a small incision near the navel to look at endometrial tissue and possibly take a sample

Treatment for Endometriosis

  • Medication – including anti-inflammatories, hormone therapy:  birth control pills, patches or vaginal rings will help control the hormone delivered to your body thereby controlling the amount of tissue that is turned over
  • Gonadotropin-releasing hormone (Gn-RH) possibly with an estrogen/progesterone drug. The Gn-RH will help shrink the endometrial tissue and the low dose of estrogen or progesterone will help stave off the effects of menopause that the Gn-RH causes.
  • Using Progestin therapy: a progestin-only contraceptive such as a intrauterine device (Mirena), a contraceptive implant or contraceptive injection (Depo-Provera) can halt menstrual periods and the growth of endometrial tissue
  • Conservative Surgery

Using a laparoscopic approach or a traditional abdominal approach, endometrial tissue is removed

  • A total hysterectomy, though the last resort, is sometimes necessary. The ovaries must be removed as well due to the estrogen they are releasing thereby causing endometrial tissue to grow.

Self treatment for Endometriosis

  • Warm baths and a heating pad can help relax the pelvic muscles that are in spasm
  • Anti inflammatories
  • Regular exercise

How can Pelvic Floor Physiotherapy help Endometriosis?

Endometriosis causes an environment of adhesions, inflammation and scarring which can all lead to pain. The pelvic floor muscles will become tight and shortened in response to this. PF physio can help by identifying where the sore ‘trigger points’ are and use techniques to release them. Helpful techniques may include positions to release/stretch the pelvic floor muscles, deep breathing techniques to help quiet the nervous system and posture re-education to lessen any extra stresses that may affect the body when someone is in pain. Visceral manipulation as well can be helpful for lower belly bloating symptoms. The level of intensity of symptoms felt for each person is different and so too is the treatment.

The most important message is that experiencing incredibly painful periods/monthly pelvic pain is not normal. If this is you, start with your family Doctor to begin the diagnosis stage but always include some conservative care along the way. Bodies in pain tighten and move differently adding to the intensity of the pain experienced. Medical care is necessary at some level, whether it is through the use of hormones or surgery, but self care is as equally as important. Pelvic floor physiotherapy can definitely help by taking the time with someone that is needed to explain options of self care and help lessen symptoms through release techniques. Don’t give up!


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