24 Nov Endometriosis- Non Surgical Treatment
Endometriosis (endo) is a topic that has a negative stigma surrounding it. As with most stigmas, the negativity is rooted in a lack of understanding. As a pelvic health physical therapist, I treat many women who know or suspect they have endo.
How can I help?
I have the knowledge to share. Helping women understand their body and endometriosis empowers them with strategies to help manage their symptoms.
What I DON’T have, is personal history with endometriosis.
I believe there is a deeper understanding that accompanies personal experience. This is why I called on my friend Jill Mueller. Jill has lived through the pain of endo, resulting infertility, and surgery. On top of the experience, she is an accomplished pelvic health physiotherapist who regularly works with women who have endo.
I turned to Jill to help me dive into endometriosis to help others understand this condition and more importantly, dispel the myths surrounding it.
What symptoms would most women experience that may suggest they have endo?
- Digestive issues
- Family history of endo or infertility
- Painful periods that are generally very heavy
- Digestive discomfort/bloating
- Pain with urination or bowel movements
- Small intestinal bacterial overgrowth (SIBO)
In girls with significant menstrual cramps, research shows that up to 70% of them will have endo (Saridogan, 2005). Adolescents are also more likely to present with non-cyclical pain over adult sufferers.
Can you explain how endometriosis forms?
There are 3 different theories:
This theory proposes that endometriosis occurs due to ‘backflow’ of sloughed cells from the uterine lining via the fallopian tubes into the pelvic cavity during menstruation. This theory is no longer widely accepted due to findings of endo tissue outside of the pelvis, in autopsied fetuses, and even in men.
This theory suggests that there is a surplus of estrogen (a hormone that is responsible for the thickening of the uterine lining during menstruation).
Some proponents believe that an autoimmune response results in the body constantly “fighting itself” and therefore in a constant state of inflammation.
How is endometriosis graded?
It’s graded by severity and location.
Stage 1 (being least) – Stage 4 (being most severe).
It is interesting to note that the stage does not necessarily coincide with the intensity of symptoms. My personal theory of why this happens can be explained by central sensitization. When pain occurs in the body, the nervous system becomes ‘wound up’ in response to the irritating feeling. Over time, the nervous system gets used to being wound up and has a hard time winding itself back down, even if the source of the original pain has been removed.
Does endometriosis progress with time?
It is suspected that it progresses with hormone fluctuations and estrogen. Symptoms can improve with decreasing estrogen levels that accompanies menopause.
How is it diagnosed?
Endo can be suspected by taking a thorough history, considering a compilation of symptoms, and including an internal evaluation of the mobility of the reproductive system.
Occasionally MRI is used but the gold standard is laparoscopy where tiny incisions are made in the abdomen to do exploratory surgery in the abdomen and pelvis.
What is the usual course of events once someone sees their family doctor?
In teenagers, birth control is not a bad option. However, it does not slow the progression of the disease, it merely manages symptoms.
If someone has children or are not considering having children, another option to consider is an IUD (with progesterone) to manage symptoms.
Many women will require pain medications to manage.
Often women are sent to a gynaecologist who specializes in endometriosis. This specialist may elect to do surgical removal of the endometrial tissue. I would suggest women do their own research and request a specialist who uses surgical excision vs ablation.
Most people are surprised to hear how long they need to wait to see an endometrial specialist and they are left suffering while they wait. Many are also surprised to find out that their symptoms linger even after surgical procedures.
What are some non-surgical treatment options?
1. Pelvic health physical therapy
· Down train pelvic floor muscles
The pelvic floor muscles often become tense and overactive in response to pelvic pain.
· Bowel and bladder health
Managing constipation and ensuring your toilet habits aren’t lending to an overactive bladder
· Visceral-fascial therapy
To help with any restrictions to the fascia that may be contributing to pain or dysfunction.
(Osteopaths and some PT’s and RMTs are also trained to do visceral-fascial therapy)
2. Anti-inflammatory lifestyle
Eat an anti-inflammatory diet, remove xenoestrogens in your life (found in makeup, plastic containers, cleaners, etc)
3. Stress management techniques
Try doing activities that help calm an overactive nervous system that is potentially causing central sensitization. (Mindfulness, meditation, yoga, walking outside)
If someone suspects that either they or their adolescent daughter has endometriosis, what do you want them to take out of this information?
- Educate and advocate for yourself. Find and request a specialist that is right for you.
- Do what you can to manage your symptoms. Changing diet and lifestyle can be very overwhelming and intimidating. Start by gathering all of the information and think about what changes you can make. Don’t change everything at once as that can be overwhelming. Try to make one change at a time which allows you to take note of how that change makes your body feel. Naturopaths can also be great resources.
- Don’t downplay the huge role of your mindset on your nervous system.
What are some resources that women may find helpful?
- Beating Endo, by Dr Iris Kerin Orbuch and Amy Stein DPT.
- Curable Health App is a great resource for persistent pain and is now starting to focus on pelvic pain. He has a great podcast called Like Mind, Like Body.
- Shelly Prosko is a physiotherapist who integrates Yoga therapy for pain management. https://physioyoga.ca
- Neil Pearson is a physiotherapist whose area of practice is Pain. He has a great website: https://lifeisnow.ca
- You can find Jill talking about all things endometriosis and pelvic pain
– E. Saridogan, “Endometriosis in Teenagers”, Women’s Health, vol.11, no.5 (2005): 705 -09.