A Guide To How Pelvic PT Can Help Manage the Symptoms of Endometriosis

Pelvic Health Physical Therapists are specially trained to diagnose and treat issues related to the pelvic floor musculature and surrounding structures.

Physical therapists are the go-to practitioners that you see for musculoskeletal problems with the bones, muscles, nerves, fascia, and ligaments for some relief. Similarly there are bones muscles, nerves, fascia, and ligaments in your pelvis and abdomen. Endometriosis directly affects the way these structures behave in the pelvis.

Below are some of the ways a PT can help with management of your Endo and pelvic pain:

1. Treating Trigger Points In The Muscles of the Pelvic Floor

The chronic pain in the pelvic region that comes along with this fabulous disease can cause chronic holding of tension in these muscles. This tension can create myofascial trigger points in the pelvic floor muscles just like the ones you get in the upper trap and neck from stress. These muscles are a little harder to get to but are treated similarly to all the other muscles in your body with myofascial release, stretching and strengthening.

Often a trigger point in the pelvic floor muscles can refer pain to other related structures in the pelvis. One example of this is a trigger point in the obturator internus muscle (one of the pelvic floor muscles) referring pain to the rectum, a common place of pain in those with endometriosis. Imagine my surprise when I was in my Pelvic Floor 101 class and a classmate "found" this muscle and my symptoms were reproduced, ouch and wow! It gave me some hope that working on this muscle could improve these symptoms and guess what, it did!

Pelvic PTs also look for pain generators outside of the pelvic floor in other joints and muscles. For example a trigger point in the adductor magnus can refer pain that feels like it's in the ovary.

Common signs of pelvic floor dysfunction:

• pain in the back, hips, and sacroiliac joint

• difficulty emptying the bladder

• urinary frequency, burning or pain

• constipation or diarrhea

• painful bowel movements and faecal incontinence

• painful sex

• inability to tolerate a speculum during a gynaecological exam

• pain with wearing tampons.

2. Decreasing Tension In The Muscles Of The Pelvic Floor

The chronic holding of tension in the pelvic muscles also causes a shortening of these muscles, just like a tight hamstring. Imagine holding your knee in a bent position all day, how functional would that be at the end of the day? It's the same in the pelvis.

Your pelvic PT can help guide you through internal and external stretching of these muscles so that they can move through the full ROM and do their job holding up all of the organs in the pelvis and doing so happily. A shortened muscle can also be very weak because full ROM of the muscle is needed to generate force. Strengthening comes later after the muscle length is improved.

3. Decreased Central Sensitization- An overstimulated nervous system

So another fun part of endometriosis is that it upregulates the Sympathetic Nervous System and starts the chronic pain loop. The fight or flight system is turned on too much and the brain's interpretation of the pain threat is heightened.

A good analogy for this is a cup that is filled when there is pain stimulus. A person without a chronic pain condition has an empty cup to start and it takes longer for the cup to fill and stimulate a pain response. In contrast a person with chronic pain and inflammation has a 3/4 full cup to start from previous experiences of pain and therefore it take less to fill that cup and stimulate a pain response. This is the chronic pain loop. The pain stimulus may be minor in reality but cause a much higher pain response than it should.

But, there are strategies to help down-train the nervous system so that the pain response is more accurate to the pain stimulus. A pelvic PT can help guide you through this.

4. Decreasing Endo Belly

Many people with endometriosis complain of excessive bloating that comes on seemingly for no reason. Some of this bloating can be attributed to the actual inflammatory response the body has to endometriosis lesions. However, tightness in the pelvic floor may also contribute to “endo belly”. If the pelvic floor is unable to provide the support the way in which it was designed because it is in spasm, the abdomen can balloon out. In particular when the hip flexor muscle or psoas muscles have spasms you can get outpouching which looks like extreme bloating.

Physical therapy can help relax this protective response. PT can also help with lymphatic drainage which can improve the swelling and discomfort in the abdomen. The abdomen is a tightly packed area and whenever there is any swelling from endometriosis, cysts or digestive issues, you are going to feel it!

Over time with chronic inflammation, the peritoneum and organs can cause the fascia around them to sense pain and proprioception (position) of the organs differently. Visceral mobilization therapy is another tool that many pelvic PTs use to treat this issue. This type of therapy can make a huge difference in the bloating, distention, abdominal and pelvic pain.

5. Management of Scar Tissue

The gold standard for diagnosis of Endometriosis continues to be an exploratory laparoscopy. Anyone who has has abdominal or pelvic surgery will have the formation of scar tissue as a normal part of the healing process. Our organs are meant to move and glide over one another as we bend and move our bodies. Scar tissue can restrict this mobility of the affecting function and causing pain. For example, constipation is a very common symptom associated with endometriosis, often due to involvement of scar tissue around the rectum.

Although this is a normal part of the healing process, it is important to address scar tissue during the time that it is still pliable and has elasticity. This is why you have PT so soon after orthopedic surgeries.

A Pelvic PT can help mobilize and release this tissue with scar massage and visceral mobilization and teach you the skills to continue that treatment on your own.

6. Creating a Community of Support

Most Pelvic PTs seek out other professionals that can assist with the care of their patients. We know we are not able to fix all the problems on our own so we create a network of providers to refer to such as massage therapists, chiropractors, acupuncturists, nutritionists, doctors, craniosacral therapists and the list goes on.

It is really important to create a web of support for yourself as well and a pelvic PT can help you and should encourage you to do this. This is can be anything from a work assistant to a friend you can go to for a shoulder to cry on. It's so important to have people in your life that you can go to for different things rather than relying on just one person such as a spouse to do it all.

There are many other ways that pelvic physical therapy can help with pelvic pain especially in the case of Endometriosis. If you are seeking relief I encourage you to reach out to your local pelvic PT. You can find one in your area on the Pelvic Rehab Practitioner Website https://pelvicrehab.com/?utm_source=hwdotcom&utm_medium=mainmenu or on the Pelvic Guru Global Health Alliance directory https://pelvicguru.com/directory/. I am also happy to help. I offer telehealth appointments via skype. Visit my website to schedule, elevatedpt.com.

Be Well,

Tracey