Endometriosis not only affects every 1 in 10 women in their reproductive years (usually between age of 15-49 years), but is also seen in pre-teen girls. Endometriosis affects an estimated 176 million women worldwide regardless of their ethnic and social background. Many remain undiagnosed and are therefore not treated.
And, although it’s considered a disorder affecting women and girls during their reproductive years, endometriosis has been found in fetuses, infants, young girls who have not menstruated yet, in post-menopausal women, in women who have had a total hysterectomy with bilateral salpingo-oophorectomy, and in cis and transgender men.
What exactly is Endometriosis?
Endometriosis is a condition in which tissue similar to the lining inside the uterus (called “the endometrium”), is found outside the uterus. It is primarily found on the pelvic cavity, on the ovaries, in the recto-vaginal septum, on the bladder, and bowel. In very rare cases it has been found on the diaphragm and in the lungs. It can also invade other vital organs and structures such as the kidneys, the eyes, liver, pancreas, brain, bone, heart, skin, nasal cavity, and C-section scars.
How does Endometriosis affects the body?
With endometriosis, the endometrial-like tissue acts as endometrial tissue would — it thickens, breaks down and bleeds with each menstrual cycle. But because this tissue has no way to exit your body, it becomes trapped. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions — abnormal bands of fibrous tissue that can cause pelvic tissues and organs to stick to each other. This causes pain which can be from mild to severe and debilitating depending on the severity of the condition which impacts on her life so that she may not be able to carry out day to day activities.
Characteristics of Endometriosis:
The most common symptom of endometriosis is pelvic pain. The pain often correlates to the menstrual cycle causing abnormal painful and heavy periods, however a woman with endometriosis may also experience pain at other times during her monthly cycle which makes this disease/condition so unpredictable and frustrating.
Pain can also be felt during /before/during/after menstruation, during ovulation, in the bowel(defecation) during menstruation, when passing urine, during or after sexual intercourse, in the lower back region and abdomen.
Endometriosis can also cause diarrhea or constipation (in particular in connection with menstruation),abdominal bloating (in particular in connection with menstruation),IBS, heavy or irregular bleeding, fatigue. The other well known symptom associated with endometriosis is infertility or can lead to endometrial cancer.
Diagnosis and treatment:
There is a significant delay in the diagnosis of Endometriosis as the symptoms are not easily recognized or ignored in the primary care or by the woman herself. The gynecologist may perform tests like ultrasound, MRI scans, CA125, gynecological examinations which may be suggestive of the condition/disease. Endometriosis can only be diagnosed via laparoscopy unless its present in the vagina where it is visible.
As of now there is no known cure for Endometriosis, but there are treatments to help relieve symptoms and improve the quality of life.
Treatment to manage symptoms include: hormone therapy, surgery, physical therapy.
Endometriosis: Psychological Impact!!!
Endometriosis pain is much worse than painful period. The chronic pain can make it difficult to go about her daily routine. She can be stressed due to worsening of her condition, inability to perform daily task, painful intercourse, concerns of infertility or infertility itself and not getting a diagnoses or treatment in early stages.
Women suffering with endometriosis can suffer from anxiety or depression.
Physical Therapy and Endometriosis:
Endometriosis can cause changes in the pelvic cavity and therefore the pelvic floor muscles. Healthy pelvic floor muscles can contract and relax appropriately during urination, sex , bowel movement , and at rest. The pelvic floor muscles can go into spasm or become overactive leading to increased pain secondary to the existing pain from endometriosis. Overactive pelvic floor muscles can make period pain worse because when the uterus contracts to expel blood, the pelvic floor muscle and fascia system will be contracting too.( imagine lifting weight with a bad back).
Apart from the pelvic floor, her muscles of the back, abdomen and buttocks can get affected due to tightness or adhesions and scar tissue formation. The Pelvic Physical Therapist will be able to assess your muscles externally as well as internally ( after obtaining your consent) Treatment of the outer muscles of the hip, buttocks, spine and abdomen, and pelvic floor will help ease pelvic and sexual pain, better bladder and bowel control, regular bowel emptying, better digestion, and best of all, less period pain.