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Physiotherapy for Endometriosis

Endometriosis is a medical condition that happens when tissue growth becomes similar to the lining of the uterus outside it. This tissue can be found in various areas, such as the abdominal cavity, ovaries, bladder, rectum and abdominal or pelvic walls.

The World Health Organization reports that at least 190 million women worldwide are affected by this, while SingHealth reports that 10% of women in Singapore are. However, there is a challenge in diagnosing endometriosis, as symptoms can be confused with other conditions such as irritable bowel syndrome or pelvic inflammatory disease. This can lead to delays in diagnosis and appropriate management.

WHAT LIFE WITH ENDO FEELS LIKE

Women seeking support at Embrace Physiotherapy often describe a range of feelings and symptoms including:

  • Dysmenorrhea
  • Pain during or after sex (dyspareunia)
  • Pain during or after bowel movements (dyschezia)
  • Pain when you urinate (dysuria)
  • Pain in the lower back or legs
  • Difficulty holding on with a full bladder or frequent urination
  • Persistent pelvic pain
  • Heavy menstrual flow or irregular periods
  • Challenges in conceiving or maintaining a pregnancy
  • Nausea or vomiting

It is unfortunate that in many cultures, discussing menstrual cycles is still considered taboo, and there exists a perception that menstrual pain should simply be accepted. We believe that when women feel any discomfort or pain, they must be able to receive support and treatment.

SURPRISING ENDOMETRIOSIS SYMPTOMS

  • Bowel movement issues: This includes bloating, constipation, and diarrhoea, which is why endometriosis has been often misdiagnosed as Irritable Bowel Syndrome.
  • Shoulder pain: When shoulder pain isn’t responding to physiotherapy, osteopathy, or chiropractic care, it could mean endometriosis affecting the diaphragm.
  • Acid reflux
  • No pain

Endometriosis affects various aspects of women’s lives, including fertility, intimacy, and mental well-being. However, there is hope. By increasing awareness of symptoms and available treatments, you can embrace life like many success stories.

At Embrace Physiotherapy, we advocate a holistic approach to women’s health. Physiotherapy does not cure endometriosis but rather manages the symptoms.

SURPRISING ENDOMETRIOSIS SYMPTOMS

  • Bowel movement issues: This includes bloating, constipation, and diarrhoea, which is why endometriosis has been often misdiagnosed as Irritable Bowel Syndrome.
  • Shoulder pain: When shoulder pain isn’t responding to physiotherapy, osteopathy, or chiropractic care, it could mean endometriosis affecting the diaphragm.
  • Acid reflux
  • No pain

Endometriosis affects various aspects of women’s lives, including fertility, intimacy, and mental well-being. However, there is hope. By increasing awareness of symptoms and available treatments, you can embrace life like many success stories.

At Embrace Physiotherapy, we advocate a holistic approach to women’s health. Physiotherapy does not cure endometriosis but rather manages the symptoms.

ENDOMETRIOSIS DIAGNOSIS AND TREATMENT

To diagnose endometriosis, a clinical assessment, ultrasound, or MRI may be used, but laparoscopic surgery and biopsy are the gold standard. Treatment options include excision surgery, hormone therapy (often via contraceptives), and anti-inflammatory and anti-neuropathic pain medications. Prolonged pain can cause an overactive pelvic floor, resulting in discomfort.

Women with endometriosis are at a higher risk of bladder pain syndrome (interstitial cystitis), or experiencing pain that can radiate from one organ throughout the pelvis. In response to pain, our bodies enter a ‘fight-or-flight’ state, leading to the protective mechanisms of tightening of abdominal or pelvic floor muscles. Unfortunately, this can aggravate irritation in already inflamed areas affected by endometriosis. Remember that pain is generated by the brain as a protective response, but does not necessarily indicate harm. Pain from endometriosis can stem from various sources, such as inflammation, adhesions, other organs, or hypersensitivity, and we can change this!

HOW CAN PHYSIOTHERAPY HELP WITH ENDOMETRIOSIS?

Physiotherapy works to improve pain symptoms, functionality, and overall quality of life. Despite emerging studies on the impact of endometriosis, there is still limited research on therapeutic options. Embrace Physiotherapy draws on studies into pain management, persistent pelvic pain, and overactive pelvic floors. Our approach combines clinical judgement with empirical evidence to effectively treat women with endometriosis.

A recent study in the Ultrasound in Obstetrics and Gynecology journal revealed that women with deep infiltrating endometriosis experiencing pain during sex showed significant improvement in pelvic floor relaxation with physiotherapy. Dr Simona Del Forno from St. Orsola University Hospital in Bologna supports that physiotherapy does indeed help, “I believe that in women with endometriosis suffering from chronic pelvic pain, the use of multiple therapeutic strategies, including pelvic floor physiotherapy, may be the key to success.”

 

WHAT DO PHYSIOTHERAPISTS DO TO TREAT ENDOMETRIOSIS?

Collaboratively, we can establish goals and a management plan, which includes:

  • Giving you a better understanding of your anatomy
  • Teaching you about your body’s natural pain response
  • Providing advice on calming your nervous system, including breathing, mindfulness, and body scanning techniques
  • Giving tips on exercise and movement strategies, including yoga for managing endometriosis-related pain
  • Guiding you about good bladder and bowel movement habits
  • Giving  techniques, positions, and exercises to help sex become less painful and more pleasurable
  • Sharing strategies to optimise pelvic floor function and the use of machines or manual techniques as treatment options
  • Educating you about sleep hygiene because quality of sleep has been shown to have an impact on women living with endometriosis
  • Guidance pre and post-surgery

There is no “best treatment”, and we can refer you to psychologists, nutritionists, or pain specialists for multidisciplinary support between your GP, gynaecologist or urogynaecologist.

Recovering from endometriosis needs patience and dedication. There will be good and bad days, and having strategies in place to manage during challenging times is important for improving your overall health and well-being.

If you’d like advice on how physiotherapy can help you manage life with endometriosis, we’re here. Please call us or WhatsApp 9780 7274, or get in touch with us at help@embracephysio.sg to make an appointment.

Feel free to look through our website, where you can learn about other women’s health conditions we treat. This is a safe space where we can discuss how we can help you with physiotherapy.

Note: While I am a physiotherapist, I am not your personal physiotherapist. The contents of this website are for informational purposes only and are not intended to serve as personal medical advice.

References:

  1. https://www.who.int/news-room/fact-sheets/detail/endometriosis#:~:text=Endometriosis%20affects%20roughly%2010%25%20(190,and%20girls%20globally%20(2).
  2. https://www.singhealth.com.sg/patient-care/conditions-treatments/endometriosis-ovarian-cysts
  3. https://www.endometriosisaustralia.org/post/endometriosis-of-the-diaphragm-and-the-chest
  4. https://www.embracephysio.sg/vaginismus-a-patients-journey/
  5. https://www.embracephysio.sg/how-to-treat-overactive-pelvic-floor-muscles/
  6. https://www.embracephysio.sg/what-is-interstitial-cystitis-or-bladder-pain-syndrome/
  7. https://obgyn.onlinelibrary.wiley.com/doi/10.1002/uog.23590
  8. https://www.contemporaryobgyn.net/view/pelvic-floor-physiotherapy-for-endometriosis
  9. Arion A, Orr N, Allaire C et al. ‘A quantitative analysis of sleep quality in women with endometriosis’. Journal of Women’s Health, 2020, https://doi.org/10.1089/jwh.2019.8008.
  10. Del Forno S, Arena A, Pellizzone V, et al. ‘Assessment of pelvic floor muscles with 3D/4D transperineal ultrasound in women with deep infiltrating endometriosis and superficial dyspareunia treated with pelvic floor muscle physiotherapy: a randomized controlled trial’, Ultrasound in Obstetrics and Gynecology, 2021, DOI: https://doi.org/10.1002/uog.23590
  11. Dos Bispo AP, Ploger C, Loureiro AF, et al. ‘Assessment of pelvic floor muscles in women with deep endometriosis’, Archives of Gynecology and Obstetrics, 2016; DOI: 10.1007/s00404-016-4025-x
  12. Endometriosis Australia
  13. G. Lorimer Moseley and David S. Butler, Explain pain supercharged: the clinician’s manual, Noigroup Publications, 2017.
  14. Goncalves, A., Barron, N., & Bahamondes, L. (2017). ‘The practice of hatha yoga for the treatment of pain associated with endometriosis’, Journal of alternate and complementary medicine, 2017, DOI: 10.1089/acm.2015.0343
  15. Mira TA, Giraldo PC, Yela DA, Benetti-Pinto CL,’ Effectiveness of complementary pain treatment for women with deep endometriosis through Transcutaneous Electrical Nerve Stimulation (TENS): randomized controlled trial’, European Journal of Obstetrics, Gynecology and Reproductive Biology, 2015, DOI: 10.1016/j.ejogrb.2015.07.009
  16. National Institute for Health and Care Excellence (NICE), Endometriosis: Guidelines and Management’, 2017
  17. Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), Australian clinical practice guideline for the diagnosis and management of endometriosis, 2021
  18. Wu CC, Chung SD, Lin HC, ‘Endometriosis increased the risk of bladder pain syndrome/interstitial cystitis: A population-based study’ Neurourol Urodyn, 2018, DOI: 10.1002/nau.23462
  19. Yoke-Fai Fong, Soon-Kit Hon, Li-Lian Low, et al. ‘The clinical profile of young and adolescent women with laparoscopically diagnosed endometriosis in a Singapore tertiary hospital’, Taiwanese Journal of Obstetrics and Gynecology, 2017, DOI: https://doi.org/10.1016/j.tjog.2016.07.013
5 Star Google Reviews
Embrace Physiotherapy is committed to 5 star client satisfaction.

Professional, Knowledgeable, Patient and Caring - highly recommended! I’ve completed 8 sessions with Preet to prepare for birth and a follow up post birth and was impressed at her level of care. She does a thorough assessment while keeping you comfortable and relaxed. I would highly recommend Preet

Leanne Avatar Leanne
September 30, 2021

Really glad to have Alex as my therapist! She helped me tremendously in resolving my pelvic pain issues after delivery. I sought help from a couple of places, but they were of little use. Thankfully, I met Alex who has the experience and patience to accurately diagnose the issue and treat my pain. On top of that, Alex and the staff at Embrace are very friendly, and it was a great experience overall. I would highly recommend anyone who is suffering from postpartum pains to visit Alex at Embrace!

Tash L Avatar Tash L
January 11, 2022

I saw Preet throughout my pregnancy and postnatal period. She is the BEST. She saved my body and provides free emotional support whole she's at it. Preet obviously knows what she's doing and could identify the root source of the pain and assigned exercises to address it. She also doesn't make you feel bad if you fail to do them. I highly, highly recommend Embrace.

Jana Shih Avatar Jana Shih
December 15, 2023

Embrace life. Embrace Physiotherapy.

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