How pelvic floor physiotherapy can help you live well with endometriosis

If you’re living with endometriosis, it can often be hard to explain what you’re living with day in and day out. Although one in 10 Canadian women is living with endometriosis, this painful disorder often gets misdiagnosed, taking an average of five years for women to be appropriately diagnosed in Canada. Research is still being done, but today, no one is sure what causes this painful disorder.  

What is endometriosis?

Simply put, people living with endometriosis have tissue resembling that of the lining of the uterus (endometrium) outside of their uterus. Lesions are areas of endometriosis that can be found on the sidewalls of the pelvis or on the surface of pelvic organs like the uterus, ovaries, fallopian tubes, bladder, bowel, ureter, and appendix. 

Sometimes, endometrial tissue can be found in unusual places like the belly button, an old Cesarean scar, or the lungs. Plus, these lesions can be many different colours, shapes and sizes. No matter what they look like, this excess tissue can irritate other organs and tissue, leading to inflammation, swelling, and scar tissue.

What are the common symptoms of endometriosis? 

Symptoms of endometriosis vary from person to person, but here are some of the most common ones: 

• Painful periods (excruciating period cramps felt in the abdomen or lower back)
• Pain during sex
• Abnormal or heavy period flow
• Pain when you pee
• Painful bowel movements – especially during your period
• Gastrointestinal problems like constipation or diarrhea
• Pain during intercourse

Sounds painful, doesn’t it? While true for many people, it’s important to remember that how much pain someone is in doesn’t relate to the severity of their endometriosis. Some people with advanced endometriosis experience no pain at all, while others live with extreme chronic pain, day in and day out. 

Going through the process of being diagnosed is challenging to start, and then learning to live with endometriosis is yet another long journey. Still, it’s important to know that you aren’t alone. There is a whole community of endo warriors out there who are living with shared experiences. Plus, there are many ways you can get the support you need to live the healthy life you deserve. One way you can embrace wellness while living with endometriosis is through pelvic floor physiotherapy.

What is pelvic floor physiotherapy?

Pelvic floor physiotherapy is a subspecialty of physical therapy that focuses on treating the pelvic floor muscles and connective tissues associated with pelvic floor dysfunction. Pelvic physiotherapists are specially trained physiotherapists who can assess the condition of your pelvic muscles, usually through an internal examination. These specialized physiotherapists can also check on the function of your pelvic region, including the abdominals, diaphragm, and pelvic muscles like the gluteal and inner thigh muscles. 

How can pelvic floor physiotherapy help endometriosis symptoms? 

The benefits of pelvic physiotherapy for managing endometriosis symptoms include: 

Reducing pelvic pain

The pain from endometrial tissue often triggers a protective response from the body, which builds-up tension of your abdominal muscles, inner thigh muscles, and pelvic floor muscles. When your muscles are constantly tight, it can cause pain in your vagina, rectum, tailbone, lower back, and hip bones. This creates a vicious cycle where everything hurts, which in turn affects your moods and energy levels. 

Your pelvic physiotherapist will teach you pelvic floor muscle relaxation exercises and gentle movements to release tension and strengthen your lower back and hip muscles.

Improving bladder pain and regaining bladder control

Chronic bladder pain (such as burning sensation with peeing or pressure in the bladder) and urinary frequency are common symptoms of endometriosis. Endometriosis causes the muscles within your pelvis to tense up, leading to difficulty peeing and bladder pain. When bladder muscles tighten, it can also lead to urinary hesitancy or frequent urination. Over time, these symptoms can cause bladder pain syndrome and bladder infections. 

If you experience symptoms of bladder pain or inability to control your bladder, try these three steps to relieve some of your pain: 

• Try to relax your pelvic floor muscles. When you tighten your pelvic floor muscles, it can lead to bladder pain and urinary frequency. 
• Try to relax your muscles by doing some deep breathing exercises or focusing on your bladder and letting go of the tension. 
• Additionally, try identifying foods that irritate your bladder, such as carbonated beverages, tomatoes, citrus fruits, coffee, alcohol, chocolate, green tea, and spicy foods.

Relieving “Endo belly” 

Women with endometriosis often complain about having a bloated or “pregnant” belly, even when not pregnant. As a result of endometrial tissue, tension can develop in the connective tissue enclosing the pelvic organs and gastrointestinal tract, impairing bowel motility. The result is bloating, constipation, painful bowel movements, and abdominal pain.

There are a few things you can do to reduce bloating and discomfort associated with the endo belly: 

• Start by adjusting your diet to help with constipation and diarrhea. Add more soluble fibres to your diet if you tend to be constipated. Bulk up your stool if you have diarrhea. 
• Drink plenty of water.
• Place your feet in a squat position so that your pelvic floor can relax during a bowel movement.
• Finally, massage your abdomen daily to relieve pain and bloating. 

Your pelvic physiotherapist can also do manual therapy to help release the tension in your abdominal and pelvic floor muscles so that elimination (pooping) is easier. You will also be taught several relaxation techniques to calm your central nervous system and help release tension in your abdominal cavity.

Reducing pain during sex

Women who have endometriosis often also experience painful intercourse (dyspareunia). If you’re one of these people, you may greatly benefit from seeing a pelvic health physio­therapist with advanced training in treating pelvic pain. If you’re experiencing pain during sex, pelvic floor treatments can include manual therapy to release muscle pain, self-stretching techniques to relax the tight muscles, and neuromuscular reeducation exercises to reduce painful intercourse.