Endometriosis- a Short Guide to the Diagnosis
Hi Everyone!
Thank you for reading another rendition of the RPT Blog! I want to start of saying that today’s topic is pretty heavy with a lot of information that is going to be shared.
But before we get started- I just wanted to say that if you are struggling with Endometriosis or chronic pelvic pain- there is hope! With a combination of treatments, we can decrease your symptoms and improve your quality of life.
What is Endometriosis?
Endometriosis is a condition where tissue that lines the uterus, called the Endometrium, is found in areas outside of the uterus. This condition also encompasses tissue that resembles Endometrium and is not within the uterus.
This tissue often acts in the same manner that it would if it were located in your uterus- a.k.a it still follows your monthly cycle. This results in the tissue becoming inflamed, and it can potentially bleed, the same way your Endometrium does when you start your monthly cycle. Endometriosis can also cause adhesions between the endo-lesions and other normal tissue around it. Adhesions generally lead to pain in most areas of the body.
Endometriosis has no clear causation- meaning there is no real “why” it occurs, and there is no cure for it at this time.
Endometriosis is found in 1 out of 10 women, and 1 out of 4 women with chronic pelvic pain. It takes most women 6-10 years to get a definitive diagnosis for a multitude of reasons.
Common symptoms include:
Chronic Pelvic Pain
Painful Intercourse
Pain with Menstruation
Low back/hip/groin/abdominal pain
Infertility
Irritable bowel syndrome
Bloating
Diarrhea/Constipation
Difficulty emptying bowel/bladder
Painful bowel movements
Generally, you do not have all of these symptoms but most experience one or more of these. 75% of women with Chronic Pelvic Pain DO NOT HAVE Endometriosis; some women have it and don’t get symptoms at all. Symptoms experienced are going to be different from one woman to the next (even if you have the same diagnosis).
How do we diagnosis Endometriosis?
The only way to definitively diagnosis you with Endo would be to perform laparoscopic surgery and biopsy any lesions found to determine the tissue type. Without doing this, we cannot be 100% sure that you have Endo. MRI’s, Ultrasound and other tests can be helpful in determining what your body is experiencing but they cannot definitively tell you if you have Endo.
When you are diagnosed- it will be in one of four stages, I-IV, depending on severity of the disease. One being the least severe and four being the most severe. It is important to note- your symptoms will not be based off of the severity/staging of the diagnosis. There have been cases where women have Stage 4 Endometriosis but they have little-to-no symptoms.
How do we treat Endometriosis?
There are several types of treatment that we will discuss- all of which has been found to be helpful via research. However, if you have been diagnosed with Endometriosis, you should have a frank and through conversation with your physician about the different treatment options available.
DO NOT BE AFRAID TO ADVOCATE FOR YOURSELF. This is the biggest thing that I see with my patients. They are afraid to ask for what they want when it comes to treatment. I also see a lot of women who are afraid to “aggravate” their physician by discussing conservative options.
Any and all healthcare providers are HERE FOR YOU. We have the knowledge but it is YOUR BODY. Take charge of your health and we can come together to create the best treatment plans for you AND your body.
Physical Therapy-
In a several studies it was noted that 94% of women with Endometriosis have painful trigger points in their abdomen, and 61% of women with Endo have confirmed pelvic floor dysfunctions. Luckily, those are things that are commonly treated by physical therapists.
Often pelvic pain is due to trigger points in the pelvic floor muscles and abdomen, chronic inflammation in the pelvic region, and adhesions (from Endometriosis, scaring or within the fascia). Pelvic Floor Physical Therapists specialize in evaluating and treating these conditions and their symptoms.
Specifically, for Endometriosis- we work to relieve your symptoms by releasing trigger points, decreasing inflammation, restoring normal blood circulation, and releasing scar adhesions. We also work to educate our patients on ways to manage your symptoms through self-treatment skills and activities.
Surgery-
The first treatment we will discuss is surgery. Now, surgery cannot cure your symptoms. But it has been shown to significantly help with pelvic pain and fertility when they remove any found adhesions within the abdomen. The research has also stated that about 21-37% of women who elect to have this surgery come back to do it again within in 2 years; 50% of women who had the surgery are electing to do it again at the 5-year mark.
If you are considering a Hysterectomy to alleviate your symptoms- it should not be done lightly. There is still a chance the symptoms will return even when you no longer have a uterus. Research also shows that those who have a partial hysterectomy have a significantly higher risk of heart disease and osteoporosis. This risk is even higher in women who have a partial hysterectomy before they hit menopause. Also, it is important to note- if you have a hysterectomy without excision of the adhesions and endometriosis- your symptoms will NOT change as the tissues that are the issue have been left within your body.
If you are considering ablation surgery- where they go and burn the adhesions and Endometriosis away, approach it with caution. This treatment has a high rate of regrowth of the endometriosis. Also- if you are having surgery to diagnosis Endometriosis, you cannot also have an ablation at that time. It would destroy the tissue that they need to examine to definitively diagnose you.
Hormone Therapy-
The aim of this type of therapy is to stabilize your hormones throughout your monthly cycle to decrease your overall symptoms. These types of treatments tend to be highly effective for reducing your symptoms except for infertility. Hormone Therapy does not cure Endometriosis; your symptoms will resume once you stop the medication. All Hormone therapies present with risks of other issues and various side effects of the medication. Speak with your physician about what type of medication would be best for you.
Pain Medications and Alternative Treatments-
Most over the counter medications can assist with pain management for Endometriosis. There are other options that should be discussed with your physician due to potential side effects associated with long term usage of pain medication.
Alternative treatment can include Acupuncture, Yoga, Stress reduction, and Diet and Nutrition. All of these have been shown to assist with Endometriosis symptoms and pain. It is important to discuss pain and stress management. Research shows that stress and feeling helpless can actually amplify your pain and overall symptoms. In one study, a combination of physical therapy and psychotherapy were shown to decrease pain and perceived stress as well as even out the levels of stress hormones found in the blood stream.
Digestive issues have also been noted to sometimes accompany Endometriosis, so it might be worth while to have your blood work checked for vitamin and mineral deficiencies.
If you are experiencing Pelvic Pain or have been diagnosed with Endometriosis- start having in-depth conversations with your physician about exploring potential treatment options. Remember that there are other potential diagnoses if you have not been formally staged with laparoscopic surgery + biopsy.
If you have any questions or need more help- feel free to contact me via phone call/text/email or on Social Media (Facebook or Instagram). I am here to help!
--Dr. Paige
Owner/Physical Therapist for Recharged Performance Therapy
(321) 802-1630
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