Endometriosis and Physiotherapy


How her insides on the outside affect her on the inside and the outside – Endometriosis

She is a woman with Endometriosis. She stands up in the waiting room. From the outside she looks fit and healthy. What is happening inside her body is not. She is suffering from Endometriosis. A disease where the tissue that is similar to the lining of the inside of the uterus is present on the outside of the uterus – invading areas in the pelvis where it shouldn’t be.

There is no cure. The cause is unknown.

It affects 1 in 10 women and is the leading gynaecological cause of pelvic pain.

She presents to a Women’s Health Physiotherapist.

Her main complaints are pain with sex (dyspareunia), pain passing a bowel motion, incredibly painful periods and hip pain after sitting for long periods.  

‘I know the cause of endo is unknown’ she says, ‘but why am I in so much pain’?

Normally, the tissue/endometrium inside the uterus will shed when menstruating. With endometriosis, women cannot shed the endometrial cells that have grown outside the uterus – these cells will bleed and set off inflammation and scarring, which leads to significant pain and sometimes difficulty conceiving.

Over time, in response to chronic pain caused by endo itself, the central nervous system becomes very sensitive – meaning what once was not painful, becomes painful. The transmission of signals to the brain is amplified. For example, sexual intercourse, ovulation and bowel motions may become painful. The whole body may even be sensitive to the lightest touch.

Following on from this, the pelvic muscles respond to this ongoing pain by contracting – creating very tight muscles in and around the pelvic region – further exacerbating the pain.

She is relieved. A justification for her pain. She is not crazy. She does not have a ‘low pain threshold.’ She is not a woman complaining of ‘period pain’.  She no longer has to think of excuses not to have sex. She has endo. Her pain is real.

However, it can be managed.

‘How Can Physiotherapy help me to have pain-free intercourse? To poo painlessly? To be able to sit at work comfortably?’ She asks.

Acknowledging and managing the original source (endometriosis) is key, but so is desensitising the central nervous system, through manual therapy and direct manual release of tight muscles and tissues to be able to live a full quality of life. Without pain.

Treatment will differ from woman to woman.

A whole-body biomechanical analysis by a women’s health physiotherapist is essential to determine what may also be driving the tight muscles and heightened sensitivity. Treatment techniques may involve directly releasing the pelvic muscles and fascia, and/or treating other parts of the body that may be contributing to her pelvic pain. She will learn correct body positioning to pass a bowel motion and she will be given an exercise program to empower her to self-manage her symptoms.

She smiles.

She walks away knowing that yes, she has Endometriosis.

She understands why she has been in so much pain. Why certain activities hurt her.

She is aware that there are treatment options to improve her quality of life.

She will shine inside and out.