I recently had a new teenage patient come to see me. It was clear just from her posturing that she was in severe pain.
She described to me the months of school she had missed, the dances she could not attend, the soccer games she sat on the bench for, and the various medications she had tried without any relief. I wish I could say this was the first time I heard such a harrowing tale, but unfortunately, that just isn’t the case. Her story is all too familiar.
Endometriosis is estimated to affect between 10-20% of American women of childbearing age, yet it is often undiagnosed, misdiagnosed, or poorly managed. The exact cause of this disease remains unknown, although several theories exist as to what may trigger and ultimately fuel it.
Endometriosis occurs when endometrial-like tissue (similar to what is found in the uterus), grows outside of the uterus. This tissue can not only invade the reproductive organs but can spread throughout the abdominal and thoracic cavities. These “spots” of tissue are referred to as lesions and can cause adhesions to form and ultimately compromise the structures they are attached to. The longer these lesions are there, the more trouble they tend to cause.
Endometriosis can impact bladder and bowel health, cause pain with intercourse or penetration, affect fertility, and cause mild to severe abdominal and pelvic pain. Pain can be cyclical in nature but can also become daily for some women. These issues can enormously impact a woman’s quality of life and take aim at her emotional and psychological well-being.
All too often, some doctors are quick to dismiss women who complain of menstrual-like pain. “Take some Midol and use a heating pad, you’ll be fine in a few days”, is certainly something I heard often growing up. In many cases, women and girls are given birth control pills, IUDs, or injections to help symptoms.
With endometriosis, these options do not treat the underlying cause. As such, symptoms typically persist and often worsen. Despite this, no additional assistance is generally offered.
The gold standard for identifying endometrial lesions is via laparoscopy, performed by a highly-skilled surgeon known as an excision specialist. It is only with this procedure that the lesions (which may be hiding and not visible with ultrasound or MRI) can be identified and ultimately removed. Many leaders researching this disease strongly advocate for early identification and excision, primarily for fertility preservation and improved quality of life.
During this process, pelvic PT can be extremely beneficial. Although we cannot cure the disease through therapeutic intervention, we can certainly work on the secondary issues caused by the disease process.
This may include patient education on pain reduction strategies, appropriate exercise/movement recommendations, normalizing bowel and bladder health, soft tissue work on the abdomen to reduce adhesions and muscular tension, and working to relax and lengthen the pelvic floor muscles, which often become shortened and irritable due to the chronic pelvic pain.
Several amazing resources are available for women seeking a diagnosis or looking for support. These include the Pelvic Health Podcast, Nancy’s Nook on Facebook, and various books including Beating Endo by Amy Stein, DPT, among many others.
If you suspect you may have any of the symptoms of endometriosis, please feel free to contact us at Grace Pelvic Health and Physical Therapy. We are here to support, educate, and guide you on what is often a long and challenging journey.
Dr. Erika Grace graduated from Duke University School of Medicine with a Doctorate of Physical Therapy and completed sub-specialty clinical training in pelvic rehabilitation. She also holds a Bachelor’s degree from Emory University and a dual Master of Social Work and Master of Science of Public Health (Maternal and Child Health) from the University of North Carolina, Chapel Hill. Dr. Grace specializes in complex pelvic pain and is passionate about offering patient-centered and LGBTQIA+ inclusive care. Her treatment of pelvic conditions incorporates a holistic approach to overall health and wellness. Dr. Grace is owner of Grace Physical Therapy and Pelvic Health with locations in Raleigh, Durham and Chapel Hill.
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