Endometriosis is one of the most misunderstood women’s pelvic health diseases in our country.
One in 10 women will have endometriosis during their reproductive years. Dr. Iris Orbuch, a OB-GYN who specializes in pelvic pain and endometriosis, states that 70 percent of all teenagers that have pain with their period have endometriosis. This disease could be responsible for up to half of the unexplained infertility women experience and it is thought that over 87 percent of chronic pelvic pain in women is caused by endometriosis.
Normally in a healthy uterus there is an internal lining called the endometrium. This is the innermost lining in the uterus. It functions to prevent adhesions between the opposed walls of the uterus and the myometrium. It helps maintain the openness and flexibility of the uterine tissue layers.
What is endometriosis? Unfortunately, sometimes this type of endometrial tissue appears to grow outside the uterine cavity. This tissue is similar to the tissue in the lining of the uterus. Without a way to drain each month, as the uterine lining does during menstruation, the cells form lesions, scar tissue, cysts and can lock together the normally free-floating organs of the pelvis.
Over time the presence of endometriosis causes an inflammatory nightmare in the pelvic cavity. It irritates the peripheral nerves of the pelvis. Then these peripheral nerves send signals to the spinal cord and brain, which then upregulates the central nervous system. This is what we call peripheral and central sensitization. It means that pain becomes part of everyday life.
It usually takes more than 10 years and eight doctors in order for a women to receive the diagnosis of endometriosis. Fifty percent of all hysterectomies are not needed as they are not a cure for endometriosis. Often women have seven to ten ablation surgeries for endometriosis with no lasting results. Each year over $130 billion is spent on women who have endometriosis, including their lost wages, medical expenses and medication for pain.
Women with endometriosis often experience excruciating pain on a cyclical basis or daily basis. It can affect all different types of organs throughout the pelvic, abdominal and thoracic cavity.
It can cause symptoms such as bleeding, bloating, pressure, heaviness in the abdomen, hot flashes, cold sweats, fatigue, organ dysfunction, diarrhea and or constipation, along with bladder voiding issues. Often there is nausea, intestinal cramps, pain with inserting a tampon and painful sex. In teenagers this is especially true.
Many other disease processes are associated with endometriosis, such as irritable bowel syndrome, interstitial cystitis, polycystic ovarian syndrome, anxiety and depression. It is an often isolating and devastating disease for young women, and it can begin early in life at the age of 8 to 10 years old and upward. If a women’s mother had endometriosis it is seven times more likely she will have endometriosis as well.
Many women are told that it is normal to have such severe excruciating pain during their periods, and often these women have to miss school and work as a result. There appears to be no correlation between the level of pain that a woman has and the level of endometriosis that is found inside the body. One woman may have an excessive amount of endometriosis throughout the abdominal cavity and have minimal pain and another woman may have a minimum amount of endometriosis present and have excruciating pain.
There is treatment for endometriosis that does not include oral contraceptives, Lupron, nonsteroidal medications, ablation surgery or a radical hysterectomy. For many years these things were the only care we had, but that is no longer the case now.
Why is more not known about endometriosis? The National Institute of Health (NIH) is allocated research dollars per person diagnosed with endometriosis. In 2015 it was approximately 92 cents per person, whereas a person with diabetes was allocated over $35 per person, per year.
According to Dr. Orbuch and her husband, who is an M.D. in their bicoastal practice in New York and Los Angeles, the best way to restore the quality of life that a women needs is for them to have minimally invasive abdominal surgery with excision removal of the endometriosis.
Often, physical therapy with a women’s pelvic health specialist is prescribed prior to surgery to decrease pain, to decrease bloating and pressure with improving the lymphatic drainage patterns, to decrease muscle spasms in the pelvic floor muscles, and to increase mobility of the short, tight muscles of the pelvic floor. The musculoskeletal system is one of the pain generators in endometriosis, along with the central nervous system and the peripheral nervous system as stated previously.
Following excision surgery, patients will then return to physical therapy to restore the natural movement patterns of all the pelvic floor and abdominal muscles. We will also decrease the risk of adhesions and pelvic congestion with mobilization of all the tissue layers during dynamic movement patterns of the body, especially in the abdominal, pelvic and thoracic region. Physical therapy will assist with nerve gliding and instruct in the down-regulation of the peripheral and central nervous system pain patterns with meditation, deep breathing and relaxation training. It is necessary to make physical therapy an integral part of healing for the musculoskeletal system and nervous system following excision surgery.
Our team understands the frustration endometriosis can have for our patients and we are here to help every step of the way.
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Sheree DiBiase, PT, is the owner of Lake City Physical Therapy and she and her staff want to help you have the quality of life you deserve. Women’s choice; choose well! Coeur d’Alene office, 208-667-1988; Hayden, 208-762-2100; and Spokane Valley, 509-891-2623.