We frequently treat patients with endometriosis here at Klein Physical Therapy, we want to bring some awareness to what endometriosis is, what are the symptoms, what treatments are available and lastly, how physical therapy can help. Consider making an appointment if you live near Denver, Colorado. You can book by clicking here.

Article by Dr. Kimberlie Landers

What is Endometriosis?

Endometriosis is a condition where cells similar to the lining of the uterus start to grow outside of the uterus. These cells are affected by estrogen which is why many symptoms begin at puberty. It is classified as an inflammatory disease and it is estimated to affect 1 in 10 women.

Symptoms of endometriosis can vary person to person. Research has found that symptoms don’t always correlate to the severity of the condition. Someone can have 10/10 pain and have mild endometriosis while others may have low pain and advanced endometriosis.

Common endometriosis symptoms include: 

• Painful periods

• Pelvic pain

• Pain with sexual intercourse

• Pain with urination and/or bowel movements

• Excessive bleeding

• Infertility

• Fatigue

• Digestive Issues

• Irritated bladder symptoms 

How is it diagnosed? 

The gold standard in diagnosing and treating endometriosis is with laparoscopic excision surgery. Finding a skilled surgeon is key because the success of the surgery is determined by the skill level of the surgeon. It is best to find someone with years of special training on endometriosis excision (not ablation) and is FMIGS (fellowship in minimally invasive gynecological surgeries) trained.

Common Myths and Facts

Myth: You can diagnose endometriosis with a pelvic ultrasound or MRI

Fact:  Although they are making strides in research, most providers are unable to diagnose endometriosis via imaging at this time. An MRI may show a deep infiltrating endo, but not many doctors/radiologists are trained in reading the results and seeing this on the scan.

Myth: Hysterectomy or menopause will cure endometriosis

Fact: Removing the uterus and ovaries will not remove the endometrial implants that are already outside of the womb and causing symptoms. Additionally, it is thought that the lesions may make their own estrogen or even the small amount of estrogen an ovary produces in menopause may still cause symptoms.  

Myth: Hormonal treatments (birth control, lupron) or pregnancy cure endometriosis

Fact: These drugs or becoming pregnant may temporarily suppress symptoms, but they do not treat or slow the disease process. The only treatment is excision surgery.

A great resource for educating yourself and for finding a list of the top skilled excision surgeons is Nancy’s Nook Endometriosis Education Group on Facebook. Another site for looking up a surgeon is https://icarebetter.com/.

What can be done other than surgery?

If you are still having pain after endometriosis surgery or if you are looking to avoid surgery temporarily, it is important to look at other pain drivers. Some other causes of pain could be hormonal changes at the vaginal tissue, musculoskeletal pain (pelvic floor dysfunction) or nervous system upregulation/central sensitization.

How can physical therapy for endometriosis help?

• Assessing for other pain drivers such has pelvic floor dysfunction or central sensitization

• Manual therapy for improving modulating pain and improving tissue mobility of abdominal, hip and pelvic floor muscles 

• Individualized exercise plan

• Education on nutrition, use of dilators/wands, and bowel, bladder and sexual health

• Help you find the right medical provider and surgeon

At Klein PT, our PTs are trained to perform a comprehensive evaluation which includes a whole body assessment of posture, strength, range of motion, palpation and movement analysis. We can perform manual therapy techniques to help mitigate neuromuscular or musculoskeletal pain including dry needling, cupping, soft tissue release, joint mobilization etc.

We will teach you nervous system down-regulation techniques if needed, as well as prescribe therapeutic exercises that are individualized to meet your needs.  Patient education topics may include nutrition, self care techniques, use of dilators or pelvic wands, and normalizing bladder, bowel and sexual health.

The goal of your physical therapist is to listen to your story, help you find the right doctors, be on your team, and support your recovery so that you can get back to doing the things you love!