Endometriosis
Endometriosis or otherwise know as ‘the invisible disease’. It is when tissue similar to the lining of the womb grows outside in other parts of the body. It usually grows on the reproductive organs such as the ovaries and Fallopian tubes, however it can also be found on the bladder, bowel, muscles, ligaments, joints, lungs and brain.
Unfortunately we still don’t really understand what causes endometriosis (although there have been many theories proposed), which makes it difficult to diagnose and treat. The gold standard of diagnosis is via laparoscopic surgery, which is why it can often take years for a patient to have a proper diagnosis.
Symptoms are not always cyclic in nature and include painful periods, pain with urination or bowel pain, pain with intercourse, heavy irregular bleeding, and infertility. Pain can be located in various places extending from the chest to the knees.
Other less commonly associated symptoms include fatigue, ‘brain fog’, nausea, vomiting, diarrhoea and/or constipation, rectal bleeding, dizziness, and headaches. Mental health conditions are also associated with a recent study showing 44.3% of women have depressive symptoms, 25.3% have anxiety, and 31.7% have increased stress.
Ultimately in terms of treatment nothing is curative! It is believed that bleeding during menstruation can enhance inflammation in the area by the activation of an immune response. This can then cause inflammation of the sensory nerves in the area, which if persists can increase the sensitisation of the body part affected as well as the brain. Essentially your body can ‘learn pain’, creating a feedback loop which makes it easier for pain to occur.
This is why the first line of treatment is to suppress the production of oestrogen and stop the female from getting her period (called induction of amenorrhea). They are trying to break the inflammation/pain cycle that can be caused by bleeding. Unfortunately hormonal therapy can be associated with some unwanted side effects and thus does not help everyone.
What else can we do? There has been new research looking into diet such as avoiding certain food triggers (once again different for every person), following an anti-inflammatory diet, and the benefits of fish oil and B12. Exercise is important, however research in this area is also limiting and may help more so with managing the pain and psychological factors that can often go with a diagnosis of endometriosis.
Physiotherapy can help with education about the condition as well as understanding pain associated. The more we understand something the less threatening it can become! We can also help with symptoms that may be associated with endometriosis in relation to the pelvic floor such as pain with intercourse, urination, using the bowels etc, as well as assist with formulating management strategies when you are having a flare up so you can live your best life!
