What is Endometriosis?
Endometriosis is a long-term inflammatory condition, where abnormal growth of tissue (similar to that of the uterine lining) is found outside of the uterus. This can occur anywhere within the pelvic cavity as well as on organs such as the bowel, bladder or ovaries.
Symptoms can vary in number and severity for each woman, and can include:
Painful periods
Heavy periods
Irregular periods
Cyclical pain – pelvis, abdomen, lower back, thighs
Painful sex
Pain with bladder or bowel emptying
Constipation or diarrhoea
Digestive problems
Bloating
Infertility or difficulty falling pregnant
Chronic fatigue
As to what causes endo – while there are many studies looking at links with various genetic and autoimmune markers, we don’t have a clear answer just yet.
Diagnosing Endo
1 in 7 women in Australia have endometriosis – a number that is becoming more and more accurate with the new developments in diagnostic imaging.
The gold standard for endometriosis diagnosis is a laparoscopic (keyhole) surgery to investigate the abdominopelvic area for lesions. A camera is inserted via the umbilicus (belly button) so that a gynaecologist can search for any endometrial lesions. If found, an excision of the tissue is often done at the same time for treatment and further pathology assessment.
Specialist ultrasound imaging is now available as a non-invasive alternative. While there is a chance the ultrasound may not detect all cases of endo, it provides a quicker, more cost-effective option for assessment.
Where to go for Endo Ultrasounds on the Gold Coast:
QUFW
Haven Ultrasound
Mermaid Beach Radiology
Stages
Endometriosis grades are based on the number of lesions found and depth of infiltration. It does not correlate with severity of symptoms or amount of pain someone may experience. There are 4 stages:
Minimal superficial infiltrates identified
Mild deeper infiltrates identified
Moderate deeper infiltrates, soft adhesions and possible endometrioma/cysts on one or both ovaries identified.
Significant deep infiltrates, firm adhesions and large cyst growth on one or both ovaries identified.
Why do I still have pain after my endo excision surgery?
Endo pain is not just caused by physical lesions, but is rather a multifaceted and complex result of the changes within the body.
Pain is a result of our brain’s interpretation of inputs from the body, nerves, mental state, stress levels, energy levels, and physical environment. This is also compared against our past experiences of pain. Once the brain has interpreted all of those different inputs, it can then determine whether something is safe or potentially harmful. Pain is the response generated if something is deemed ‘not safe’.
If you experience pain regularly, your body will adapt to it. The nerves between the affected body region and the brain become more sensitive to any signals that might be harmful, which can amplify a signal before the brain gets a chance to decide if the situation is truly harmful. We call this central sensitisation. The brain processes a lot of signals from a lot of body parts every single second of the day, so if it begins to get flooded by a lot of ‘painful’ inputs from one area, your brain can misread this and attribute pain to other local body parts. It becomes harder for your brain to distinguish where the ‘painful’ signal is coming from, so just in case the brain sends a pain response to the body parts it thinks the signal is originating from. This is what causes the pain to spread to other body parts. This sharing of pain can also happen locally between the pelvic organs, which we call ‘cross-sensitisation’.
You also develop feedback responses to anticipate pain. For example, when your hormones start to change levels prior to your period or ovulation, your body may recognise this and create a pain response to this change.
What can a Pelvic Physio do for Endo?
A LOT!
We see and help a lot of women at FPC each day manage their pelvic pain. We’re a bit biassed, but also we have good reason to be!. The latest research shows that Pelvic Physiotherapy is highly effective in managing chronic pelvic pain and endometriosis, and recommends it as a first-line treatment option for women.
Common areas we help women with include:
Managing painful periods
Reducing painful sex
Reducing painful penetration
Reducing vulvar pain
Improving sexual function and orgasm
Help you start or return to exercise
Reduce pain during and around endo-flares
We can help walk you through understanding your specific symptoms and help identify what factors might be contributing to them. We will also make sure you understand what treatment options might be best for your particular situation.
Some of the ways we do this:
Pain education
Desensitisation of vulvar pain
Pelvic relaxation techniques
Pelvic floor muscle downtraining
Internal muscle release
Hands-on external physiotherapy (muscle release, dry needling, cupping, joint mobilisation, stretching)
Dilator Therapy
Vibrator Therapy
Pelvic Wand Therapy
Exercise
Clinical Pilates
Each woman’s treatment plan and journey is different, so booking an appointment or having a chat with a pelvic physiotherapist about your particular goals is essential in figuring out what is best for you.
Will exercise make my pain worse?
We are asked this so often, and the answer is no it won’t! But balance and pacing yourself is key.
A slow and gentle approach to exercising is best to minimise potential flare ups. Once we find your initial exercise tolerance, we can form a plan to get you back to your desired exercise type.
Currently, we have research to show a lot of endometriosis, chronic pelvic pain symptoms and even menstrual flow as well as pain can be improved with exercise. Particularly, light cardio, pilates and yoga have the most research behind them (there are more studies looking into the benefits of strength and resistance training, so watch this space!)
Come See Us!
All of our physios are experienced and passionate about treating pelvic pain. You can read more about our clinicians here, because finding the right person for you and your healthcare team is always important.
If there’s any specific questions you have before your appointment, you can always speak to one of our amazing admin team. Bookings can be made over the phone or online here.
We can’t wait to start working with you! 🩷
Useful Links
Endozone
Evidence-based platform for information and advice for people affected by endometriosis. A collaborative project created by health professionals, the Australian Government and women affected by endometriosis.
Endometriosis and Pelvic Pain Clinic
Located on the Gold Coast, Medical Super Clinic Benowa is one of 22 new clinics to open nationally under the federal government-funded initiative to provide better support to women affected by endometriosis and chronic pelvic pain.
EPPICS Program
EPPICS is a public-system initiative which utilises an interdisciplinary approach to treatment of pelvic pain and endometriosis. Your GP (or GCUH/Robina Hospital Specialist) can organise a referral for you to be assessed and managed by a range of medical specialists, allied health professionals (including pelvic physios, dietitians and psychologists) and nursing staff. This team can then organise a plan to provide care tailored to your individual symptoms, experiences and goals.
EPPICS also offers educational sessions to help understand symptoms, develop self-care and self-management skills.
References
Starzec-Proserpio, M., Frawley, H., Bø, K., & Morin, M. (2024). Effectiveness of non-pharmacological conservative therapies for chronic pelvic pain in women: a systematic review and meta-analysis. American Journal of Obstetrics and Gynecology. https://doi.org/10.1016/j.ajog.2024.08.006