Approximately 1 in 10 women are affected by endometriosis , an inflammatory disease that can begin as early as the first period. Endometriosis (endo) is a chronic, inflammatory disease in which tissue similar to the lining of the uterus, called the endometrium, grows outside the uterus. Since those cells are not supposed to be there, this prompts an inflammatory response leading to pain and sometimes the formation of scar tissue or adhesions. Endometriosis can be hard to diagnose as its symptoms often mimic other conditions. On average, it can take 7-10 years and seeing many providers to reach this diagnosis, that can only be confirmed with laparoscopic surgery.

What Does Endo Look Like?
Lesions can appear in different forms from dark spots with blood pigments, red and inflamed, to nodular, cystic-like growths, or white from adhesions that cause organs to stick together.

Symptoms
Endometriosis should be considered if 1 or more of these red flag symptoms occur:

• Chronic pelvic pain (cyclical or non)
• Painful periods affecting ADLs or quality of life
• Cyclical GI symptoms (i.e. painful bowel movements)
• Cyclical urinary symptoms
• Infertility in conjunction with 1+ above

Potential Causes
The exact cause of endometriosis is not fully understood, but several factors may contribute to its development. These potential causes include:

• Retrograde Menstruation: Instead of flowing out of the body, menstrual blood flows backward through the fallopian tubes into the pelvic cavity leading to the implantation of endometrial-like tissue outside the uterus.
• Genetic Factors: If a woman has a close relative (mother or sister) with endo, she may be more likely to develop it herself.
• Environmental Factors Exposure to certain environmental toxins, such as dioxins, may be linked to an increased risk of developing endometriosis.
• Immune Deficiency: Immune system doesn't properly recognize and eliminate endometrial-like tissue growing outside the uterus.

Pelvic Health & Endo
Unlike the cells of the uterus lining which flow out of the body during menstruation, endo cells do not dissipate through a natural exit--rather, they thicken and expand. As they do, these implants affect both the organs they are growing on or adjacent to and the muscles & fascia that underlie the organs.

Bowel “I get so bloated I look five months pregnant...”
Endo implants on or near the GI tract can cause diarrhea, constipation, bloating, painful bowel movements, and abdominal pain. The resultant pulling and tugging on fascia and muscles can prevent the bowel’s normal peristalsis and slow colon motility, causing constipation and bloating that can be painful. In some, these symptoms occur randomly and in others, they occur in sync with the menstrual cycle.

Bladder “It hurts to urinate...” “I pee 15-20x per day...”
It is estimated that 7 out of 10 people with endo have concomitant painful bladder syndrome. Pain often causes people to tense their muscles which can then become a new source of pain and dysfunction. Tight pelvic floor muscles can not only lead to feeling pressure and discomfort, but can also result in urinary retention and difficult voiding as well as urinary urgency, frequency, bladder pain, and sometimes infections.

Sex “It hurts during and sometimes for hours after sex--even for days...”
Sexual dysfunction and pain are common symptoms of endometriosis. The implants, especially near the sex organs, can restrict the natural sliding and gliding of tissues, intensifying pain during sexual activity. This pain can lead to reflexive muscle tightening, further exacerbating discomfort and heightening sensitivity. The nerves irritated by endometriosis send pain signals throughout the pelvic floor which amplifies the sensation of pain during sexual penetration.

Core “I have pain & cramping in my lower abdomen that gets worse during my period.”
Thickening cells pull on underlying muscles, fascia & nerves. This pulling, along with the inflammatory response that endo ignites, causes pain. The body’s natural response to pain is to protect, so your body reflexively tenses muscles at or near the point of pain. Over time, muscle tightening and clenching leave those muscles and fascia tighter, less flexible, less effective at their job of movement and stability, and the surrounding nerves more sensitive. The abdomino-pelvic core is where endo begins, where the cells grow, and where many will first feels its pain.

The Role of Physical Therapy in Endometriosis
Pelvic physical therapy uses a variety of techniques, such as manual therapy, neuromuscular re-education, and targeted exercises, to help treat endometriosis. These techniques aim to ease tension in affected muscles, fascia, nerves, and joints, calming the nervous system, reducing pain sensitivity, and improving overall muscle & organ function.

Manual Techniques
Goal: to downregulate nervous system, relieve pain, reduce muscle tension, scar restrictions, improve mobility of tissues and joints, enhance circulation and lymphatics

• Myofascial Release
• Scar Tissue Mobilization
• Visceral Mobilization
• Joint Mobilization
• Lymphatic Drainage

Neuromuscular Re-education
Goal: improve awareness and coordination of muscles, retraining bladder, bowel, & sexual functions

• Pelvic floor Muscle Coordination (relaxation & awareness)
• Postural Retraining/Correcting Movement Patterns
• Muscle Recruitment & Stabilization
• Neural Desensitization

Therapeutic Exercise
Goal: improve overall health, strength, & endurance, enhance long term benefits achieved by manual and neuromuscular re-education interventions

• 360 Diaphragmatic Breathing
• Pelvic Floor Stretches
• Hip & Spinal mobility
• Strength

Education
Pelvic PTs provide a wide range of education to help patients better understand their condition, manage symptoms, and improve their quality of life.

• Tools: use of dilators and/or pelvic wand for self-internal release of pelvic floor muscles
• Nervous System Downregulation: deep breathing (diaphragmatic breathing), meditation, yoga and gentle stretching
• Lifestyle Modifications: guidance on habit changes, managing stress, nutrition & hydrated, habits to improve bowel, bladder, and sexual health

Favorite Resources
Managing endometriosis can be overwhelming, but there are many resources to support you. From educational materials and practical tools to the interdisciplinary support of healthcare professionals, each resource plays a vital role in helping you manage symptoms and navigate your journey with greater ease and care. It's all about finding the right combination to support your journey - remember, you're not alone, and there's no one-size-fits-all solution.

Tools
Dilators: Gently stretch vaginal tissues to help reduce pain during intercourse, promote muscle relaxation in the pelvic floor, improve tissue elasticity & blood flow, especially if scar tissue or pelvic floor tightness is present
Vaginal Wand: Targets deep tissue in the pelvic floor, helps release muscle tension, reduce trigger points, and alleviate pain in areas affected by endometriosis
Therapy Ball: Gently rolling ball over the pelvic muscles, glutes, back, and surrounding tissues can help reduce tension, increase blood flow & improve flexibility, all of which can alleviate pelvic pain and discomfort associated with endometriosis
Heating Pad: Applying a heating pad to the pelvic, back or abdominal area helps relax muscles and provides relief from cramping and discomfort commonly experienced with endometriosis

Lubricants
When selecting a lubricant, it's important to choose one that is pH-balanced to your vaginal microbiome and has low osmolality to prevent irritation. A good lube can help reduce discomfort during sex by providing moisture and reducing friction, which is especially helpful for individuals with endo who experience pelvic pain or sensitivity.

Our Favorites: Good Clean Love, Uberlube, Slippery Stuff !

Interdisciplinary Support
Endometriosis requires a comprehensive approach to care, which is why interdisciplinary support is so important. From pelvic PTs/OTs & gynecologists to nutritionists and counselors, each professional plays a unique role in managing the condition.

For example:

• Pelvic Physical & Occupational Therapy (PT/OT)
• Nutritionists/Dietitians
• Therapists (Counselors/Psychologists)
• Medical Physicians: Obstetricians/Gynecologists (OB/GYNs), Gastroenterologists, Urologists, Reproductive Endocrinologists
• Massage Therapists
• Acupuncturists

Together, they address the physical, emotional, and nutritional aspects of endometriosis, helping to reduce pain, improve quality of life, and support healing. Collaboration is key!

Remember, you are not alone.
Managing endometriosis can be overwhelming, but there are so many resources available to support you. From educational materials and practical tools to the collaborative care of healthcare professionals, each resource plays an important role in managing symptoms and supporting your journey. It's about finding the right combination that works for you – remember, you’re not alone, and there’s no one-size-fits-all solution.

**Please note**
This overview is not all-inclusive. Endometriosis is a complex condition that can affect different body systems and can present in vastly different ways, even in individuals with the same diagnosis.

If you or someone you know is seeking resources or support, please don't hesitate to reach out.

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