What is endometriosis?

  • Endometriosis is a progressive and chronic condition that affects approximately 10% of women of reproductive age.
  • It specifically refers to when the endometrium (the tissue that normally lines the inside of the uterus) is found growing outside of the uterus.
  • Endometrial tissue has been found in many parts of the body including the bladder, bowels, vaginal wall and pelvic floor muscles.

What is adenomyosis?

  • Adenomyosis is where cells that are like those that line the uterus grow in the layer of muscle in the uterine wall.
  • Around 1 in 5 women have adenomyosis and this condition is often associated with endometriosis.
  • Adenomyosis needs the female sex hormone oestrogen to For this reason, it mainly occurs in women aged between 30-50 years.

Signs and symptoms

  • Pain

    • Pain immediately before or during a period (called dysmenorrhea)
    • Pain during or around ovulation
    • Pain during or after sex (called dyspareunia)
    • Abdominal, lower back and/or pelvic pain
    • Vaginal discomfort due to pelvic floor muscle spasm or tightening
  • Bleeding

    • Heavy bleeding or irregular bleeding
    • Bleeding longer than normal or before a period is due
  • Bladder and bowel problems

    • Increased urinary frequency, difficultly emptying your bladder, pain when emptying (called dysuria)
    • Diarrhoea and
    • Pain
  • Bloating

  • Fatigue

  • Mood changes

    • Anxiety and depression due to ongoing pain
  • Reduced quality of life

    • Needing to take days off work, study or school

How can physiotherapy help?

  • Treatment to manage endometriosis and adenomyosis is usually provided by a team consisting of your gynaecologist, physiotherapist and sometimes a dietician or
  • Physiotherapy treatments usually address two main concerns associated with endometriosis – managing your pain and managing symptoms of worsening muscle dysfunction leading to bladder, bowel and sexual dysfunction.

What the evidence says

  • TENS machine
  • Retraining of the pelvic floor muscles and nerves
  • Lubricant and vaginal moisturisers
  • Relaxation strategies and down regulation of the central nervous system drivers
  • If indicated, manual techniques to desensitize the nerves and muscles of the pelvic floor which can include self-massage, pelvic trainers and/or wands
  • A musculoskeletal assessment of your posture, breathing, thorax, abdomen and pelvis
  • Bladder and bowel retraining
  • Low to moderate exercise can help manage your symptoms by;
    • Reducing and managing pain by reducing muscle tension
    • Increase blood flow to the uterus which can reduce cramping pain
    • Exercise induced endorphins help balance and lower excess oestrogen
    • Increase the bodies anti-inflammatory and anti-oxidant markers