Endometriosis is a disease in which tissue that is similar to the lining of the uterus grows outside it, including on surfaces in the abdominal cavity, ovaries, bladder, rectum and abdominal/pelvic walls.

The World Health Organization reports that at least 190 million women and girls of reproductive age worldwide are affected. Endometriosis diagnosis can take years as symptoms can be confused with conditions such as irritable bowel syndrome or pelvic inflammatory disease.

What life with endometriosis feels like

Endometriosis can affect women in varying degrees of severity but exhaustion, a sensation of heaviness in the pelvic area, pain during sex, and particularly painful periods are common. Some discomfort with periods may be normal; pain that stops you from living everyday life is not. There are endometriosis symptoms that are hallmarks of the condition, which may include:

  • Pain around your period (dysmenorrhea)
  • Pain during or after sex (dyspareunia)
  • Pain during or after bowel movements
  • Pain when you urinate (dysuria)
  • Pain in the lower back or legs
  • Having trouble holding on when you have a full bladder or frequent urination
  • Persistent pelvic pain
  • Heavy menstrual blood or irregular bleeding
  • Difficulties with fertility
  • Nausea and/or vomiting

Surprising endometriosis symptoms

You may be aware of the top signs that you have endometriosis, but there are other symptoms that can lead to a misdiagnosis, or the root cause of endometriosis may be missed entirely.

  • Bowel symptoms such as bloating, constipation and diarrhoea, which is why endometriosis is often misdiagnosed as irritable bowel syndrome
  • Shoulder pain that isn’t responding to physiotherapy, osteopathy or chiropractic care, which could be endometriosis affecting the diaphragm
  • Acid reflux – you may be managing this with antacids, but the underlying cause could be endometriosis on the intestinal walls
  • No pain, and infertility. You may have lived with endometriosis for some time and be at an advanced stage with ovarian cysts (endometriomas).

Endometriosis impacts so many aspects of women’s lives, from issues around fertility to intimacy, fatigue and anxiety in correlation to persistent pain. By arming yourself with greater awareness of endometriosis symptoms and endometriosis treatment options, it is possible to live with less pain, enjoy a healthy sex life and support your fertility – there are many endometriosis pregnancy successes.

Is there a cure for endometriosis?

Our women’s health osteopaths take a holistic approach to women’s health. Osteopathy helps manage the symptoms and early diagnosis and management are the key.

Endometriosis diagnosis and treatment

The gold standard for diagnosis is laparoscopic surgery and biopsy. Treatment options include surgical removal of endometriosis lesions and scar tissue (excision), hormone therapy to lower oestrogen or increase progesterone (often through the contraceptive pill or IUD/coil) and pain medication.

When you are in pain it’s common for your muscles to tighten in response. If you’ve been suffering from pain for months — or even years — you may not even realise you are holding your muscles in a tight position.

Your pelvic floor may lose its ability to contract and relax fully — known as an overactive pelvic floor — and can lead to discomfort while the bladder fills, doing a poo, pain in the pelvis, and /or painful sex.

Endometriosis-led inflammation, scar tissue and adhesion formation between organs can also lead to the surrounding structures reducing their mobility. This consequently reduces blood circulation in the tissue and organs, causing tight muscles and trigger points — resulting in pain and movement dysfunction including bladder pain syndrome (interstitial cystitis).

Can osteopathy help with endometriosis?

Osteopathy works to improve pain symptoms, function and quality of life as a result. A recent study found that women suffering from deep infiltrating endometriosis and associated pain during sex, benefited from pelvic floor treatment and displayed significant improvement in pelvic floor relaxation and also chronic pelvic pain.

Our osteopaths have found that many endometriosis patients want so much to be “normal” that they will subject themselves to suffering (perhaps to conform to the heteronormative ideals of penetrative sex) which can be challenging within loving relationships.

They can discuss alternative approaches to self-pleasure and help you reconnect with a part of your body that is usually viewed as a source of pain, leading to feelings of dissociation. Scar tissue and adhesions can make penetrative sex PAINFUL, in addition to which fear, apprehension or just lack of control can make you tense up, aggravating pain symptoms at a moment when you should be experiencing the opposite.

Feeling your muscles relax post-orgasm can give your nervous system input for a different movement strategy, in a very safe way.

How osteopaths treat endometriosis

We provide treatment options such as manual therapy to help with trigger points, stretching and release exercises, hands-on-techniques to help ensure your organs can move naturally as they should, give advice on gentle movements to help release and relax tight fatigued muscles. We can also help you identify hypersensitivity to pain. Together, we work on your goals and a management plan for when flare-ups occur. This could involve:

  • Giving you a better understanding of your body’s structure
  • Education on your body’s natural pain responses, to help you calm your thoughts and re-frame your pain and suffering
  • Provide advice on calming your nervous system, including breathing, mindfulness and body-scanning techniques
  • Advice on exercise and movement strategies
  • Educate and guide you on good bladder and bowel movement habits
  • Advice on techniques, positions and exercises to help sex become less painful and more pleasurable
  • Strategies to optimise pelvic floor function and the use of machines or manual techniques as treatment options
  • Pre and post-surgery – help you prepare for surgery and recover

Our goal is to help you feel like you are in control of your body, with a whole-body approach. There is no one-size-fits-all.

As with most conditions, finding relief takes time and dedication to your programme. Remember that there can be good and bad days and knowing how to manage during these times will go a long way in improving your health and wellbeing.

We extend our thanks to our colleagues at www.embracephysio.sg for their inspirational blog posts