You’ve Been Diagnosed with Endometriosis…Now What?
Now that you’ve gotten a definitive diagnosis, you’ll likely want to get started with treatment. While there is no definitive cure for endometriosis, there are many treatment options that can help reduce pain and improve function. In most cases, treatment will need to be multi-disciplinary and will likely include a combination of medication, pelvic PT, and surgery.
While the use of estrogen blocking medications or oral birth control have long been recommended, it is now thought that the use of these medications only reduces symptoms and does not actually address the causative factors of endometriosis. In many cases, surgical treatments are often a more substantial treatment option.
Common Surgical Treatments
According to an article written by Dr. Sinervo of The Center for Endometriosis Care, there are two common types of conservative surgical treatment for endometriosis. The first type are ablative procedures where the extra-uterine endometrial cells are cauterized, laser vaporized, or removed with a harmonic scalpel. While these are the most commonly performed types of surgeries by gynecologists treating endo, Dr. Sinervo states that these procedures do not treat the root cause and have a high recurrence rate. He stated that ablative procedures can also lead to scar tissue and damage to the adjacent tissue.
The second procedure he discusses is an excision of the extra-uterine endometrial cells with surgical scissors and a CO2 laser. Dr. Sinervo notes that this procedure allows surgeons to be more precise and thorough with the removal of the endometrial cells, while minimizing damage to the surrounding tissue. This procedure also has a much lower recurrence rate than that of ablation procedures. In more severe cases, and for women not wanting to conceive, hysterectomy may be recommended. However, this is an aggressive approach and does not eliminate the disease. Many times, women who have this procedure done will continue to have pelvic pain.
Pelvic Floor Physical Therapy Can Help
As chronic pelvic pain is a common part of endometriosis, many patients may also be referred to pelvic PT. While pelvic PT cannot affect the disease process itself, it can help improve function and reduce pain with urinary, bowel, and sexual function. Some of the ways in which pelvic PT can help reduce pain and improve function include:
- Examination of the connective tissues of the lower abdomen, glutes, and inner thighs to determine if there is tissue restriction.
- Internal pelvic exam to determine if the patient has proper motor control, muscle strength, and mobility of the pelvic floor muscles.
- Myofascial release to external tissues that may cause pain and limited function.
- Internal trigger point release to the pelvic floor muscles that may be affecting urinary, bowel, or sexual function.
- Education of proper pooping mechanics and urinary habits to reduce strain on the pelvic floor.
- Dry needling for pain control and improved myofascial mobility.
Although there is no cure for endometriosis, there is hope for improved function and reduced pain. Treatment should be patient specific, and take into account each patient’s individual symptoms and goals. Many times this includes a multidisciplinary approach, and each clinician involved should be included in the discussion of the care plan. If you think you may have endometriosis, I encourage you to speak with your physician. Typically, your OB/GYN will be the first person you should speak with. However, diagnosis and treatment may need to involve an endocrine specialist, gastroenterologist, and/or excision specialist.
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