Why the Pelvic Floor should not be forgotten in the treatment of Endo

Finding out you have Endometriosis can be a relief, a burden, and often a mix of both. It can be validating that finally you can put a name to the pain and suffering you have experienced. It can be a relief that there is a diagnosis for what you were told was normal for so many years. It can feel like a life sentence, in that, it’s chronic and currently there is no known cure. Lots of questions can circulate in your mind like “will I always feel like this?”, “why did it take so long”, “will I live a normal life?”

Your doctor or gynaecologist is usually the person who helps navigate the medical management of Endo, however, this is not enough. By the time Endo is diagnosed, it has likely been there for many many years, and the result of delayed diagnosis is how the body has adapted and changed how it perceives and responds to pain, and how the body functions. 

Imagine when you have a blister on your foot. You start to change the way you walk to avoid hurting the area of the blister. You might try wearing shoes that avoid that spot. You may decide not to go for long walks as you know it will begin to hurt more and more the longer the blister gets rubbed. After a week or so, you notice the blister has healed and you have to tell yourself that it’s ok to wear closed in shoes again and walk more normally… you may not have realised that the blister had healed until you look and see that it’s ok, as you had made a lot of changes to accommodate the blister and get on with life.

Endo could be seen similarly, in that, it’s there, it has caused changes in that area, and that will mean you change or limit how you use your body. You can’t SEE the Endo, so you can’t be sure where exactly it is. You don’t know what pain is related to Endo, and what pain is related to the changes your body has made to manage with the Endo. Some of these changes are subconscious, like your muscles tightening up to “protect” against the pain. Some changes are more conscious like avoiding exercise during your menstrual period because it seems to make pain worse. 

The problem we face here is that, even when the Endo is excised, the changes our body has made from having it there for so long, are still there. The blister isn’t there but the changes we made to cope with the blister are still there…

As a Pelvic Health Physio, one of the areas I like to highlight as pertinent to Endo symptom management is the treatment of the Pelvic Floor. The pelvic floor muscles are a group of muscles located inside the pelvis. There are a group of superficial muscles which are at the entry to the vagina and just below the skin, and there are deeper muscles on the inside of the pelvis shaped like a trampoline spanning the base of the pelvis.

These muscles are important for bladder, bowel and sexual function. 

Very commonly people with Endometriosis will describe pain or problems with the bladder filling or emptying, abdominal pain, bloating, pain with emptying the bowel, pain with using tampons or having internal examinations or intercourse.

Having Endometriosis can explain some of these symptoms, however, simply removing the Endo doesn’t always make these symptoms go away… Why?

The answer is, because these symptoms may be as a result of tightness or poor co-ordination of the pelvic floor muscles. These muscles do not always “KNOW” that the Endo is gone, and simply keep doing what they have been doing for many years… holding tight and trying to protect against pain.

Clues that your Pelvic Floor muscles might be contributing to your symptoms include

Bladder

• Urinary frequency
• Urinary urgency
• Painful bladder emptying – like a UTI
• Not completely emptying, or a slow flow

Bowel

• Painful emptying
• Constipation or having to strain
• Feeling like you haven’t completely emptied/finished

Sexual function 

• Pain when inserting something in the vagina e.g. tampon, finger, doctor exam, ultrasound probe, penetration
• Pain after intercourse, lingering pain or muscle spasms
• Pain in the labia, clitoris, vulva
• Pain on orgasm or afterwards

It can be tricky to navigate this journey by yourself. I recommend you do the following to find the help you need. 

• Find a team of health professionals who can work together to find what works best for you, and make sure they all have a a special interest and training in managing Endometriosis. This team usually includes a Doctor, Gynaecologist, a Pelvic Health Physiotherapist, a Psychologist, a Dietician, and possible some additional practitioners like a Naturopath, Yoga or Pilates instructor or a Personal trainer - someone who can help you in finding supportive movement and exercise options.
• Connect with other Endo warriors in your local community or online like our Endo Online Community group
• Take the free 5-day Move and Soothe Challenge, or jump straight into our 8 week EVOLVE course, and start to find the strategies that will help you manage your Endo, your way