Women don’t always open up about the full extent of the effect of their endometriosis during our first session. Once I get to know a woman and she feels more comfortable often a bit more will start to come out and the full impact of her pain, her search for answers and her ultimate diagnosis of endometriosis starts to become evident.
Endometriosis can be (but is not always) a crippling concern of pain, worry and burden for women. A condition in which the lining of the uterus grows on and around other organs in the body often causing significant pain, especially around menstruation and often having an impact on bladder, bowel and sexual function. Not to mention all the flow on effects from this. In a systematic review of the research around women’s experience of endometriosis https://srh.bmj.com/content/41/3/225 there were a staggering number of areas women felt the effects of their condition. To mention but a few these things included lack of support from their healthcare provider, family and friends; difficulty complying with their prescribed healthcare regime; sick days; problems with fatigue, nausea and diarrhoea; side effects of medication; infertility concerns and the list goes on.
Patients admit to me ‘I’m late handing in all my assignments to uni because I can’t manage the workload’, ‘looking after the kids is really hard sometimes’ or ‘my relationship is struggling because sex hurts and I don’t have any drive any longer’. The amount of women’s stories I hold in my mind are really adding up and I want to be doing more in helping women get the help they need. My opinion is that the best help comes from a good collaborative multi-disciplinary team. This should involve a team with knowledge and interest in treating the condition including a women’s health GP, a gynaecologist, a physiotherapist , a dietitian and any other complementary therapy or other allied health personnel that provide benefit to the patient.
I’m a women’s health physiotherapist and my role in caring for a woman with endometriosis is to work holistically in assessing the whole person and what do they need but generally in my role I am assessing their pelvic floor; bladder and bowel health; sexual function; pain education and management; and exercise. The issues that I’m treating vary significantly person to person so there is no cookie cutter approach to any one woman as her experience of endometriosis will be very different to the next.
Some basic tools of the trade when dealing with a woman with this condition are to start with the basics by:
- Encouraging women to eat well and if needed referring to a dietitian
- Encouraging women to drink well- ensuring that they are drinking enough to be hydrated but not so much their bladders are bursting as well as avoiding caffeine, sugary drinks and those with artificial sweeteners
- Encouraging women to move well. Really helping them to understand what their body is capable of despite their condition. Perhaps they need a new approach, a bit of encouragement, some pain management strategies or even just some reassurance that they’re on the right track. Perhaps they push too hard and need to do things more gently or vice versa.
- And finally encouraging women to think well. Pain can be all consuming and stop you from doing things. We need to ensure that these women have mental strategies to help them cope with their condition. Such techniques as body scanning, belly breathing, mindfulness or getting out in nature can help quiet down the central nervous system. If women are stressed and running on empty then they are fuelling an adrenaline/cortisol cycle which tends to have the effect of amping pain up. Ensuring women are aware of the effects of a stressed system via some good pain education and support in learning these techniques can be very meaningful in managing pain without medication or on reduced regimes.
The gold standard diagnostic tool for endometriosis is a laparoscopic exploratory surgery and then excision or removal of the endometrial tissue if it is found within the abdominal/pelvic cavity. This process of having surgery and the stress and cost can be a significant burden on a woman affecting her ability to perform her activities of daily living and exercise. A good women’s health physiotherapist should be able to support patients both before and after surgery in ensuring that they are doing all the right things to support their already stressed bodies through another stressful time. Basically I am here to help at any age or stage that a woman is experiencing pain or problems associated with her endometriosis.
Some local healthcare professionals and myself who have an interest in endometriosis are putting on an event for local women to come and learn a bit more about endometriosis up here in tropical, stormy, rainy Cairns for any local readers. Details below.
Some useful links and resources if you or a loved one have endometriosis and need some more information are:
Amy Lamb Physiotherapy 