Pelvic Floor Mythbusters: Endometriosis Edition

Fiona McMahon PT, DPT and Amy Stein PT, DPT Featuring excerpts from Beating Endo by Iris Kerin Orbuch, MD and Amy Stein D.P.T. Welcome back to our Pelvic Floor Mythbusters series! We have explored the effects of prolonged sitting and pee holding and now it’s time to move on to endometriosis. With endo, there are so many different myths, concepts, and sorta truths, that we figured we would address them lightning round style so we can cover as much ground as possible. Endometriosis (endo) comes with a lot of misconceptions and because of this, the time from symptom onset to official diagnosis and treatment is long. The diagnosis of endo can often take in excess of a full decade to get, which delays further intervention and prolongs suffering. It’s a huge deal and is the reason why Dr. Amy Stein, PT, DPT and Dr. Iris Orbuch, MD. set to the task of writing a book where they bust endo myths right, left, and sideways. Beating Endo goes into much more detail than we do here. If you wish to purchase it, you may here So without further adieu, here is a list of myths and truths taken from Beating Endo:! Common Endo Myths The abdominal and pelvic floor muscles are rarely affected by endometriosis. False: Constipation, frequent urination or retention, Pain with vaginal penetration from endometriosis causes tightening of the abdominal and pelvic floor muscles; So too does assuming the fetal position which is our go to pose when we are in pain. Both contribute to tight abdominal and pelvic floor muscles which causes pain. The pelvic floor and abdominal muscles do not cause bladder, bowel, sexual dysfunction or abdominal-pelvic pain in patients with endometriosis. False: Tight pelvic floor muscles caused by years of straining or reflexive tightening due to pain, often cause a severe amount of pain which results in further tightening and shortening of the pelvic floor muscles. Good news is that pelvic floor physical therapy benefits most people who have been experiencing abdomino-pelvic or sexual pain and/or are straining due to ongoing bladder and bowel symptoms. Hysterectomy is a cure for endometriosis. False: Hysterectomy is neither a treatment nor a cure. By definition endometriosis consists of cells similar to those in the lining of the uterus but found outside the uterus. Only surgical ‘excision’ removes endometriosis cells. Medical menopause is a cure for endometriosis. False: Explanation: Just because your medicines give you hot flashes doesn’t mean your endometriosis is going away. The best treatment approach is to meet with an Endo specialist to discuss options, and in most cases PT management. As well surgical excision has much better results than ablation of Endometriosis. There is no correlation between quantity of endometriosis and severity of disease.

Truth: Even if you have a minimal amount of endometriosis, you can be in debilitating pain with lots of symptoms and in most cases dietary changes, physical therapy and mindfulness practices can help manage a lot of your symptoms. Teenagers are too young to have endometriosis. False: Teenagers can have endometriosis and their endometriosis can cause debilitating symptoms. Pregnancy is a cure for endometriosis. False: Just plain no. Pregnancy does not cure endometriosis. Ablation surgery is the same as excision surgery. False: Not even close. Excision surgery is the proper treatment for endometriosis. Ablation surgery, burns the surface of the endometriosis lesion but leaves the bulk of endometrial implants behind. Surprising Endo Facts: Fact: Physical therapy (pelvic PT) can help many suffering from the many pains and symptoms of Endo, including back, abdominal and pelvic pain, bladder, bowel and sexual function. Fact: The majority of patients with Endometriosis require pelvic floor physical therapy. Pelvic floor PT can be instrumental in the healing process and can help abdominal-pelvic pain, bladder and bowel urgency, frequency, retention, incomplete emptying, and any sexual pain related to the musculoskeletal system. Truth: Painful bowel movements, constipation, diarrhea and bloating are symptoms of endometriosis as well as symptoms of pelvic floor dysfunction . Truth: Painful sex is a symptom of endometriosis as well as a symptom of pelvic floor dysfunction. Truth: 40 to 50% of women with unexplained infertility is caused by Endometriosis. Truth: Teens with endometriosis often have acyclic pain, that is, pain at other times of the month rather than only during their period, in addition to cyclic pain. Truth: Back pain is a symptom of endometriosis. Truth: If your ultrasound is normal you can still have endometriosis. Truth: roughly 10% of women have endometriosis. That’s close to 200 million women worldwide. Endometriosis is much more than just bad period pain. 1 in 4 women have pelvic floor dysfunction. Truth: Endometriosis commonly affects the musculoskeletal system, and in many cases can be a primary contributor to one’s pain and symptoms..