How to reduce the pain of endometriosis with physical therapy?

Endometriosis is a female gynecological disease characterized by an inflammatory condition caused by endometrial-like tissue that migrates out of the uterus. The disease can materialize in several forms: cystic endometriosis, infiltrated endometriosis or adenomyosis. Endometriosis causes pain that is difficult to reduce.

Endometriosis can cause severe pain that can limit schooling or work. This pain is often very poorly controlled by medication. The pain and symptoms resulting from endometriosis are different from one woman to another because each woman has her own endometriosis. However, the pain occurs mainly during menstruation, during ovulation, but also during sexual intercourse: this is called dyspareunia. Another sign that can hide endometriosis is having heavy periods.

The problem with endometriosis is that in addition to causing disabling pain on a daily basis, the diagnosis of this disease is extremely complicated. In fact, the average time taken to diagnose this disease is approximately 7 years. During this time, patients find themselves in a state of total medical uncertainty. Sometimes, the disease is even discovered during operations, because the imaging sometimes does not correspond to the clinical picture.

Even though there is currently no treatment for endometriosis, the pain linked to this pathology can sometimes be relieved by physiotherapy or osteopathy. Indeed, by working on massages, mobilizations and movements, and by listening to the patient's needs, we can help to reduce and learn to manage the pain.

How to reduce pain with physical therapy?

The physiotherapist can act externally but also internally through massages, mobilizations, postural re-education, physiotherapy, respiratory re-education etc...

There are several techniques:

• Abdominal and respiratory work: because of pain, patients tend to block themselves. The objective of abdominal and respiratory physiotherapy is to be able to breathe again, to relax, to manage the pain, to gently stretch the sensitive areas. The physiotherapist can first concentrate on the whole abdomen, then on the diaphragm, and finally do a visceral work on the visceral fascias by listening to the patient and the tissues that relax during the movements. The most important thing is to listen to the patient and her pain, because each endometriosis is different and so is the pain.

• The physiotherapist can help to reduce pain during sexual intercourse (dyspareunia) by learning to relax the perineum, and beyond the perineum, by concentrating on relaxing the muscles of the vagina because endometriosis can create adhesions which, by limiting the mobility of the tissues, make intercourse painful. The goal is to regain tissue mobility.

The idea is to promote adapted physical activity that will be beneficial for the patient both physically and mentally, followed by management of the pain itself: how to manage the pain and relieve it on a daily basis.

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