Physiotherapy for Endometriosis and Pelvic Pain Sufferers
Persistent pelvic pain can be debilitating for those who experience it, affecting many aspects of their lives. At South Burnett Physiotherapy, we are passionate about helping empower patients to better understand their body and give them tools to manage their pain. Physiotherapy plays a significant role in helping those experiencing pelvic pain, or pain associated with endometriosis or adenomyosis. This blog explores how physio can help and what place it has within the multidisciplinary team in managing pelvic pain.
Why see a pelvic health physiotherapist?
Many people associate pelvic floor therapy with birth and postnatal recovery, but pelvic health physiotherapy can support people through different stages of life and a wide range of conditions. Pelvic health physiotherapy is about more than symptom management. It can help you better understand how your body functions and how everyday habits affect your pelvic health. Sessions may include discussions about education about anatomy, pain education, posture, breathing strategies, pelvic floor muscle training and practical lifestyle advice. A pelvic physiotherapist’s role is to support and guide you in a safe, judgement-free environment.
Physiotherapy for Pelvic Pain
Physiotherapy treatment aims to reduce pelvic pain and tension by helping you better understand your pain, identify contributing factors and develop effective management strategies. This process can help restore confidence in the body and improve overall quality of life.
Over time, persistent pain can lead to increased sensitivity within the nervous system, where everyday stimuli such as movement, stress, noise, light, certain environments and even some foods may trigger or heighten symptoms.
Physiotherapy can assist in addressing myogenic (muscular) pain and dysfunction by improving pelvic floor muscle awareness, coordination, relaxation, strength, tone, and endurance. It is also important to recognise and address the many factors that may contribute to ongoing pelvic pain.
Connecting with your pelvic floor is crucial in helping relax muscles that are holding tension and contributing to pelvic pain. A physiotherapist can teach you how to do this and helps give you tools that equip you to self manage your pain. Our role is to empower you to actively take part in your healing journey, not solely direct and lead it.
Research supports a holistic approach to pelvic pain management, recognising the important interaction between biological, psychological, and social influences. Therefore, an individualised approach to care is essential.
Management Beyond The Pelvis
When managing chronic pelvic pain, we have to look deeper at the contributing factors and look beyond the pelvis.
We must consider:
The nervous system- is it dysregulated and in need of some attention/consideration?
Pelvic floor muscles- are they a source of contraction, pain and tension?
Pain pathways to the brain- is your pain system hypersensitive?
Psychological implications- fear and stress around how pain affects you socially, romantically, economically
Gut microbiome, immune system and systemic inflammation- are these aspects impacting your body’s overall stress and contributing to increased levels of pain?
We have to take a holistic approach to managing persistent pelvic pain, recognising its multifactorial nature. We aim to create a space where we collaboratively create a comprehensive and plan together. We help to facilitate self-management in order for you to access the wisdom of your body and take charge of your journey, merely supporting and guiding you on the way.
Many people experiencing pelvic pain on most days, for longer than 3-6 months will often find themselves in the perpetual cycle of pain
The Persistent Pain Cycle and how to navigate it
Did you know that all pain, no matter what, is produced in the brain? Many people think that pain is produced at the skin or within the affected soft tissue. However, in the world of pain science what we do know if that the primary purpose of pain is to protect us; it tells your body to get moving to get away from potential damage. Pain is defined as a sensory and emotional experience and therefore, how someone reacts in a sensory sense depends on the individual and the situation. An individual’s pain therefore can’t be judged against another person’s pain. If you experience ongoing pain, the good news is you’re not alone.
Pain can lead to avoiding movement and activity, leading to weakness, stiffness and tiredness, which lead to increased discomfort, sleeplessness and mental health challenges, all of which then in turn add to the pain experience.
The rollercoaster of emotions and feelings of not being understood, not having answers and not making progress are all normal. A key component to making progress and regaining control over the downward spiral of pain is to understand what you can do to manage it.
The importance of safety
The good news is, with increased activity and increased confidence, people can experience less pain, which in turn, leads to further positive changes. Evidence-based research suggests that working with the nervous system is paramount in managing persistent pain. The autonomic nervous system responds to environmental cues to help keep the body safe. For some individuals experiencing ongoing pain, a perceived potential threat can dysregulate their autonomic nervous system if their nervous system is already in a heightened state. The process of unwinding the nervous system begins with helping our parasympathetic nervous system ‘wind down.’
In physiotherapy, we work on nervous system dysregulation and the body's protective responses, recognising that pain is a messenger that sends information and can be influenced by a variety of different stimuli (environmental, inflammatory for example). Like any other condition, being aware and observing what triggers stimulate the nervous system can do wonders to being able to manage these cues. Looking at the body’s response to normal environmental cues can help explain why some people experience pain more intensely or are more sensitive to pain than others. Finding ways to deal with environmental cures that the body perceives as dangerous therefore can help improve our experience of pain. Working with Polyvagal Theory has been shown to help control pain by alleviating inflammation and modulating neurons involved in pain pathways. Implementing strategies and tools to help your body and nervous system feel safe and know how to recognise safety is a key element in helping manage ongoing pain. If the body and nervous system can’t recognise safety, it will continue to be ‘on alert;’ always looking for potential danger. The body needs to recognise safety not only physically, but also cognitively and emotionally.
Final Thoughts
Whilst it can seem overwhelming to speak with a health practitioner about very personal experiences and symptoms, it is important for new patients to understand that you are not alone on your health journey. We practice trauma informed care, which entails that the patient guides treatment sessions and is an active participant, meaning you can adjust or redirect at any time. It’s also worthwhile recognising that nobody needs ‘fixing, we aren’t here to ‘fix’ anything because you’re not ‘broken.’ Your body is giving signals that something is at play and we aim to actively seek to understand and therefore develop a strategy and plan collaboratively, in conjunction with your healthcare team.