Different treatments can support you to manage the symptoms of endometriosis. One of those treatments is pelvic physiotherapy. In this blog we speak to pelvic health physiotherapist, Georgia Clarkson from The Pelvic Health Clinic about what you can expect from your assessment and treatment plan, including the best exercises for helping cramps and sitting at your desk.
Why is pelvic physio so important, especially to those with endo?
Research has shown that people with endometriosis also develop tension in the lower abdomen, hips and pelvic floor muscles. This can further contribute to pain and tension throughout the body. Increased pelvic floor muscle tension can lead to pelvic pain, bladder or bowel problems, difficulties with sex, and reduced ability to exercise. Physiotherapy management includes a range of treatment options including – bladder or bowel habit retraining, pelvic floor and abdominal muscle retraining. Pelvic health physiotherapists also look at you as a whole person, which involves understanding your nervous system and how sensitive it is. A sensitive nervous system increases our pain sensitivity. Therefore, a pelvic health management program will also include identifying the key factors linked to your symptoms, pain education, coaching you in body relaxation, breathing techniques, relaxed fearless movement, graded activity and sleep rehabilitation. A long-term plan is the key to managing your pain!
Would you recommend getting a pelvic floor assessment?
Understanding your pelvic floor function can help to further understand your endometriosis symptoms. The pelvic floor muscles are a sling of muscles that extend from the pubic bone at the front to the tail bone at the back. In people with endometriosis, these muscles have difficulty relaxing, resulting in increased tension. Like elsewhere in the body, (think about those shoulders), increased tension often results in pain and dysfunction. Learning to relax your pelvic floor muscles can improve your symptoms. Our assessment includes asking questions about your bladder and bowel function, sexual function, lifestyle factors including stress, exercise and sleep. We then complete a physical assessment which will include a pelvic floor assessment. We offer different ways of assessing this – both external and internal. We also assess the outer pelvic muscles, such as hips and abdominal muscles to understand pelvic support and function.
Is physiotherapy still beneficial to those who aren’t comfortable with internal work?
Absolutely! We have the option of using the Real Time Ultrasound machine, which provides a non-invasive visual feedback of pelvic floor muscle function. A probe is placed over the lower abdomen and this gives an image of the bladder. The pelvic floor lies under the bladder and this way we can see a lift and relax of the bladder on pelvic floor contraction. This makes it a great option for those who don’t feel comfortable with any internal vaginal examinations. Pelvic floor physiotherapy is also more than just hands on treatment. We talk a lot about pain education and setting you up with strategies to self-manage your pain, so we encourage everyone to see a pelvic floor physiotherapist remember it is always your choice to have an external or internal assessment, your physiotherapist will discuss this with you and allow you to decide.
How long do I have to see a physio to notice a difference?
Generally, we would like to see a change in symptoms in the first 3-6 sessions. If we haven’t, we would be reflecting to see if any important information has been missed from the assessment, which may be causing a barrier to improvement. It is also important to remember there is not set timeframe to recovery. This is because every person is different, everybody is different, every story is different, and this means the level of nervous system sensitivity is also different. So consequently, everyone’s journey of management is also different. That is why it is so important to have a pelvic health physiotherapist on your team to help support you as you navigate your endometriosis symptoms.
Once initial treatment and completion of treatment, how often should we ‘check in’ with a physio to see if we may need treatment again?
This is very individual, and a plan needs to be discussed with your pelvic health physiotherapist. Generally, we find checking in regularly at the start of treatment is useful as it helps you to build confidence in strategies to manage your pain more independently. Appointments then becomes less frequent as you become more confident in managing your pain. It is useful to remember flare ups of symptoms are common and normal part of life. They teach us a lot about our pain and what may drive and influence our pain. A flare up may mean you reach out to physiotherapy for some more regular support for a short period, to get you back on track. Our aim with physiotherapy is to support you in a having a long term self-management plan for your health!
How do you work collaboratively with our other doctors? (E.g. Endo Specialist)
This is a very big part of our role as a pelvic health physiotherapist. We write letters or emails to gynaecologist, pain specialist, GPs – anyone in your care team to ensure everyone is on the same page and working towards your goals. We also stay up to date with the research around endometriosis and pelvic pain – which often includes professional development with different health professionals so we can provide the optimal support to our clients. Part of our role is also to see you as a whole person – not just your pelvis. Therefore, we also consider other health professionals who might be useful members of your healthcare team – psychologists, dietician, naturopaths, and link you in with these professionals.
What exercises are best for cramps?
Everyone is different in what type of exercises suit them best, but bodies love movement! Research has shown significant benefit for movement and exercise is in the management of chronic pain conditions such as endometriosis. As physios, we love to move and help those around us to feel confident and comfortable moving too. Exercise can look different for all people and just like trying on shoes, we have to find the right type, size, and fit for you. We want to help you slowly increase your exercise capacity, whilst monitoring any changes in your pain. We find things like walking, swimming and yoga can generally be good for most women living with endometriosis. We tend to find abdominal, or ‘core’ based exercises can often be the most aggravating exercise for pain, as tension in the abdominals can increase tension in the pelvic floor. This is the beauty of working with a pelvic health physiotherapist – we explore exercise options with each client individually to find the best type for each person.
Are there any exercises we can do whilst sitting at our desks?
Yes! We often suggest working in exercises throughout the day. An easy one to do is diaphragmatic or belly breathing. Focus on lengthening your breath down to your abdomen and pelvis. This encourages relaxation of your pelvic floor and diaphragm, but also calms your nervous system which directly impacts pain sensitivity. Pelvic floor contract and relax exercises can also be helpful and simple to do when at work without anyone knowing. These exercises help to get blood flow into the muscles and encourages them to completely relax when performed correctly. A pelvic floor physiotherapist can take you through an individualised program to ensure you are contracting and relaxing correctly.
Important note:
People with chronic disease like endometriosis may be able to access five sessions of physiotherapy with a Medicare rebate. Speak to your GP who can set you up with a chronic disease management plan.