Menu
“Pelvic pain and abnormal pelvic floor muscle (PFM) tension frequently are present in individuals with endometriosis and often persist even after surgical excision of the endometriosis lesions” (Hunt, 2019).
Links:
Studies:
“Given that endometriosis is a disease in which hormonally dependent, inflammatory, ectopic endometrial lesions engage the reproductive, endocrine, vascular, musculoskeletal, and neuronal systems, there are several factors that may contribute to CPP….Since a myofascial source may contribute to endometriosis-associated CPP even after hormonal and surgical treatment has been undertaken, a growing number of practitioners are exploring pain management methods that directly address myofascial pain.”
“Acute or chronic pelvic pain is often due to musculoskeletal disorders, which may go unrecognized during a traditional pelvic examination. Proper evaluation facilitates the diagnosis of spasm or trigger points, and physical therapy often achieves a major improvement in quality of life for these women. Pelvic floor musculoskeletal disorders are common in women and too often go unrecognized during the evaluation of pelvic pain syndromes. Although well described in the literature, these disorders cause diverse symptoms that may be missed by a traditional examination of the cervix, uterus, and adnexa. Screening the inferolateral pelvic floor musculature during a routine pelvic examination is very useful for identifying spasm and trigger points contributing to, or resulting from, a patient’s pelvic pain. A brief palpation of the posterior and lateral pelvis to identify spasm in the levator ani (pubococcygeus, iliococcygeus, and puborectalis) often identifies components of pelvic pain that may be dramatically improved by physical therapy and other interventions.”
“Unlike in pelvic floor disorders caused by relaxed muscles (eg, pelvic organ prolapse or urinary incontinence, both of which often are identified readily), women affected by nonrelaxing pelvic floor dysfunction may present with a broad range of nonspecific symptoms. These may include pain and problems with defecation, urination, and sexual function, which require relaxation and coordination of pelvic floor muscles and urinary and anal sphincters. These symptoms may adversely affect quality of life.”
“In women with Stage I/II or Stage III/IV endometriosis, severity of deep dyspareunia was strongly associated with bladder/pelvic floor tenderness and painful bladder syndrome, independent of endometriosis-specific factors, which suggests the role of myofascial or sensitization pain mechanisms in some women with deep dyspareunia.”
“Pelvic floor physical therapy (PT) is often helpful for women with abdominal myofascial pain or with pelvic floor pain. This type of PT aims to release the tightness in these muscles by manually “releasing” the tightness; treatment is directed to the muscles in the abdomen, vagina, hips, thighs, and lower back. Physical therapists who perform this type of PT must be specially trained.”
Reference
Hunt, J. B. (2019). Pelvic Physical Therapy for Chronic Pain and Dysfunction Following Laparoscopic Excision of Endometriosis: Case Report. Internet Journal of Allied Health Sciences and Practice, 17(3), 10. Retrieved from https://nsuworks.nova.edu/cgi/viewcontent.cgi?article=1684&context=ijahsp