Endometriosis
WHAT IS IT ?
Endometriosis is a chronic disease characterized by the presence of tissue similar to the uterine lining (endometrium) outside the uterus. This tissue can develop in the pelvic region—particularly on the ovaries, peritoneum, bladder, or rectum—and, more rarely, in other parts of the body. This condition also causes inflammation and scar tissue formation in the pelvic area: In the pelvic peritoneum (superficial endometriosis) In the ovaries (endometrioma or endometriotic ovarian cyst) In the rectovaginal septum, bladder, and/or rectum (deep endometriosis) In rare cases, lesions can be found outside the pelvis:
- In the pelvic peritoneum (superficial endometriosis)
- In the ovaries (endometrioma or endometriotic ovarian cyst)
- In the rectovaginal septum, bladder and/or rectum (deep endometriosis)
- In rare cases lesions may be found outside the pelvis.
WHAT CAUSES IT?
Malgré plusieurs théories, les causes de l’endométriose ne sont toujours pas connues. Ce qu’on sait c’est que d’avoir un membre de la famille du premier degré (une mère, une soeur) atteint d’endométriose augmente le risque de développer de l’endométriose à votre tour.
WHAT ARE THE SYMPTOMS?
Inflammation and scar tissue formation often cause acute pain in the pelvis during menstruation, during or after sexual intercourse, or when urinating or defecating.
Quoique la douleur aiguë est le symptôme le plus souvent reconnu, d’autres symptômes peuvent être présents tels que:
- Chronic pelvic pain
- Heavy bleeding during menstruation or at other moments of the cycle
- Difficulty becoming pregnant
- Digestive issues such as bloating and nausea
- Intense fatigue
- Impact on mental health: depression, anxiety
Diagnosis
The diagnostic process for endometriosis can be performed using different methods.
Complete Physical Examination
In this type of examination, your doctor collects information about your medical history, including the progression of your symptoms, details of your menstrual cycle, pregnancies, and the use of hormonal contraceptives. With your consent, an external and internal pelvic exam may be performed. The external exam involves observing the external genitalia for skin signs. The internal exam includes an examination with a speculum and palpation of the uterus, ovaries, and adjacent tissues using a hand placed on the abdomen and two fingers inserted into the vagina. This exam may recreate the pain you are experiencing.
Medical Imaging
Medical imaging is another method used to diagnose endometriosis.
Ultrasound
Ultrasound is a medical examination method that uses ultrasound waves to obtain an image of the area being examined. Two types of ultrasound can be used to diagnose endometriosis: transabdominal ultrasound, which involves placing the transducer on the skin of the pelvis, and transvaginal ultrasound, which involves obtaining images of the pelvic region by inserting the transducer into the vagina.
In Canada, the ultrasound technique used can only detect the presence of growths on the ovaries, but not those that may develop on the pelvic peritoneum (superficial endometriosis) or in the rectovaginal septum and/or rectum (pelvic endometriosis).
A negative ultrasound result does not mean that you do not have endometriosis. Your medical team may insist on the need for other types of imaging to definitively rule out the disease.
Magnetic Resonance Imaging (MRI)
If your doctor suspects the presence of endometriosis and the results of the basic ultrasound are inconclusive, an MRI scan may be performed. Diagnosing endometriosis this way can only be done by a physician with specialized training..
Surgery
Laparoscopic surgery can be used to diagnose endometriosis. During this procedure, small abdominal incisions are made to insert a microscopic camera and surgical instruments, allowing the surgeon to better view endometrial growths. If endometrial growths are identified, it is recommended that they be removed at the same time. Examination of the tissue samples is the only way to establish a diagnosis.
A long process
The average time between the first consultation and diagnosis is 5 years.
Several factors can influence the slow diagnosis:
- Reluctance to share menstrual pain due to fear of judgment and stigma
- When symptoms are shared, they are not taken seriously
- Failure to differentiate between typical and atypical menstruation, resulting in a lack of knowledge about when to seek help
- Condition less well understood by healthcare professionals
- Symptoms similar to other conditions
- A complex diagnostic process that can involve several steps - as described above.
HOW CAN PHYSIO HELP?
Although there is currently no cure, there are options to relieve symptoms, including medications, laparoscopic surgery to remove lesions, tissue buildup, and scar tissue, and also pelvic floor physiotherapy..
Our physiotherapy treatments for endometriosis
Our physiotherapists with expertise in perineal physiotherapy, can help you relieve your symptoms - both those related to endometriosis and those related to other conditions that contribute to your suffering. Using a biopsychosocial approach, our therapists understand and take into account the mental, social, and environmental conditions that can influence a patient's health. Furthermore, our physiotherapists are aware of the impact of trauma and are committed to creating a safe and calm environment conducive to treatment.
Sessions may involve these different components, which will be explained to you at the beginning of the session. You will be able to decide which treatments you accept and consent to receive.
- Pain education
- Breathing exercises and other relaxation techniques to help manage pain and muscle tension
- Manual therapy to help with adhesions, often administered internally through the vagina or anorectally
- Addressing any other concerns related to the pelvic organs, pelvic floor dysfunction, and your sexual health.