Pelvic Floor Physical Therapy After Excision: Let's Clean Up The Leftovers

You have endometriosis, you know you are getting surgery.  Great, the surgeon will fix this, it will be gone, obliterated into outer space and then you will feel like a new person! Yay!  Right?  Sorry, nope. 

Surgery to remove endometriosis has come a long way in a short amount of time, it’s really impressive and amazing for people who suffer daily.  But the problem is we cannot ensure that the surgeon gets every single bit of Endo. 

So what can we do?!  Lots of things: diet, stress management, etc . . . and physical therapy.  Let me be clear: pelvic floor physical therapy is NOT going to cure that last bit of endo, but what it will do is help fix the leftover garbage that endometriosis left in its place.  

Chances are you have suffered for years before actually being diagnosed, and then even more time till you have surgery.  Your body is essentially a punching bag trying to take the hits of Endo and guess what?! It is tired, weak, stressed and strained and has developed compensatory mechanisms to function with the pain.  

When treating people with Endo, it is not uncommon to see a lot of hip and back dysfunction go along with it.  

Assuming endometriosis is the first domino of this chain effect.  You can understand how having surgery may fix the initial catalyst, but the train has left the station and the dominoes keep toppling over.  So even stopping the initial catalyst doesn’t fix all your pain!

Things that surgery doesn’t change:

1. Your neuroanatomy/ brains perception of pain

   1. Stay tuned for another in depth blog post about this at a later time, but here is the short version! Pain is a protective mechanism, when you are in pain, a signal is sent to the brain saying pain is in my leg ( for example) ouch ouch, if the signal doesn’t stop being sent (chronic pain), then the brain magnifies it and it becomes more permanent. So even if surgery was done, you may still feel/ perceive pain. You aren’t crazy, it is somewhat in your head, and PT can help!

2. Muscle compensations

   1. This one is an easy one to understand, when we are in pain, we tend not to move a lot and weaken some muscles while others tighten- think of fetal position

3. Postural patterns and behaviors- see #2, sitting slumped, sitting on one heel, sitting cross legged leaning to a side- oh yes girl, I see you!

4. Poor bowel and bladder habits- this is what I call the low hanging fruit, so many men and women I see, not just Endo patients tell me about their habits. Pushing your pee out isn’t helping, getting red in the face while trying to push the poop out is the opposite of what you need to! The sphincters need to open

5. Physical endurance to get through meaningful tasks- this one is tough. You have spent so long not socializing because your pain is so much worse after going out with friends, going to a concert, or you may even be on disability because you can’t sit at work for 8 hours. How do we work towards that? That could be endurance to be able to have the strength to walk for 1 hour or be able to properly sit for 8 hours

So as you can see my friends . . .  surgery is not the last step.  Pelvic floor physical therapy has a place.  At this point you are probably like great- how long will this take? Now what? 

Honestly, for most it’s not that bad!  At 6-8 weeks post surgery (aka cleared by your surgeon) we see if you are still having any pelvic floor symptoms and address them.  Can you all see how these pieces may add to your quality of life?  You do?!  That’s the point my friends :).

You will survive this, endometriosis won’t kill you, but it may kill your spirit and your quality of life,  PT is supposed to help with that-  helping you live a life you want to lead, not the life you feel like you must accept.