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Women’s Health: Pelvic Pain.



One of the common causes of Pelvic Pain: Endometriosis


Endometriosis is defined as the presence of tissue similar to the lining of the uterus (endometrial glands or stroma) outside the uterus. The tissue just belongs in the uterus. It is commonly seen in women of childbearing age. It affects 176 million women worldwide.


The area where the lesions are located is very variable, however, they are most often in the pelvis. We can differentiate :



Genital endometriosis :

● Extraperitoneal - affecting cervix, vagina, rectovaginal septum, vulva, and perineum (episiotomy scar)

● Intraperitoneal - affecting ovaries, uterine tubes, uterosacral ligaments, and rectouterine or vesicouterine pouches


Extragenital endometriosis :

● Affects the digestive system (rectum, sigmoid, appendix, loops of the small intestine) and/or urinary system (bladder, urethra).

● Rarely the tissue is also found in the thoracic cavity ( pleura, lung, diaphragm).


Why is this problematic?


Scar tissue and adhesions develop due to endometriosis which affect the normal slide and glide of the organs and fascia surrounding them. As the organs cannot move freely within the body and its surrounding structures the body has to compensate and move differently around the restricted area. The most common symptom of endometriosis is pelvic pain often exacerbated with periods. For many women, this pain due to its severity can affect their quality of life, sexual pleasure and their ability to bear children. Endometriosis is one of the top three causes of infertility.


Standard Diagnosis and Treatment


The only way to diagnose Endometriosis is through surgical biopsy. Unfortunately, the treatment for moderate to severe Endometriosis is surgery and many cases are treated successfully with laparoscopic excision surgery. Thus, women with suspected Endometriosis have to go through laparoscopic surgery which leads to more scar tissue formation and adhesions in and around the organs, pelvic or abdominal cavity and peritoneum.


Non-invasive Treatment


Manual Therapy:


It is very important for women to understand that surgery is not a fix to their pelvic pain. The scar and adhesions can lead to compensations in the area of surgery or in the surrounding structures even without patients feeling any pain after the procedure but in a few years it may lead to hip or back pain. It is worth investigating manual therapy assessment and treatments to avoid further compensations. The scar tissue and adhesions might not show up in the scans or ultrasound following the laparoscopic procedure for diagnosis or surgery so the surgeons might not find it necessary to refer the patients to a manual therapist after the procedures.


The manual therapist can assess the scar tissues and adhesions caused by the endometrial tissue or post-operative scar tissue and adhesions with their hands. Once the therapist assesses what organs or structures are limited causing the body to compensate because of the scar tissues and adhesions, he/she can manually work on facilitating the mobility in the tissues so that the body can regain free range of movement throughout the system and thus have optimal level of function.





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