First things first: it’s important to understand what endometriosis is before discussing how to prepare for surgery.
Endometriosis is when inflammatory tissue similar to the lining of the uterus grows outside of the uterus. It can grow anywhere in the body, however, most commonly around the abdominal and pelvic area, surrounding the bowels, bladder, and the pelvic floor. The tissue releases inflammatory compounds that can cause pain.
The most well-known symptom of endometriosis is dysmenorrhea, also known as painful periods. Women with endometriosis may also have abdominal pain and distention or bloating, pain during and/or after sexual intercourse, painful urination or bowel movements, bleeding between periods, urinary urgency and frequency, and severe fatigue or low energy. In addition to these symptoms, patients may also have digestive issues, such as constipation, diarrhea, or a cyclical pattern of both. At times this pain is so debilitating that women may miss work, school or cannot participate in daily activities. However, the severity and symptoms vary from patient to patient.
The definitive treatment for endometriosis is surgery, usually laparoscopically, by an experienced endometriosis excision specialist. However, there are some things you can do prior to surgery that can help promote an optimal recovery post-operatively. But first you will want to understand how endometriosis impacts the nerves and muscles of your pelvic floor.
Endometriosis affects the muscles and nerves of the body, particularly those of the pelvic floor. Endometriosis tissue releases inflammatory markers, which can cause pain.
Pain can cause the muscles of the pelvic floor, back, abdomen and hips to become hypertonic. In other words, the muscles respond to pain by becoming spastic.
Additionally, spastic muscles may compress nearby nerves, which then causes nerve irritation and inflammation. Endometriosis is inflammatory, progressive and can invade the space in and around nerves, which in turn, causes the nerves to become inflamed.
Initially, the pain may only be present during menstruation, however, over time the pain can become constant.
Chronic pain can lead to compensatory patterns of the muscles, which can lead to functional misalignments, asymmetry and poor body mechanics. Osteopaths call this somatic dysfunction.
A multimodal approach is preferred as a combination of means of treatment works best in treating chronic pain. This comprehensive treatment plan may include pelvic nerve and muscle treatments, also called ultrasound guided pelvic peripheral nerve blocks and trigger point injections, medications, lifestyle changes and physical therapy.
Unlike temporary band-aids that give short-term relief, trigger point injections and peripheral nerve blocks provide a restorative approach to create an optimal environment for the nerves and muscles to “heal.”
Medications, such as muscle relaxers and nerve pain medications may also provide relief. Muscle relaxers in suppository form are preferred over oral muscle relaxers as suppositories provide more localized relief and have less systemic side effects. In addition to suppositories, oral medications help with central sensitization.
Central sensitization is when the central nervous system is upregulated due to membrane excitability in chronic pain syndromes. In other words, central sensitization causes an altered pain processing that leads to magnification of pain. Oral central nervous system neuromodulating medications, even for a short term of 3 months, help to down-regulate the central nervous system. Meditation and movement meditation, like yoga, can also calm the central nervous system.
Another crucial component of this multimodal treatment is pelvic floor physical therapy. A licensed pelvic therapist with additional training in the pelvic floor should evaluate you. The pelvic therapist will perform manual work to relieve spastic muscles, provide nerve desensitization techniques, and teach exercises to help relax spastic muscles as well as strengthen weak muscles. Pelvic floor physical therapy often includes internal work, vaginally or rectally.
Lastly, lifestyle modifications may aid in the relief of symptoms. Hippocrates said, “Let food be thy medicine, and let medicine be thy food.” Since endometriosis is an inflammatory condition, an anti-inflammatory diet will help minimize inflammation in the body, and thereby, reduce overall pain. Avoiding inflammatory foods may also help resolve diarrhea. Additionally, eating fiber in the form of whole foods and adequate hydration aids in constipation.