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Endometriosis is a chronic, hormone-dependent, systemic inflammatory disease characterized by the presence of endometrial like tissue outside of the uterine cavity. It is typically associated with pelvic pain and infertility.
We know that patients with endometriosis often suffer for many years and see multiple physicians and medical providers before receiving a diagnosis. In patients aged 18- 45, the average delay in diagnosis is 6.7 years. This may be secondary to the fact that endometriosis is a diagnosis of exclusion.
The gold standard for the diagnosis of endometriosis has been visual inspection by laparoscopy, preferably with histological confirmation. Because there is lack of a noninvasive test for endometriosis, there is often a significant delay in diagnosis of this disease.
The most common location for extragenital endometriosis is the bowel. Common gastrointestinal symptoms for endometriosis patients are:
In addition, some endometriosis patients complain about blood in their stool around their menstrual cycle.
Take PRM’s Endometriosis Symptoms Quiz to learn more
about your symptoms and what we can do to help.
Currently there is no definitive cure for endometriosis however, therapy has three main objectives:
(1) to reduce pain
(2) to increase the possibility of pregnancy
(3) to delay recurrence for as long as possible
Hormonal Treatment Options
One example of a hormonal treatment option is Elagolix (Orilissa). Elagolix is an oral, nonpeptide, gonadotropin-releasing hormone (GnRH) antagonist used to treat moderate to severe pain related to endometriosis. Inhibition of GnRH leads to estrogen suppression and subsequent dose-dependent inhibition of endometriotic proliferation.
Surgical Treatment Options
Surgical resection can be accomplished through therapeutic laparoscopic techniques using scissors, electrosurgical instruments, lasers, suture, and staplers.
At PRM, we propose a non-operative neuromusculoskeletal approach in addition to the hormonal and surgical combination, to help reduce pelvic pain symptoms associated with endometriosis.
Endometriosis can cause gastrointestinal symptoms via several mechanisms:
Endometriosis can directly innervate pelvic nerves, particularly the pudendal nerve. This contributes to pudendal neuralgia symptoms of anorectal pain and pain with bowel movements. Innervation of the pudendal nerve also contributes to increased bowel frequency.
Endometriosis can also directly invade the bowel itself, contributing to bowel symptoms of constipation and pain with bowel movement. The presence of endometriosis in the pelvis can cause a secondary chronic guarding of pelvic floor musculature.
This chronic guarding state leads to nonrelaxing pelvic floor dysfunction and myofascial trigger points (MTrPs). A nonrelaxing pelvic floor, will cause symptoms:
The pelvic floor muscles in nonrelaxing pelvic floor dysfunction are short, spastic, weaker, and poorly coordinated. This leads to dyssynergic defecation, which occurs when the nerves and muscles within the pelvic floor do not function well enough to properly have a bowel movement.
Our protocol aims to simultaneously reverse the pelvic floor myofascial pain and dysfunction, peripheral sensitization, and central sensitization that exists in endometriosis patients.
Our approach works in three ways:
In treating endometriosis patients, we believe it is important to look at the integration of the organ systems, with the peripheral and central nervous system, muscles, and fascia. As there is no “silver bullet” or known cure for endometriosis, a multimodal, interdisciplinary medicosurgical approach to a complex multi-faceted disease process may help endometriosis patients not only decrease pain but also improve function. Patient’s endometriosis symptoms can be explained and treated with safe, effective, non-opioid therapies.
A Note to Providers
We encourage gastrointestinal physicians who see women with persistent gastrointestinal symptoms despite a negative work up and appropriate medical treatment to consider endometriosis in their differential. We propose a functional, restorative approach to ameliorate the pelvic pain symptoms associated with endometriosis. Targeting peripheral mechanisms in endometriosis-associated inflammatory pain may lead to improved treatment.