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BY KIMBERLEE LEISHEAR, DO
Endometriosis – a condition that impacts up to 11% of female patients – is a disease in which cells and tissue similar to the lining of the uterus grow elsewhere in the body. The most common symptom is chronic pelvic pain; however, it can cause a wide range of symptom presentation – and it can affect can affect the hips.
Endometriosis can affect the whole body and can have a widespread area of pain and inflammation.
The underlying inflammatory endometriosis lesions themselves can be found not only in the pelvis but outside the pelvis. When endometriosis lesions are within the pelvis, there is underlying inflammation affecting the pelvic floor muscles, which are a sling of muscles from the pubic bone to the tailbone supporting the pelvic organs.
It is important to note that anything going through the tight muscles is restricted. This means that your blood flow can be restricted in the hip that can cause pain in the muscles and nerves. Nerves can also be restricted. Nerves need space to properly function. If they get cramped and don’t have enough room, they get irritated and can cause pain and can become more sensitive.
When the nerves are more sensitive, what normally does not cause pain now causes pain. What normally causes a little bit of pain now causes a lot of pain. The “volume” essentially has been turned up or amplified. Over time, the brain or central nervous system can become sensitive as well contributing to an increased level of pain as well as a wider area of pain.
You might wonder if your hip – and even groin – pain is related to your endometriosis. Put simply, it can be! The structures in the hip – including the muscles, nerves, fascia, ligaments – can all become restricted and irritated due to the tight and weak pelvic floor muscles. This can contribute to hip and groin pain.
Also, there can be referred pain to the groin and hip. The nerves going to the hips and groin can be irritated as well and cause pain.
Although not common, endometriosis lesions can sometimes be found in the hip or in the nerves and muscles around the hip directly invading the nerves and muscles causing pain and dysfunction.
While endometriosis can directly and indirectly affect the hip and groin, it is important to note that there may be other things that are contributing to hip and groin pain.
Pelvic pain in general is usually multifactorial – meaning there are many different things causing the pain and dysfunction. The pain generators need to be properly diagnosed in order to provide the most optimal treatment and outcome. That is why it is crucial to be evaluated by a provider who is not only a specialist in pelvic pain but who is also an expert in evaluating muscles, nerves, and joints in the pelvis, hips, and low back.
Assessment is necessary to rule out any hip impingement, labral tear, sports hernia or core muscle injury that can all contribute to hip and groin pain. From there, your pelvic pain specialist can talk to you about the right treatment options for your pain.
After 3-months, our patients are experiencing a decrease in pain by 50%, a 35% increase in functional ability in intercourse, bowel movements and bladder function, and seeing improvement in absenteeism and presenteeism at work and in their lives. That’s our goal: get patients back to their lives.