Event 2: Diana's Treatment for Endometriosis

Diana’s Initial Treatment Summary

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Diana has many options to help treat her pelvic pain. Targeting the suppression of activity of the implants (e.g. with hormonal therapy) and addressing the myofascial (muscle pain) can greatly help patients like Diana.

You will first start with some basics:

• Physical therapy 
• Pelvic floor physical therapy and lumbopelvic muscle treatment
• Medication management 
• Trial of suppressive hormonal therapy (continuous oral contraceptive pills to stop menstruation) as pain is worse around her menses
• Behavioral strategies 
• Stress reduction techniques for acute pain, 3-minute daily deep breathing exercises

Pelvic Floor Physical Therapy (PT) Strategies

• Pelvic floor physical therapists have completed special training to treat pelvic, abdominal, and musculoskeletal pain in women as well as men.  This can involve external as well as internal (e.g. transvaginal or transrectal) manual manipulation depending on the patient’s symptoms.  
• The benefit of a pelvic specialist is that they have experience and knowledge in treating pelvic floor disorders, generalized pelvic/vaginal/rectal pain and muscular pain.  They also provide a critical component of education, counseling, and support for patients.
• The pelvic PT specialist will evaluate the alignment, musculature, fascial systems and movement patterns in the pelvis and body and come up with a treatment plan to restore function and education in independent pain management.
• If a pelvic PT specialist is not available, general musculoskeletal techniques to address core stabilization and physical function and well as deep tissue massage (back and abdomen) can still be beneficial.

Reference

Bradley MH et al. Physical Therapy Treatment of Pelvic Pain. Phy Med Rehabil Clin N Am 2017; 28(3):589-601.

Diana’s Pelvic PT

Relaxation/Mindfulness Techniques

• When pain increases, stress and anxiety can increase, and vice versa.
• Behavioral and relaxation strategies to reduce pain as well as stress and anxiety can help to de-escalate the pain response and physiologic symptoms.
• Mindfulness refers to the practice of maintaining a nonjudgmental state of heightened or complete awareness of one's thoughts, emotions, or experiences on a moment-to-moment basis.
• Two basic steps to elicit the relaxation response are: 
  1. the repetition of a sound, word, phrase, prayer, or movement;
  2. the passive setting aside of intruding thoughts and returning to the repetition. 
• This can be done using any number of meditative techniques, such as diaphragmatic breathing, repetitive prayer, qi gong, tai chi, yoga, progressive muscle relaxation, jogging, even knitting.
• Diaphragmatic breathing is an easy relaxation technique Diana can try to help decrease pain, anxiety and stress (try it yourself!):
  • Begin with diaphragmatic breathing (lean over your thighs, placing weight on forearms to relax chest muscles, notice belly rise and fall as breathe)
  • Count slowly down from 10 to 0, one number for each breath)
  • If dizzy, slow counting
  • When get to “0” see how you are feeling; if not relaxed, try again!

Learn more at www.bensonhenryinstitute.org.