Mend Physical Therapy Blog and Injury Information

Top 5 Tips To Improve Endometriosis Symptoms

April 22, 2021


Endometriosis is a chronic inflammatory condition that affects 1 in 10 women of reproductive age worldwide. Classically, symptoms of endometriosis are painful menstrual cycles and chronic pelvic and abdominal pain, though a myriad of symptoms exist including rectal pain, abdominal bloating, back pain, bladder and bowel dysfunction, and pain with sex. Current treatment regimens for endometriosis often include surgical excision or ablation of endometrial cells, though reports suggest 20-28% of patients do not have pain relief following surgery (Abbott et al, 2004). This tells us there are more complex pain processes going on beyond the endometrial cell and associated adhesions. Some of these include global inflammation, sensory nerve activation, and altered nociceptive or pain pathways contributing to central nervous system up regulation (Zheng et al, 2019). Here are 5 tips on how to manage pain associated with endometriosis:

  1. Epsom salt baths: You may know magnesium (the mineral in epsom salt) is useful in treating menstrual cramps, but it does much more than that. Magnesium is involved in over 300 essential enzyme processes in the body, but many of us are deficient in this mineral therefore contributing to symptoms such as muscle aches and pain, headache, fatigue, weakness, and constipation. Magnesium baths are one way to restore optimal levels to improve symptoms across the body. Research by Waring et al suggests soaking in a bathtub with the addition of 500-600g of magnesium sulfate (Epsom salt) 2-3 times per week for at least 10 minutes to increase our blood concentration levels of magnesium.

  2. Eliminate irritants and inflammatory foods: Certain foods have an inflammatory effect on our body systems when consumed. Research has shown that foods containing sugar or sweeteners, dairy, gluten caffeine, and alcohol increase inflammatory markers (Giugliano et al 2006) thus correlating to higher pain levels. Other foods such as processed foods, trans fat, and partially hydrogenated oils also increase inflammatory markers (Mozaffarian et al 2009). Start by cutting these foods entirely, it can take the immune system 3-4 weeks to “quiet” so hang in there to see results. See our therapists for a full elimination diet guide based on individual food sensitivities.  

  3. Pelvic floor physical therapy: Chronic pain syndromes like endometriosis often cause changes in our central nervous systems, contributing to upregulation of our sympathetic nervous system. Living in this “flight or fight” response contributes to hypertonicity, or tension, in our muscles. We often see this tension in the muscles of the pelvic floor and those surrounding the pelvic girdle due to guarding, or the body’s way of responding to pain. This tension of the peripheral muscles and upregulation of the central nervous system can be treated by manual muscle releases and downregulation techniques performed by a physical therapist who has been specifically trained in pelvic floor therapy. Visit our website for more information. 

  4. Movement: Including exercise and stretching into your daily regimen will improve your pain symptoms immediately. Exercise has been shown to increase endorphin levels which in turn reduce the brain’s perception of pain. Even low level exercise such as walking has this effect. As discussed above, muscle tension is common in endometriosis. This can contribute to a cyclic pattern of pain: tight muscles cause pain which increases nervous system upregulation which causes increased tension…and the cycle continues. Stretching can reduce muscle tension and break this cycle. Specific stretches such as happy baby pose, cat/cow, and child’s pose target the pelvic floor muscles. Spend 1 minute in each pose daily or when pain spikes. See your physical therapist for a more tailored exercise program.

  5. Just breathe: Diaphragmatic breathing has a profound effect on the central nervous system. New research suggests the diaphragm has an influence on the emotional and psychological spheres, raising the somatic pain threshold and reducing painful perception by the brain (Bordoni et al, 2018). A diaphragmatic breath is performed by lying or sitting in a comfortable position. Relax the neck and shoulders. Place one hand on your belly and inhale through the nose, keeping your mouth closed. Feel the air fill the lungs and your belly rise. Exhale through an open mouth. Practice this for 2-5 minutes daily, then start incorporating this breath into everyday activities.

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