The Pros and Cons of Exercise When You Have Endometriosis
Part 3: Exercises That Can Help with Endometriosis Pain
Before you can understand how to exercise help endometriosis, it is important to understand what makes endometriosis painful, your pelvis and your pelvic muscles, and the two-way interaction between your endometriosis and the muscles you contract unconsciously with pain. These concepts [SEE PARTS 1 and 2] provide a good foundation for Part 3 of my 3-part series, which now explores the exercises themselves.
Pelvic floor pain is a consequence of endometriosis pain.
In Part 1, I described two ways that endometriosis causes pain:
- Its growth and invasion into normal tissue causes inflammation from a localized immune response which is painful in itself, and the local inflammation it causes evokes a more global immune response for further inflammation, often involving the entire abdomen.
- The organ (bladder, rectum, colon, ovary, etc.) it invades suffers dysfunction when the inflammatory response and global immune response cause tissues to stick together and remain stuck (scarred), even after the endometriosis has been removed.
To these two, however, I must add a third one, discussed thoroughly in Part 2:
- Muscle pain of the pelvic musculature, from continuous cramping of the muscles you unconsciously clench in response to the pain of endometriosis. Almost any unpleasant sensation—physical or even emotional—can cause these muscles to spasm over time, since they unconsciously contract as a natural defense in our fight-or-flight response.
Are the right exercises for endometriosis as simple as just doing them?
Unfortunately, no, for several reasons – how to exercise help endometriosis. The Internet has many sites that describe doing exercises to help with the pain of endometriosis, but it is important to know that endometriosis is not a muscle disease, but muscle disease can come from your suffering from endometriosis. This cause-and-effect will make any exercises irrelevant if there is still present endometriosis pain that provokes your pelvic floor clenching and spasm.
- No exercise will eliminate endometriosis, which requires surgery (excision/removal) to get rid of it.
- Exercise without removing the endometriosis may even make things worse, flexing and contracting those muscles already in spasm.
- Without a pelvic floor evaluation by a pelvic floor physical therapist, you won’t even know which of the pelvic floor muscles are your problem.
It also must be pointed out that most of the information on the Internet on pelvic floor dysfunction is about too much relaxation (“hypotonic”), causing incontinence, and not spasm (“hypertonic”). These sites will tell you how to do the exact wrong thing, i.e., increasing contraction of muscles already in spasm!
The first step, therefore, is eliminating the source of your defensive and unconscious muscle clenching.
Whether it’s endometriosis or any other sources of chronic pain (e.g., irritable bowel, painful bladder, etc.), the muscle spasm cannot be addressed until the source of the pain is eliminated; otherwise, even with successful muscle relaxation, your cramping will come back. Once the source of the pain is eliminated (i.e., surgery) or modified (with hormones, for example), then work can begin on the residual pain of your pelvic floor.
Why doesn’t the muscle cramping go away on its own once the cause of the cramping is eliminated? How to exercise help endometriosis?
The pelvic muscles can continue to cramp as a chronic process. The biochemistry of runaway muscle fiber spasm can continue as its own disease. You won’t experience it as muscle contraction, but only as pain. Sitting, walking, sex—anything involving your pelvis—will give you this pain. And since the pelvis is your center of gravity, that means almost any activity.
So what is the answer? Exercise after removal of the original cause of the spasm?
Now we’re getting into the actual therapy for muscle spasm:
- Removal/resolution of the initial cause of the muscle spasm.
- After removal of the source of the pain (e.g., robotic excision surgery like Dr. Ulas Bozdogan at NYCEndometriosis performs), the second step is to identify which muscles are involved. This is best done via an internal evaluation by a pelvic floor physical therapist.
- Once the pelvic floor is evaluated and the problem areas identified, it is important for you to recognize when and how often you are clenching these muscles. Remember, it is an unconscious reflex. BIOFEEDBACK is a process that uses a vaginal sensor to wave a needle on a meter when there is the increased pressure or tone in the pelvic floor muscles.
What if the pelvis is too painful for an exam or biofeedback?
A frequent cause for unsuccessful therapy is that your pelvis may be too tender to touch, much less examine (step 2, above) or insert a biofeedback sensor. If simply inserting a tampon is very painful, you may fall into this category. Fortunately, there are remedies.
You can have what is called “myofascial release” of the trigger points in the muscles, done under anesthesia. This involves rubbing them out like you would a cramp in any other muscle—hence, the need for anesthesia. You can also have Botox injected under anesthesia to relax the muscles, giving you almost 6 weeks to undergo pelvic floor physical therapy for biofeedback and therapeutic massage (a gentler type of myofascial release).
Assuming all is done properly, are there actual exercises recommended to aid in biofeedback for after therapy has completed?
A quick review:
- Levator ani muscle (as the Latin indicates, its contracting lifts the anus): made up of two muscles, the puborectalis (responsible for continence of urine), the pubococcygeus, and the ileococcygeus.
- Obturator internus from the lower portion of your pelvis to the head of your upper leg bone (femur): it causes rotation of your hip/leg, either toward or away from the pelvis, depending on whether the thigh is flexed of not.
- Pyriformis: nearer the top of your pelvis, toward the back, running from your spine to the head of your femur. It rotates the hip, turning the leg and foot outward.
While jumping into exercise with no specific knowledge of which muscles are in spasm can do more harm than good, improving the tone of the known offenders will help keep the pain of pelvic floor spasm away forever.
Think of the example of the out-of-shape runner in Part 1 of my series. The reason why this runner cramps is because of calling on muscles to do what they are not prepared to do. This “overshooting” of the muscle biochemistry causes bad biochemistry indeed (lactic acid build-up), and the muscle cramps. But that same runner, training in ever-increasing increments of exercise, will tone the muscles such that they can be called upon to do more. Thus, specific exercises for specific spasming muscles can help, but they must be in an individualized program designed by your pelvic floor physical therapist.
When you consider what your pelvic floor muscles do—create continence of feces and urine, allow for rotation of your thigh, leg, and foot, add to the conjugate sensation of sex, and participate in constant posture adjustments—you will see the sense in certain exercises- How to exercise help endometriosis- (leg lifts, squats, etc.) recommended in your individualized program. I emphasize “individualized,” because there is no one-size-fits-all regimen that can be read on the Internet that will pertain 100% to everyone—not even 50%–and may even make things worse for you!
NYCEndometriosis is my practice for reining in the complicated web of interaction between your endometriosis or fibroid pain and the muscle spasm that can emerge, even after I remove the endometriosis. But the first step is for me to remove it, with minimally invasive, robotic, same-day surgery, which has a speedy recovery so that you can proceed on to the physical therapy you may need. Many patients won’t need it, but many will, and I can tell which group you are in after I take care of your initial endometriosis problem.
You may think you just have pelvic pain or pain with intercourse, but it could be your pelvic floor spasm that is telling me you have endometriosis. Call me so we can get started. Even if you’ve already had endometriosis surgery from someone else, still call me. Your problems may not be over, and I can help.