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Adenomyosis written by Claire De Vos (Physiotherapist)

What is Adenomyosis?

Adenomyosis is a condition that affects up to 1 in 10 women yet is rarely spoken about. It occurs when cells similar to those that line the uterus (womb) grow into the muscle wall of the uterus. The extra tissue can cause the uterus to enlarge and with each menstrual cycle it thickens, breaks down and bleeds which can lead to cramping, pain, and heavy periods. Adenomyosis most commonly occurs in women aged 35-50 years who have had children, although it can occur in young women and teenagers as well. The cause of adenomyosis is largely unknown, although it is believed that childbirth or previous surgeries can increase the risk of developing it.

Uterus model showing Adenomyosis

Adenomyosis differs from endometriosis (another common pelvic pain condition), although many women have both adenomyosis and endometriosis. Endometriosis occurs where cells similar to those that line the uterus grow on other parts of the body, commonly the fallopian tubes, ovaries, bladder and bowel

Adenomyosis Symptoms

Diagram showing a healthy and a uterus with Adenomyosis

Adenomyosis can vary greatly from woman to woman. For some women, symptoms can be severe and extremely debilitating. However, up to 30% of women with adenomyosis experience no symptoms at all. The correlation between the severity of symptoms and the amount of adenomyosis is also poor so it is difficult to predict who will experience symptoms.

Symptoms of adenomyosis can vary between women but may include:

  • Heavy, painful periods
  • Menstrual cramping
  • Pain in lower limb and lumbar spine
  • Pressure in pelvis and/or bloating
  • Chronic pelvic pain
  • Pain with sexual intercourse

How is it diagnosed?

Adenomyosis can be difficult to diagnose. If a medical practitioner suspects you have adenomyosis they will likely refer you for a transvaginal (internal) pelvic ultrasound.
MRI is also a useful tool for diagnosing adenomyosis and is non-invasive.

How is it treated?

There are medical, surgical, and conservative management strategies. Although the only definitive cure is hysterectomy, there are many lifestyle and medical interventions that can decrease pain and improve quality of life.

Conservative management

Uterine model Adenomyosis

The good news is physiotherapy can help! Physiotherapy management may include lifestyle modification advice and pain management strategies including heat, ice, pacing and gentle movement. Physiotherapy management may also include; soft tissue release, pelvic floor muscle down-training, biofeedback, and retraining good bladder and bowel habits. Your pelvic health physiotherapist will conduct a comprehensive assessment and work together with you to identify your goals and create a tailored management plan.

Exercise is an important part of managing any persistent pain condition and working with an exercise physiologist who specialises in managing pelvic pain conditions is a great way to incorporate regular movement and activity into your daily routine.

Medical Management:

  • Pain management and analgesia
  • Hormonal therapies. These may be either oral medications or an intrauterine device can help such as the Mirena.

Surgical Management:

  • Laparoscopy
  • High intensity ultrasound
  • uterine artery embolization
  • Endometrial ablation

If you experience any of the above symptoms, get in touch today to discuss the role of Pelvic Floor Physiotherapy and Exercise Physiology.

 

Book an appointment today for your assessment!

Blog by Claire De Vos (Physiotherapist)

Continence and Women’s Health Physiotherapy Services by Claire De Vos (Physiotherapist)

Total Physiocare is now offering Continence and Women’s Health Physiotherapy Services!

Women’s health physiotherapists are highly trained and skilled in assessing, diagnosing and managing a variety of health concerns that may affect women throughout their lives. Such conditions may include; incontinence and bladder dysfunction, pelvic organ prolapse, sexual pain or dysfunction, chronic pelvic pain, lactation issues, as well as musculoskeletal aches and pains associated with pregnancy and menopause.

Our Women’s Health Physiotherapist Claire explains a little more about common conditions she treats below:

Bladder Dysfunction:

Bladder dysfunction refers to difficulty with the storage or emptying of the bladder. Common forms of bladder dysfunction include:

  • Stress urinary incontinence: leaking on exertion e.g. cough, sneeze, laugh, jump, run
  • Urge urinary incontinence: leaking on the way to the toilet
  • Mixed Urinary Incontinence: both stress and urge urinary incontinence
  • Urinary Urgency: experience of a sudden, non-deferrable urge to empty your bladder. May be accompanied by urge incontinence and/or urinary frequency (see below).
  • Urinary Frequency: Emptying your bladder frequently (more than 6x per day, or more than 2x overnight)
  • Difficulty or pain emptying your bladder/feeling of incomplete emptying.

Physiotherapy is considered by the International Continence Society to be a first-line treatment of these conditions. Treatment may include: pelvic floor muscle training, bladder training and bladder calming techniques.

 

Pelvic Organ Prolapse:

Pelvic organ prolapse is extremely common, occurring in 1 in 3 women (a very similar rate to incontinence). It often occurs as a result of pregnancy/childbirth and may worsen during menopause. Pelvic organ prolapse occurs where there is increased laxity in the vaginal wall, resulting in descent of one or more pelvic organs (bladder, bowel, uterus or cervix) into the vagina.

Symptoms may include:

  • Heaviness or dragging within the vagina, particularly after long periods on your feet, lifting or at the end of the day
  • Some women may feel low back pain

Physiotherapy management often includes pelvic floor muscle training as well as education about strategies to reduce the symptoms of prolapse. Your physiotherapist will work closely with your GP/specialist to help you manage your prolapse and achieve your goals.

 

Chronic Pelvic Pain:

Chronic pelvic pain can have a significant impact on a woman’s quality of life. It may be associated with other conditions including endometriosis, painful periods and IBS.

Women with chronic pelvic pain may experience associated heavy periods, experience pain/difficulty with insertion or removal of tampons and often experience discomfort during intercourse.

Physiotherapy treatment will often involve pelvic floor muscle down-training, mindfulness, relaxation strategies and stretches. Your physiotherapist will work with you and your healthcare team (which may include GP, specialist and psychologist) to help to decrease your discomfort and get back to activities.

 

Pelvic Girdle Pain:

Pelvic Girdle Pain (PGP) occurs frequently during pregnancy, with approximately 50% of women experiencing some degree of PGP during their pregnancy.

PGP refers to pain felt either over the joint between the sacrum (lower spine) and pelvis on either one or both sides of the body. It may also radiate into the sides of the hips or be felt over the pubic symphysis (the bone at the front of your pelvis).

PGP usually resolves once you have delivered your baby but in the meantime physiotherapy can help you manage you symptoms and keep active for the remainder of your pregnancy.

 

Mastitis:

Mastitis, which often occurs as a result of blocked milk ducts results in inflammation of the breast tissue. This can result in redness, engorgement and pain for the breastfeeding mother. Fortunately, therapeutic ultrasound administered by a physiotherapist is effective at relieving the inflammation of mastitis and enhancing your recovery.

 

Abdominal Separation:

During pregnancy your tummy muscles stretch to accommodate your growing baby. After delivery you may have been told you have an abdominal separation or “DRAM” which is where these stretched muscles are taking a little more time to come back together.

There are certain exercises you should avoid if you have an abdominal muscle separation, particularly crunches.

Your physiotherapist can assess your tummy muscles (usually around 6 weeks post-natal) and advise you on the best exercises to manage your separation.

 

Post-Natal Check:

Congratulations on the arrival of your new baby! Growing and delivering a baby, as well as taking care of a new born can be both physically and emotionally draining.

One of the best ways to help manage this is by getting regular exercise. However, we recommend a post-natal check (usually around 6 week’s post-partum) so that your physiotherapist can guide you on an appropriate return to exercise plan.

It is common to experience pelvic floor dysfunction and abdominal separation (see above) following the delivery of your baby and it is important to have these issues assessed and addressed before returning to high level exercise.

 

Book an appointment today for your assessment!

Blog by Claire De Vos (Physiotherapist)