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Endometriosis is a disease in which the inner lining of the uterus grows outside the uterine cavity, usually around the pelvis and abdomen. The condition affects roughly 10 percent (190 million) women and girls of reproductive age, globally, according to the World Health Organization (WHO). There are several questions that come to mind around endometriosis, and one is: is exercise a good idea when you have this condition?
But before we get to that, it’s important to know about some of the symptoms associated with endometriosis:
* Painful periods
* Chronic pelvic pain
* Pain during and/or after sexual intercourse painful bowel movements and painful urination
* Fatigue, depression and anxiety, abdominal bloating and nausea
When a woman with endometriosis has her periods, she has bleeding from the lining of the uterus, and also from the endometrial tissues that are outside the uterus. The bleeding from the outside of the uterus cannot exit and causes inflammation, scar tissue, and adhesions to form, causing severe pain.
Exercise is a promising conservative treatment that can help relieve the symptoms and improve the quality of life. The most common treatment of endometriosis is medication and surgery, depending on the condition and its severity.
Inflammation is the main side-effect of endometriosis. A 20-minute session of moderate exercise can stimulate the immune system, producing an anti-inflammatory cellular response, as per a study published in the journal Brain, Behavior and Immunity. Improving anti-inflammatory and antioxidant markers helps in the better management of this condition.
Exercise reduces estrogen secretion. Endometriosis is also termed a benign estrogen-dependent disease. The decrease in estrogen can help in decreasing endometriotic tissue growth that also helps to reduce pain.
Exercise has a protective mechanism for chronic diseases, improves cardiovascular function, maintains good bone and muscle strength.
Exercise helps in stimulating the production of endorphins, which are considered feel-good hormones. They improve mood, stress, and depression, and have a pain-relieving effect.
Regular exercise boosts confidence, endurance, and flexibility. Being active helps relieve constipation, abdominal bloating, and bowel health.
Chronic pain is commonly seen in endometriosis, which makes it is difficult to start the exercise. However, choosing the right exercise is important as symptoms might flare up, if you choose exercises that are not appropriate.
As endometriosis is associated with inflammation, chronic inflammation can cause scarring in the areas like the pelvic and abdominal cavity. This causes severe pain, leading to the formation of a guarding mechanism resulting in bad posture, weakening, and tightening of the muscles. Good posture helps improve alignment and muscle balance.
Pilates is an excellent form of exercise which works on posture, controlled movement, and breathing. Pilates focuses on the diaphragm, transverse, multi-fundus, and pelvic floor muscles. It helps decrease adhesions around the pelvic area and the abdomen. This exercise also helps in improving pelvic floor muscle integrity, which helps in decreasing pain.
Pilates increases muscular strength, endurance, flexibility, and cardiorespiratory endurance. Pilates exercises like clamshell, hip release, hip rolls, spinal rotation etc. are examples of some simple and low-impact exercises to start with.
Yoga offers multiple benefits for women with endometriosis. It helps in relaxation, relieving discomfort from the symptoms. A randomized control study concluded that yoga helps in reducing chronic pelvic pain due to endometriosis and improved quality of life.
Swimming is a good exercise to start. The properties of water have less impact on the joints and lower abdomen. Swimming is a gentle way to become active and strengthen your muscles and improve your cardiorespiratory system.
Walking is another low-impact exercise that works on your general well-being. On a day when you are not in the mood for other exercises, walking is a very good alternative. It improves your cardiorespiratory function, and strengthens your muscles. Walking helps improve energy levels and the secretion of serotonin which is the feel-good hormone. It uplifts your mood, and decreases anxiety and depression.
Avoid any exercises that put pressure on your abdomen and lower back:
* Exercises like crunches, planks, scissors, burpees, reverse crunch, etc.
* High-intensity exercises like skipping, weight lifting, high-intensity circuit exercises should be avoided.
* In yoga, avoid poses that put excessive pressure on your abdomen and cause your pelvic floor muscles to tense up.
* In Pilates, avoid exercises like hundreds, chest lifts, and rollups that contribute further to the pelvic floor muscle tension.
Endometriosis often causes adhesions and scarring in the abdomen and pelvic area, causing pain and tightness of the hip, adductor, and lower back muscles. Knowing which muscle to relax and strengthen is important. A physiotherapist will carefully assess your posture, muscle strength, flexibility, and endurance.
Exercises should focus on deep abdominal breathing, strengthening of the weak muscles, stretching, and relaxing of the tight muscles. From the prescribed exercises, you will benefit by restoring your muscle balance and ensuring pain reduction.
Working to relax the pelvic floor muscles, re-balance and train the muscles will be the primary focus of your physiotherapist.