Management of Endometriosis

The physical and emotional effects of endometriosis can be serious and far reaching. It can be distressing to live with a chronic condition like endometriosis. Often, quality of life is affected and this can impact on family, friends and colleagues, relationships, education and career.

Managing endometriosis is not just about what your doctor and specialist can do for you but also what you can do for yourself.  Here’s some management options that may help to relieve symptoms:

 

Pain Management

‘Endometriosis may be associated with pain. Indeed that may be the way it declares its presence. Despite medical treatment, the pain may not go away and hence become what is called chronic pain. In spite of numerous investigations – e.g. blood tests, xrays, laparoscopies – nothing may be found. And yet, there is still pain. Very frustrating, depressing and interfering with life.  The goal then becomes one of finding a way to live acceptably with pain. This is not resignation, rather it is accepting the situation and actively pursuing strategies to improve function. Often in so doing the pain improves.  This may include cognitive-behavioural therapy, certain drugs, sometimes invasive techniques, exercise and support networks. It is also useful to be referred to a Pain Clinic at some point, where specialists in pain management can assess and coordinate your care.’

 

Coping

People cope with chronic pain differently as our emotional state influences our physical health. Stress, anxiety and guilt can make pain worse. Take a look at your health habits and determine where improvements can be made. Don’t try to change your habits all at once. Learn techniques for managing pain and stress and schedule time for fun and leisure activities. Smoking and being overweight severely affects a woman’s fertility and general well being. Sexual intercourse was never meant to hurt. In addition to the physical discomfort, pain during sex can cause emotional distress and impact on relationships. Tiredness and other persistent symptoms negatively affect quality of life and mental health. Good communication and understanding is essential.

When you are not able to do the things that previously brought you joy, you grieve that loss. You may be able to address these difficulties on your own or with the help of friends. However, there are times when a counsellor, psychologist or psychiatrist can help to assist you on a pathway to wellness, particularly when you consider you may have struggled with symptoms for a very long time. It is often difficult, even after successful surgery, to overcome the cycle of unwellness, without help.

 

Nutrition

You can relieve bowel related symptoms, by making changes to your diet.You may have been diagnosed with irritable bowel syndrome (IBS) and while this might be the case, often endometriosis is overlooked as the primary cause.  However, conditions such as Crohns or Coeliac disease should be investigated too before making dietary changes or the diagnosis might be missed. More often though, it is the sensitivity to certain foods that women with endometriosis commonly experience. Often you become so used to the symptoms, that while they are often annoying (at the very least) or can be disturbing and painful, they are often accepted as normal. Comments like “it's just my funny tummy” and “I've got IBS, so I just live with it” are commonly heard.It is helpful to know which foods frequently make the bowel symptoms worse. Begin taking notice of what you eat and keep a record. 

The following foods often cause discomfort, pain or an adverse reaction:

FODMAP FOODS ™.  FODMAP’s™ are carbohydrates which are not well absorbed by some people and can irritate the bowel.  Women with endometriosis often have a sensitised bowel and therefore have difficulty coping with too many of these foods.

• Fructose is commonly found in foods like wheat, so some women find that they have more pain after eating bread or pasta. They may also have problems with apples or onions which release fructose in the bowel. 
• Lactose - many women with endometriosis are lactose intolerant or have lactose sensitivity (in other words a small amount can be tolerated).
• Raffinose or Galactose - These are found in foods like brussell sprouts, beans and broccoli. They increase wind in almost everyone.
• Polyols These are found in artificial sweeteners.
  
  

Other foods can also trigger unpleasant or painful bowel symptoms:

• Animal fats - dairy, takeaways, fatty meats etc.

• Alcohol – Wine and beer often pose problems for some women. This could be due to the preservatives (often sulphites) used in the process and yeast and sugar often cause a reaction.

• Coffee - Caffeine, like alcohol, is also thought to impair fertility and is a diuretic. Try herbal teas and coffee substitutes for a change unless you have an irritable bladder. 

• Fizzy drinks – putting bubbles in a bubbly tum is not a good idea. If it’s a diet drink it contains sugar substitutes which are FODMAP™ foods. These are also known to be carcinogenic.

• Highly spiced food.  This could be the spice but more commonly it’s probably the rich creamy sauce which might be causing your bowel grief.

• Food combinations - pizza for example (dough base coupled with processed foods).

• Additives / preservatives particularly sulphites. Look out for ‘E’ numbers (the numbers given to food additives) particularly, but not limited to, those in the 220 range.

• Other – listen to your body and moderate your diet accordingly.

The book “Endometriosis and Pelvic Pain” has several easy to understand chapters on nutrition and dietary changes to help relieve the bowel symptoms including more about FODMAPs and which foods are the culprits. 

Be honest with yourself, if you need to lose weight address this now. Many women find by doing so, their distressing bowel symptoms improve along with their self-esteem and general well being.

 

Supplements

We don’t always absorb the nutrients we need from our daily food intake no matter how healthy our diet may be. Most of the food we eat today has been grown with the use of chemicals or processed in some way which can diminish the nutrient value. Many New Zealanders have mineral deficiencies such as selenium, zinc, magnesium, calcium and vitamins A, C and E to name a few. When a chronic problem like endometriosis is evident, the body is put under extra strain and needs help to function efficiently. Taking a dietary supplement may therefore be helpful to improve general wellbeing.

Always choose a quality product, follow the recommended course and seek expert advice from a dietary health professional.

Natural Remedies

Many women use various complementary treatments for healing and the management of pain relief. These include dietary supplements, nutritional changes, herbal treatments, visualisation, meditation, acupuncture, naturopathy and Chinese herbal medicine to name a few. Women who use these treatments often have a more holistic approach to health, healing and well being or use a combination of surgical / medical and natural remedies.  It is important to seek the advice of an experienced health practitioner.  

Exercise

Exercise is a critical component of good health in that it not only tones the body, but also raises the levels of endorphins in the blood stream. These brain chemicals are natural painkillers and elevate mood. Toned stomach muscles support pelvic organs and exercise aids bowel movement. Rehabilitation in the form of gentle exercise like walking is considered one of the best choices because it is easy, safe and inexpensive. Whatever exercise you choose, start slowly. Doing too much too soon can be harmful.  Exercise should not worsen symptoms and may signal something else is wrong eg nerve pain (neuropathic).  This requires investigation.  

Complementary Therapies

Complementary and Alternative Medicines (CAM) are not generally considered to be part of conventional medicine and there are still key questions to be answered about where the therapies are safe or effective.  Many women maintain such therapies improve or relieve their symptoms.  Here are some remedies our women have found helpful.

• Massage is gentle and healing and releases tensions. Massage can allow the flow of more nutrients to areas in need of healing. There are many types of massage. For endometriosis, shiatsu massage, also known as acupressure, is probably the most relevant. Find a reputable practitioner.
• Acupuncture was developed by the Chinese centuries ago in accordance with the theory that energy flows through channels between the surface of the body and internal organs. Pain is the manifestation of blockage in the energy flow and acupuncture is meant to break up the blockage by placing acupuncture needles at specific pain points. This aims to release the body’s natural painkillers and perhaps helps the immune system cells and the brain.
• Relaxation, meditation and visualisation are healing techniques which send positive energy to the mind and are very beneficial for those who live with chronic pain.
• Naturopathy aims to support the body’s ability to heal itself through dietary and lifestyle changes and CAM therapies.
• Traditional Chinese Medicine is a combination of practices to aid healing by restoring the yin-yang balance and the flow of energy.

Sleeping Well

Just like a proper diet and regular exercise, a good night’s sleep is vital. Studies suggest that sleep deprivation results in hormonal and metabolic changes, inflammation, and increased levels of pain.

If you’re having trouble sleeping, try homeopathic sleep remedies, a cup of chamomile tea, or a spritz of diluted lavender oil on your pillow. If sleep deprivation becomes a problem, see your doctor. A referral to a sleep clinic may be recommended. 

Simple rules for sleeping well

• maintain a regular bed and wake time schedule
• establish a regular, relaxing bedtime routine such as soaking in the bath and then reading a book or listening to soothing music
• create a sleep-conducive environment that is dark, quiet, comfortable and cool
• sleep on a comfortable mattress and pillows
• it is best to take work materials, computers and televisions out of the sleeping environment
• finish eating at least two to three hours before
• going to bed
• exercise regularly. It is best to complete your workout at least a few hours before bedtime

Contact ENZ for more information on the treatment and management of endometriosis