Physiotherapy
urogynecological

• Pain reduction
  Using manual therapy techniques, a physiotherapist can help relax tense pelvic floor muscles and surrounding tissues. Adhesions resulting from endometriosis can cause chronic muscle tension, which intensifies pain. Regular therapy can reduce tension and improve blood flow to the areas affected by endometriosis.
• Improving the mobility of tissues and organs
  Physiotherapy mobilization techniques help to stretch and elasticize scar tissue and adhesions, which helps to improve the mobility of the pelvic organs and reduce discomfort.
• Supporting the regeneration process after surgery
  For patients who have undergone endometriosis surgery, urogynecological physiotherapy can support the rehabilitation process by reducing pain, promoting wound healing and scar care, and improving the mobility of organs and tissues. It's worth seeing a urogynecological physiotherapist before surgery to learn muscle strengthening exercises and postoperative mobility techniques.
• Increased body awareness and improved pelvic floor muscle function
  Patients with endometriosis often experience pain, which can lead to unconscious pelvic floor muscle tightening, which in turn increases overall discomfort. A urogynecological physiotherapist can help patients learn how to relax their pelvic floor muscles and strengthen them properly, which can help alleviate pain.

A visit to a urogynecological physiotherapist for a patient with endometriosis includes similar stages to a standard visit, but is tailored to the specific nature of the disease and the individual needs of the patient.

1. Detailed medical interview
   The physiotherapist will carefully inquire about the patient's medical history, endometriosis treatment course, symptoms, and previous surgical procedures. It's also important to determine which symptoms are most bothersome (e.g., pelvic pain, difficulty urinating, painful periods, pain with intercourse) and how the disease affects the patient's daily life. This interview is crucial to developing an appropriate treatment plan.
2. Posture assessment and palpation of the pelvic floor muscles
   A physiotherapist assesses posture to identify any abnormalities that may affect pelvic floor muscle tone. A pelvic floor muscle test may also be performed, which is crucial for patients with endometriosis, where excessive pelvic floor muscle tone is common.
3. A therapy plan individually tailored to the patient
   After conducting an interview and assessing pelvic floor muscle function, the physiotherapist creates a treatment plan. For patients with endometriosis, this may include relaxation techniques, strengthening exercises, manual therapy, tissue mobilization, and other techniques aimed at reducing pain and improving quality of life.

Preparing for a visit to a urogynecological physiotherapist in the case of a patient with endometriosis does not differ significantly from standard recommendations, but it is worth paying attention to a few details:

• Describe your symptoms in detail
  Before your appointment, it is a good idea to write down all your symptoms related to endometriosis, including the type, severity and frequency of pain, to help your physiotherapist determine the appropriate therapeutic approach.
• Take your test results
  Imaging test results (e.g. ultrasound, magnetic resonance imaging) and surgical treatment records may be helpful in planning therapy.
• Prepare for questions about your menstrual cycle
  Your physiotherapist may ask about your menstrual cycle, as endometriosis symptoms often worsen during certain phases of the cycle.
• Take care of your physical comfort
  It's important to dress comfortably and take care of your intimate hygiene. Prepare for a possible examination. transvaginal and/ or transanal, which may be necessary to carry out.

Transvaginal examination procedure:

• Patient's interview and consent

Before the examination, the physiotherapist will conduct a detailed medical interview regarding the course of endometriosis, symptoms experienced, and previous treatment. You will be thoroughly informed about the purpose of the examination and its procedure, which aims to minimize anxiety and facilitate your full consent.

• Preparation for the examination

The examination is performed in a calm and intimate setting, all designed to make you feel safe. What does it involve? You lie on your back with your knees bent, and your body is covered for comfort. If pain is a concern, the physiotherapist pays special attention to the gentleness and pace of the examination.

• Performing the test

The physiotherapist gently inserts one or two fingers into the vagina, using disposable gloves and a lubricant to reduce discomfort.

• Conclusion and discussion of results

After the examination, your physiotherapist will discuss the results with you and suggest further treatment steps, which may include relaxation techniques, exercises to strengthen the pelvic floor muscles, and manual therapy to loosen adhesions.

The test allows for the assessment of:

• Pelvic floor muscle tension – in patients with endometriosis, the muscles may become excessively tense, which contributes to chronic pain.
• Muscle strength and flexibility – the test checks how well the patient is able to control the tension and relaxation of the pelvic floor muscles, which is crucial in pain management.
• Presence of adhesions and scarring – endometriosis often leads to the formation of adhesions that can limit tissue mobility, which is also assessed during the examination.

For patients with endometriosis, transvaginal and transrectal examinations are important diagnostic and therapeutic tools. Endometriosis often leads to chronic pain and excessive muscle tension, which can lead to pelvic floor muscle dysfunction. These tests allow for:

• Identify areas of excessive tension – as a result of chronic pain, the pelvic floor muscles may become excessively tense, which increases the pain.
• Assess adhesions and their impact on pelvic organs – adhesions caused by endometriosis can restrict the mobility of organs and muscles, which can lead to chronic pain and functional problems.
• Tailor the treatment plan to the patient's individual needs – based on the examination results, the physiotherapist can plan a therapy that will help reduce pain, improve pelvic floor muscle function, and support the post-operative healing process.

In patients with endometriosis, these tests may cause some discomfort, especially in areas where muscles are very tense or adhesions are present. However, the physiotherapist works very gently to minimize pain and adapts the examination to the patient's response. The patient always has the right to discontinue the test if she feels uncomfortable.