When you think of the phrase “womxn’s health practitioner,” a pelvic health specialist probably isn’t an option that immediately springs to mind. Since gynecologists are regarded as the one-stop shop for womxn’s reproductive health needs, it can be easy to forget about the plethora of resources and specialists available. While our topic for today focuses specifically on the ways that pelvic physical therapy can alleviate endometriosis-related pain, this covers such a small facet of the field’s many applications. You can bet that we’ll be diving deeper into pelvic health-related topics in the future, but for now, endometriosis is a complex subject that deserves our full attention.
For this article, we reached out to Dr. Ryan Simmons, a Seattle-based pelvic health specialist and founder of her private practice, The Well Woman Way. She has 10+ years of experience within the medical field, and is personally invested in helping treat womxn’s health issues specifically (if you couldn’t tell from the name of her practice).
How does endometriosis affect your pelvic health?
Since endometriosis is such a complicated disorder, it would be impossible to come up with an all-encompassing solution to alleviate its painful symptoms. However, pelvic pain often presents itself as a key symptom of womxn’s reproductive health disorders. Pelvic Floor Dysfunction (or PFD) is not exclusively linked to endometriosis, but occurs when the pelvic floor muscles are unable to relax or contract properly . . . say, because of inflammation caused by endometrial adhesions or scarring. PFD is characterized by the following symptoms: frequent or painful urination, diarrhea or constipation, painful sex, and in serious cases, agonizing muscle spasms.
“Muscle spasm, especially in the pelvic floor, occurs in response to, or in correlation with, chronic pelvic pain,” Dr. Simmons explains. “We hold our bodies tight to brace for pain, and in chronic pelvic pain diagnoses like endometriosis, the pelvic floor is sometimes holding on for dear life. This creates an environment of tension, decreased circulation, and inflexibility.”
When Dr. Simmons treats patients with endometriosis, they usually fall into one of two categories, pre- and non-operative, or post-operative. The differentiating factor, she explains, is that pre- and non-operative patients are diagnosed “via clinical presentation,” which means that their experiences point to endometriosis, but have not been confirmed by a surgical procedure called a laparoscopy.
“Most of the time, these patients suspect endometriosis, but are sitting in a heart-wrenching purgatory with few answers and a lot of pain and suffering,” she describes. “With these patients, my main priorities are to decrease scarring, adhesions, and muscle spasms via manual therapy, to control the inflammatory response with diet, and to give the patient practical exercises for pain management.”
The second group, as you can probably guess from the name, has undergone surgical procedures to confirm the diagnosis of endometriosis and/or remove endometrial growths from the body. “Post-operative patients are slightly different in that there is a sense of relief in finally having been diagnosed. And that someone - a surgeon - has visualized and excised the pain culprit,” she says. Dr. Simmons also notes that post-op patients may have a calmer “pain response,” but overall, her methods for treating pre- and post-operative individuals are fairly similar.
Education and proper nutrition also play significant roles in her treatment plan. In regards to diet, this means cutting down on gluten, sugar, and dairy, and eating more non-processed and organic foods. Additionally, chemicals like phthalates, PCBs, dioxins, and fire retardants are known for disrupting endocrine function, yet can be found in plastics, pesticides, and even mattresses or furniture. Being aware of the presence of these toxins in the environment and taking steps to actively avoid them can significantly improve one's quality of life.
What happens during your first visit?
Most PT evaluations take one hour, but Dr. Simmons’s are twice as long. Different practices will have different methods, but these longer sessions allow for her to dig deeper into certain things that other practitioners may not cover.
“The first thing I do is sit down with my patients to conduct a comprehensive medical history. Sometimes this is the longest part of the session,” she says. “You can think of me as a detective looking for clues about how a lifetime of events may have shaped a patient’s current reality. A lot of times, she doesn’t know how to connect skiing accident at the age of nine to pelvic floor dysfunction at the age of forty.”
When Dr. Simmons lists the topics she covers in her evaluation, you realize that the word “thorough” is an understatement. She asks patients about their bladder and bowel health, their diet, sexual history, their experiences with trauma or abuse, menstruation, sexual satisfaction, fertility, and birth. But she also asks questions that may not come to mind when you think of a pelvic PT evaluation, questions like: “When do you go to sleep at night?” and “Does your partner know you are here today?” and “Do you meditate or have a spiritual practice?”
The physical portion of the evaluation starts off with a bit of natural observation. Dr. Simmons watches her patient perform simple movements, like sitting, standing and walking, squatting, and bending over, while noting their posture, balance, strength, and flexibility. “The way you perform everyday movements has a lot of bearing on your pelvic health,” she says. “I want all of my patients to know that, and I educate them on the ‘why’ and ‘how’ as we work together.”
Next, she performs an internal exam, which is a very common procedure for pelvic PT evaluations. However, these are a little different, because Simmons takes specific steps to create a comfortable environment for her patients:
“I do my exams on the floor, in my patient’s house, in a room of her choosing. This is definitely not typical, but I personally can’t stand stir-ups and treatment tables. I sit facing my patient, and they sit facing me. Then, they lay back and drape one of each of their legs over mine. In this position, my body mirrors hers and her body is fully supported by mine. In my experience, this immediately creates a powerful and supportive connection. The patient’s hips rest on a cloth pad that I bring with me, and I use gloves and lubrication for comfort. My only tools are my hands and my eyes - no speculums! - and the progression of my pelvic evaluation depends entirely on the patient’s comfort and communication.”
“85% of the time during an evaluation, the patient consents for internal assessment and I am able to evaluate the tissues and organs of the abdomen, hips, and pelvis,” she says. “I assess bony landmarks, tissue health, movement coordination, and muscle function. . . . With all of these techniques I’m looking for abnormal movement, sensation, position, tissue quality, coordination, and response to touch.”
One of the most striking things about Dr. Simmons’s methods is her emphasis on mental healing, in addition to the physical. This is something that she describes as an integral part of pelvic physical therapy in general.
“It’s funny for people who have never seen a physical therapist because they don’t understand,” she says. “First of all, we see our patients for at least an hour, most of the time. . . . You get to know where they’re vulnerable, where they’re strong. And so I really think that the ability to deal with the emotional aspect of pelvic pain is a skill that almost all physical therapists have, because we’re dealing with people in pain everyday of our lives.”
What else do pelvic PTs want you to know?
There are so many reasons why pelvic physical therapy can improve one’s health, but unfortunately, people simply don’t know about them. Dr. Simmons wants to stress that pelvic physical therapy can be your “first line of defense.” In almost all 50 states, you can walk into a pelvic PT office without a referral, which means you don’t have to wait for someone else to suggest PT as an option. You can make that first move.
If you are an individual living with endometriosis and you live in the Seattle area (or Mexico!), you can find Dr. Ryan Simmons’s practice right here on Hezalia, under Fertility & Birth and Pelvic Physical Therapy. Quality womxn’s health and wellness products can also be found right here on our site. If you are a womxn’s health practitioner specializing in treating the symptoms of endometriosis, or other facets of reproductive health, you can create a free profile on Hezalia.com, so new patients can find your services!
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Note for readers: You probably noticed that we have chosen to write 'womxn' instead of woman/women in our piece. Don’t worry, this isn’t a typo. At Hezalia, our mission is to foster an inclusive, welcoming environment, one that addresses the health and wellness needs for all womxn, which includes members of the transgender community. As you can see, this is a work in progress. Over time, we’ll be making these changes to all the articles on this site, so please be patient with us. Thank you for your support as we take this next step!