Endometriosis is a disease in which tissue resembling the lining of the uterus (endometrium) develops outside the uterine cavity, usually in the pelvis (surface of the ovaries, endometrium, fallopian tubes, bladder, intestines, abdominal wall, and brain). This tissue reacts similarly to the endometrium to hormonal changes, leading to inflammation, bleeding, and the formation of scars or cysts that can cause pain, fertility problems, and other symptoms. Endometriosis is a chronic and complex disease that affects women’s quality of life. Despite numerous researches on this disease, the exact cause is still unknown. However, there are some risk factors, such as heredity, immune disorders, increased oestrogen exposure, and also some environmental factors.

The presence of ectopic endometrial tissue embedded in the subcutaneous fat layer and abdominal wall muscles is called abdominal wall endometriosis (AWE). AWE may occur spontaneously but usually develops in association with a previous surgical procedure such as a caesarean section (CS), hysterectomy or appendectomy.

Cesarean Scar Endometriosis (CSE) is the most commonly reported form of AWE. Some authors suggest that CS significantly increases the risk of developing AWE. The pathophysiology of CSE may be due to direct implantation of endometrial tissue in the caesarean scar (implantation theory). With the proper supply of nutrients and hormonal stimuli, endometrial cells survive and proliferate, eventually leading to CSE. Although it is an atypical disease with an incidence of 0.03-0.45%, CSE can cause long-term discomfort in the form of cyclical abdominal and pelvic pain.

Physical therapy for CSE focuses on reducing scar pain and discomfort and improving pelvic floor muscle function. There are several physical therapy techniques that can be used for CSE, including:

• Manual therapy – A physical therapist can perform scar therapy to relieve muscle tension and improve blood flow to the area. It can also help relieve the pain you are experiencing.
• Pelvic floor muscle exercises – they not only strengthen the muscles, but also improve their flexibility and coordination. Most importantly, they facilitate the relaxation phase, which helps reduce pain and discomfort.
• Biofeedback – can be used to measure the muscle tone of the pelvic floor muscles and teach the patient how to control the phases of contraction and relaxation of the pelvic floor muscles with the help of feedback.
• Pelvic floor muscle electrostimulation – in some cases, pelvic floor muscle electrostimulation can be used to stimulate these muscles and increase their strength and flexibility.

Martyna Kasper-Jędrzejewska

References:

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