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Endometriosis

I'm worried that my Endometriosis will stop me from conceiving.

Question

I am 34, a paediatric physiotherapist and have been battling endometriosis, diagnosed through a laparoscopy three years ago. The surgeon found several adhesions in the pelvic region and around the bowel and bladder. These were removed by laser but I still suffer a lot of pain which is only partly relieved by acupuncture and co-codamol. My husband and I are trying for a baby, but I have had two early miscarriages and haven't been able to conceive for the past l6 months. I would be so grateful for any advice on the pain and how to conceive.

Answer

In recent years endometriosis has become major problem for women in the West and urban societies worldwide. My belief is that stress plays a major role in its genesis, though this is difficult to prove.

The endometrium, or inner lining of the womb (endo- inside, metrium- uterus), is soft and jelly-like in consistency and full of blood vessels. Sometimes, for reasons we don't know, it starts to migrate and lodge in other tissues such as the gut walls, ovaries or the ligaments that suspend the womb. As my colleague Dr Michael Dooley puts it; 'Grass normally grows on your lawn - if it begins to grow on your path or balcony, then you're in trouble.

The main symptoms of endometriosis are pain (mainly before the period), bleeding (because this is natural for the endometrium) and disturbed cycles (longer or shorter periods).

Massage is one of the most powerful therapeutic tools for many conditions, so I have spent a lot of time prodding and feeling patients, abdomens. This has led me to discover that a lot of abdominal pain actually originates in the walls of the abdomen.

First an anatomy lesson: there are straight muscles running from the centre of the ribcage to the pubic bone and two sets of oblique muscles crisscrossing the abdomen from the ribcage to the top of the hip bone and the ribcage to the top of the pubic bone. (Strengthening these muscles is the basis of exercise systems such as Pilates.) However, this leaves some areas which are not covered by muscle - I have called these 'Dr Ali's abdominal points'. The lower ones, which lie about three or four fingers either side of the belly button and about four fingers below, are most relevant to the pain of endometriosis. Prod these areas with your index finger and a sharp pain will guide you to the exact location.

If some of the tissue of the endometrium gets lodged on the gut walls, it clings, like a cobweb on your sleeve. This is what forms the adhesions. Now if you get gas in the intestines that causes bloating, the gut walls are pulled in different directions causing pain. The situation gets worse if the gas becomes trapped: in an effort to release it, the gut starts contracting and expanding in spasms, causing colicky pain. If abdominal gas and pelvic congestion build up, the sensitive lining of the abdomen (called the peritoneum) reacts by trying to herniate, or penetrate these weak points that I have mentioned above. This causes excruciating pain. Massage is very effective. Gently rub and stroke the affected lower abdominal point with peppermint balm or cream when the pains strikes.

Also massage both lower abdominal points twice daily for two or three days just before your period, or when pain starts. Also massage your neck and shoulder area and the base of your skull, to improve blood flow to the pituitary gland: this controls your hormonal activity and thus your ability to conceive. Your partner can help with this.

How to ease the pain of endometriosis:

  • Control abdominal gases: If you are constipated, take Isapgol psyllium husks as directed on the label, and Herbolax : one tablet after your evening meal for two months; eat papaya, spinach and prunes and drink about two litres of still water daily. Also avoid yeast containing and gas-producing foods such as beer, fizzy water, mushrooms, vinegar, chickpeas, beans, high-fibre cereals, radishes, sugar and preserved products.
  • Help self-healing by boosting your body's energy with Indian ginseng, Ashwaganda: take one or two daily for four months.
  • Also take Zinc (Biocare tablets): one 15mg tablet daily (preferably in the evening) for one month, then alternate days for three months.For relaxation, take one tablet of the Ayurvedic remedy Mentat at bedtime for two months.
  • Help heal your womb with specific yoga exercises: you can find them in my book Therapeutic Yoga co-wrote with Jiwan Brar; for a qualified practitioner in your area, contact the British Wheel of Yoga (tel: 01529 30685l). Beneficial poses are the cobra, abdominal pump, boat and child.
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