Blog / 2015 / Treating Endometriosis: Physical Therapy and Squatting

Today, I want to talk about all things toilet, starting with my bladder.

Here’s the thing: I used to pee a lot. A really lot. It started after a urinary tract infection in 2006, which happened to be around the time I first became certain there was something wrong with my lady bits. It worsened after my first surgery in 2009 and became unbearable in 2011 when I had the Mirena Coil put in. In fact, to make matters more painful, once I had the Coil, my bladder also began aching sometimes when I went, making relieving myself less than a relief. I managed to control the crazy and get used to the Coil, but I never got a proper explanation for why my bladder kept telling me I had to pee when I didn’t have enough urine in me to warrant it. Or rather I never got an explanation until last fall.

I was complaining about it to my gynecologist (who’s only been my doctor for about a year) and she suggested it might have to do with spasming bladder muscles. She gave me the choice between a pill to stop the twitchiness and a referral to a physical therapist, and I chose the latter because I would rather understand my body better than simply dope it into a faux normalcy. This was one of the better decisions I’ve ever made: it turns out that a physical therapist who knows all about going number 1 and number 2 as well as all things sex is a genius when it comes to endometriosis treatment.

These are three things I’ve gleaned from my handful of physical therapy appointments that all women with endo should know:

1. If you’re around my age (I’m 33), you should be peeing no more than 5 or 6 times a day.

And when you do, you should be expelling at least 6 ounces of fluid, which you can measure by counting “1 one thousand, 2 one thousand” as you go. My physical therapist explained that I needed to train my bladder and not let it rule me.

2. If you have to pee, but you know you’re going too often, use quick flicks to stop the urge.

Do 5 Kegel’s exercises but really quickly. This signals to your bladder that there’s something else going on right now and you’re not going to be peeing anytime soon, stopping the urgency signals that it’s sending to your brain.

3. PT for your lady bits isn’t scary.

Your insides are supposed to move around easily, flowing over each other like when you drop a silk scarf and it slides over itself as it piles up. Endometriosis and other inflammation causes stuff to stick together over time, and the physical therapist’s work is to get it all moving again. I don’t have a huge amount of experience with physical therapy and I obviously don’t know every woman’s case, but I can say this: no one has to stick anything up your vagina in order to get things moving again. I’m saying that because I know a lot of women worry about how PT for endo works.

All that is well and good, but, in order to fully explore today’s theme, I’m afraid we must now talk about poo and, more specifically, the act of pooping. Beginning in January 2014, I added using a Lillipad to my noninvasive treatment regime. This solid and fairly unobtrusive piece of furniture turns a traditional Western sit-toilet into a full-on squat-toilet. The Lillipad is not the only thing out there that can transform your pooping experience, but I prefer it to the huge platform options that force everybody to go the way you go. The Lillipad site is here.

I made this change to my number-2ing because I’ve read that the pushing required when using a sit-toilet is terrible for the nerves and muscles in the pelvic area. It’s even suggested that this regular misuse of muscles could be related to endometriosis. Now, I’m not saying that the sources of that information are so reputable, but the questions they brought up did intrigue me, so I decided to give squatting a try.

When I told my gynecologist and my physical therapist about this new choice, they both sort of blinked and shrugged. Still, they also absolutely agreed that squatting to poo is more natural and healthful for plenty of reasons, so whether or not it’s mending my lady bits might be beside the point.

At this juncture, I guess I can only say that squatting falls more into the must-help-with-something category than in the endo-healing one, but I’m still pleased with how things are going. I had an ultrasound in August 2014 and one last month. The first showed that the cyst on my remaining ovary had shrunk a bit, and the second showed that it was maintaining this smaller size!

I should also add that I still have the Mirena Coil that I got in 2011, and, at this point, I intend to re-up it when it expires. I don’t want to change the delicate balance that seems to finally be working. Fingers crossed!