ENDOGYM: A Holistic Approach With Pelvic Floor Physiotherapy and Yoga for Endometriosis Pain Relief

Azienda Ospedaliero-Universitaria di Modena82 enrolled

Overview

The aim of this study is to evaluate the combined effects of Yoga practice and pelvic floor physiotherapy (PFP) on chronic pelvic pain (CPP) and dyspareunia in endometriosis patients. This is a retrospective study carried out from April 2024 to November 2024 conducted by University Hospital Modena (Italy). A total of 82 women with confirmed diagnosis of endometriosis were initially enrolled in the ENDOGYM program. Among them, 50 patients (61%) were therefore included in the final analysis. ENDOGYM consists of 12 weekly sessions over a period of 3 months. It includes two PFP sessions, lasting 1 hour each (one at the start and one at the end of the program), and 12 Yoga sessions, once a week, each lasting 60 minutes. EHP-30 questionnaire was used before and after the program to evaluate women's QoL; NRS scale was used before, half-way and after the program to evaluate CPP and dyspareunia.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Endometriosis

Interventions

YogaOTHER

The Yoga sessions were designed to address specific physiological needs related to endometriosis, such as CPP, myofascial pain, chronic fatigue, and hormonal imbalance. The asanas were selected to stimulate the nervous system, promote blood circulation, and relax the pelvic muscles. The poses were adapted to avoid any direct pressure on the pelvic organs, fostering a sense of lightness and awareness. Deep breathing techniques were taught to reduce stress and improve tissue oxygenation, with a positive impact on pain management and immune function. The breathing exercises were often hypopressive to reduce the load on the pelvic area. The use of mindfulness was encouraged to increase awareness of bodily sensations, reduce anxiety, and improve emotional balance. The practice was not just "a physical activity" but an opportunity for the participant to deeply connect with her body, promoting an overall improvement in the QoL.

Pelvic Floor PhysiotherapyOTHER

During the two one-hour sessions of PFP, various tools were used, such as balls of different textures and a cylindrical cushion provide tactile biofeedback and help identify the boundaries of the perineum. Patients were free to adjust the intensity of the feedback by choosing or removing the appropriate aid. By perceiving the different muscular layers of the perineum and altering the posture of the pelvis and lower limbs, patients learned about perineal movements, muscle activation, and myofascial tensions. The goal was to internalize the therapeutic exercises demonstrated and apply them in various daily life situations to maintain improvements in the perineal-pelvic structures.

Eligibility

Sex: FEMALEMin age: 18 YearsMax age: 50 Years

Medical Language ↔ Plain English

Inclusion Criteria: * women with an ultrasound and/or post-operative histological diagnosis of endometriosis * aged between 18-50 years * currently undergoing medical treatment (for at least 3 months before the start of the study), and/or who have previously undergone surgical treatment * with myofascial pain ≥ 7 (NRS scale) and deep dyspareunia ≥ 7 (NRS scale). Exclusion Criteria: * being pregnant * undergoing surgery in the past 6 months * concurrent diagnosis of fibromyalgia * documented pelvic and/or spine trauma within 5 years of recruitment * patients with interstitial cystitis and \> 2 urinary tract infections per year, unless possibly related to endometriosis (non-bacterial) * patients with recurrent vaginal infections, mucocutaneous inflammations of the vulva and vagina.

Outcomes

Primary Outcomes

Evaluate the combined effects of Yoga practice and pelvic floor physiotherapy (PFP) on chronic pelvic pain (CPP) in endometriosis patients

Before the start of the project, a disease-specific questionnaire to measure the QoL of women with endometriosis, the Endometriosis Health Profile-30 (EHP-30) questionnaire, was used to collect data about pain, control and powerlessness, emotional well-being, social support, self-image, work life, sexual intercourse, relationship with children, the medical profession, treatment, and infertility. Response categories are evaluated using a five-point Likert scale (0-4), and each EHP-30 scale is converted into a scoring system ranging from 0 to 100, where 0 indicates the best possible health status and 100 represents the worst possible health status. The Italian version of EHP-30 was used. Finally, at the end of the project, the women completed the EHP-30 questionnaire again. Comparisons of EHP-30 total and domain scores before and after the ENDOGYM program were performed using paired t-tests (two-tailed).

Time frame: From enrollment to the end of the lessons at 3 months

Secondary Outcomes

Evaluate the combined effects of Yoga practice and pelvic floor physiotherapy (PFP) on dyspareunia in endometriosis patients

Before the start of the project, the NRS scale was used to collect data about deep dyspareunia in patients with endometriosis. An additional assessment of deep dyspareunia using the NRS scale was performed halfway through the process. Finally, at the end of the project, the women assessed their deep dyspareunia one last time using the NRS scale.

Time frame: From the enrollment till the end of the lessons at 3 months