Endometriosis & Pelvic Floor PT
- Katherine Koch, PT, DPT
- Mar 26
- 6 min read
Pelvic Floor Physical Therapy for Endometriosis: A Path to Relief and Healing
Endometriosis is a chronic, often painful condition where tissue similar to the lining of the uterus grows outside the uterus, leading to inflammation, adhesions, and sometimes severe pelvic pain. One of the often-overlooked aspects of managing endometriosis is addressing the pelvic floor. Pelvic floor dysfunction can contribute significantly to the symptoms of endometriosis, and pelvic floor physical therapy (PFPT) has emerged as a powerful tool in helping individuals manage pain, improve mobility, and enhance quality of life.
This blog post will explore the connection between endometriosis and pelvic floor dysfunction, the role of pelvic floor physical therapy in treatment, and how individuals with endometriosis can benefit from this specialized form of therapy.
Understanding Endometriosis and Pelvic Floor Dysfunction
Endometriosis is often characterized by severe menstrual cramps, pelvic pain, and sometimes infertility. In fact, the pain can persist throughout the month, not just during menstruation, and can affect areas beyond the pelvis, such as the lower back, thighs, and intestines. This pain results from the inflammatory response triggered by the misplaced endometrial tissue, and the adhesions that develop can cause the organs to become abnormally connected or restricted.
The pelvic floor muscles are a group of muscles that support the pelvic organs, including the bladder, uterus, and rectum. These muscles are involved in various functions, such as controlling urination and bowel movements, sexual function, and providing stability to the pelvic organs. When these muscles become overactive, tight, or weakened due to the effects of endometriosis, they can lead to pelvic floor dysfunction.
Pelvic floor dysfunction can manifest in different ways, including:
Pelvic Pain: Chronic pain in the pelvic region, often exacerbated during menstruation or sexual intercourse, is a common symptom of both endometriosis and pelvic floor dysfunction.
Urinary Issues: Difficulty controlling urination, frequent urination, or painful urination can be signs of pelvic floor dysfunction, as the muscles may be too tight or weak to function properly.
Bowel Problems: Constipation, painful bowel movements, or the sensation of incomplete evacuation can occur when the pelvic floor is not functioning optimally.
Sexual Dysfunction: Pain during sex (dyspareunia) can be a direct result of both endometriosis and pelvic floor dysfunction.
How Pelvic Floor Physical Therapy Helps with Endometriosis
Pelvic floor physical therapy focuses on assessing and treating the pelvic floor muscles. For individuals with endometriosis, PFPT is aimed at both relieving the pelvic floor dysfunction and addressing the symptoms associated with endometriosis, such as pain, dysfunction, and impaired movement.
1. Muscle Relaxation and Pain Relief
One of the primary goals of pelvic floor physical therapy for endometriosis is to address the tightness or overactivity of the pelvic floor muscles. Chronic pelvic pain associated with endometriosis often results from these muscles being in a constant state of tension. Through techniques such as manual therapy, trigger point release, and deep breathing exercises, pelvic floor physical therapists help release this tension, allowing the muscles to relax.
Manual therapy can include internal and external techniques that target specific areas of tension. By gently working on tight spots within the pelvic floor muscles, the therapist can help release knots and trigger points that contribute to pain. These techniques also promote better blood circulation, which can speed up the healing process.
Additionally, certain exercises can help individuals with endometriosis retrain their muscles to move more fluidly and respond to pressure without causing pain. This process often involves learning to relax and contract the pelvic floor muscles in a controlled manner.
2. Improving Pelvic Floor Strength (and more!)
While some individuals with endometriosis experience overly tight pelvic floor muscles, others may have weak pelvic floor muscles. These weakened muscles can contribute to a variety of issues, such as urinary incontinence, sexual dysfunction, and difficulty with bowel movements.
Pelvic floor physical therapy can help to strengthen the pelvic floor muscles through exercises that target specific muscle groups. Strengthening the muscles of the pelvic floor helps improve bladder control, prevent prolapse, and enhance sexual function. These exercises, often referred to as pelvic floor exercises or Kegel exercises, involve contracting and relaxing the pelvic floor muscles in a controlled manner.
By learning to engage the pelvic floor correctly, individuals with endometriosis can improve their overall pelvic health and prevent further dysfunction. Strengthening the pelvic floor muscles also improves posture and can reduce the risk of developing additional pelvic health problems in the future.
We also want to support the pelvic floor with good strength and coordination with the surrounding lumbopelvic musculature. This includes the glutes, core, adductors, even down to the foot and ankle or up to the shoulders and neck!
3. Addressing Scar Tissue and Adhesions
One of the challenges of living with endometriosis is dealing with the development of scar tissue (fibrosis) and adhesions. These can form as a result of the body’s healing response to the chronic inflammation caused by endometrial implants. When adhesions form between organs or tissues, it can restrict movement and cause pain. Scar tissue and adhesions can also affect the pelvic floor muscles, leading to stiffness and discomfort.
Pelvic floor physical therapists can use techniques such as myofascial release to help break up the scar tissue and adhesions. Myofascial release is a form of hands-on therapy that targets the connective tissue and fascia surrounding the pelvic floor. By gently applying pressure to the affected area, the therapist can encourage the release of built-up tension and help improve the flexibility of the muscles and tissues.
This approach can be particularly beneficial for individuals with endometriosis who experience pain and discomfort due to scar tissue formation in the pelvic region.
4. Improving Blood Flow and Circulation
Chronic pelvic pain from endometriosis is often exacerbated by poor blood circulation. When the pelvic floor muscles are tense or injured, blood flow can become restricted, leading to further inflammation and pain. Pelvic floor physical therapy helps improve blood flow to the pelvic region through manual techniques, exercises, and the use of modalities such as heat therapy.
Improved circulation can help reduce inflammation and promote healing, allowing the body to better manage the pain associated with endometriosis. Enhanced blood flow also ensures that the muscles and tissues receive the nutrients and oxygen they need to function optimally, reducing the risk of future flare-ups.
5. Educating and Empowering the Patient
Pelvic floor physical therapy is not only about hands-on treatment; it also involves patient education and empowerment. A key component of PFPT is teaching individuals how to manage their symptoms at home through exercises, posture correction, and relaxation techniques.
Education about pelvic health, body mechanics, and breathing techniques can go a long way in helping people with endometriosis take control of their symptoms. For example, diaphragmatic breathing and vagus nerve techniques can be used to relax the pelvic floor muscles and reduce tension. Likewise, understanding the importance of posture and ergonomics can help reduce unnecessary strain on the pelvic region during daily activities.
What to Expect During Pelvic Floor Physical Therapy
If you're considering pelvic floor physical therapy for endometriosis, it’s important to know what to expect. At Sage Physical Therapy, our pelvic floor specialists will perform an initial evaluation to identify what specific impairments we need to address with you and your body. This may include a thorough discussion of your medical history, symptoms, and goals, as well as a physical exam.
Depending on the nature of your condition, the therapist may perform an external or internal examination of the pelvic floor muscles to assess their function and identify areas of tension or weakness. Based on the evaluation, a personalized treatment plan will be developed, which may include exercises, manual therapy, and education on posture and movement.
Our sessions are an 55-minutes, and the frequency of visits will depend on your specific needs and the severity of your symptoms. Over time, as you progress, the therapist will adjust the treatment plan to meet your evolving goals.
Conclusion
Pelvic floor physical therapy is a valuable treatment option for individuals with endometriosis. Whether the primary concern is chronic pelvic pain, muscle tightness, urinary dysfunction, or difficulty with bowel movements, PFPT provides a non-invasive, holistic approach to managing the condition. By addressing both the physical and emotional aspects of the disorder, pelvic floor physical therapy can improve quality of life, promote healing, and empower individuals to better manage their endometriosis.
If you are living with endometriosis and are struggling with pelvic pain or dysfunction, it may be time to explore pelvic floor physical therapy. With the right guidance and support, you can regain control of your pelvic health and take important steps toward living a pain-free, more fulfilling life.