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Pelvic floor therapy: What is it and how can it help endometriosis

Updated: Jul 5, 2023

Pelvic floor therapy is a type of physical therapy that focuses on the muscles and tissues of the pelvic region.

This therapy can help alleviate a variety of symptoms related to endometriosis, a chronic condition that affects the tissue lining the uterus.

Pelvic floor therapy can help improve pain, reduce inflammation, and increase mobility, making it an effective complement to other treatments for endometriosis.

Whether you're dealing with endometriosis or any other pelvic condition, pelvic floor therapy is a safe and effective way to manage symptoms and improve overall quality of life.

In this blog post we will cover:

  • What is endometriosis?

  • What are the symptoms of endometriosis?

  • How is endometriosis diagnosed?

  • What is your pelvic floor and why does it matter?

  • Pelvic floor and endometriosis

  • What is the role of pelvic floor physical therapy and can it help with endometriosis symptoms?

  • When to seek professional help

What is endometriosis?

Endometriosis affects 1 in 10 reproductive-aged women. Endometriosis occurs when the endometrium, or lining of the uterus, grows outside of the uterus in the pelvis and abdomen.

Endometriosis can grow on the ovaries, fallopian tubes, intestines, bladder, and lining of the pelvis, and has been identified in almost every organ of the body.

Endometriotic implants grow in response to estrogen and can trigger an inflammatory response in the pelvis. This inflammation is what causes painful symptoms.

What are the symptoms of endometriosis?

The classic presentation of endometriosis is extremely painful periods. The pain typically begins before your period and continues until after the period is over.

People with endometriosis often describe pain in their lower abdomen that travels to their back and down their legs.

Other common symptoms include pain with sex, pain with bowel movements, painful urination, and pelvic pain outside of periods.

Endometriosis can also cause infertility. Up to 7 in 10 women with pelvic pain and infertility will have endometriosis.

Finally, some individuals with endometriosis are asymptomatic or have very mild symptoms.

The severity of symptoms does not correlate with how much endometriosis is present.

How is endometriosis diagnosed?

On average, patients see seven doctors over eight years between symptom onset and diagnosis.

Endometriosis is underdiagnosed because the only way to definitively confirm endometriosis is with a biopsy performed during surgery.

In the primary care setting, endometriosis is a clinical diagnosis based primarily on history and physical exam.

There are no accurate blood tests for endometriosis however medical providers can use imaging (such as an ultrasound) to narrow their diagnosis for endometriosis.

What is your pelvic floor and why does it matter?

The pelvic floor muscles are located between the tailbone (coccyx) and the pubic bone within the pelvis. They support the bowel and bladder (as well as the uterus and vagina in females).

Muscular bands (sphincters) encircle the urethra, vagina, and anus as they pass through the pelvic floor.

When the pelvic floor muscles are contracted, the internal organs are lifted and the sphincters tighten the openings of the vagina, anus and urethra.

Your pelvic floor muscles help you to control your bladder and bowels.

The pelvic floor muscles are very important in sexual function because they are responsible for the relaxation and contraction combination that be the difference between painful and pleasurable sex.

A woman’s pelvic floor muscles support her womb (uterus), bladder, and bowel (colon). The urine tube (urethra), the vagina, and the anus all pass through the pelvic floor muscles.

A man’s pelvic floor muscles support his bladder and bowel. The urethra and the anus all pass through the pelvic floor muscles.

If your pelvic floor muscles are not functioning well, your internal organs will lack full support, which may stop you from being able to control your urine, feces, or gas.

Common causes of a weakened pelvic floor include pregnancy, childbirth, prostate cancer treatment in males, obesity, and the associated straining of chronic constipation.

Pelvic floor and endometriosis

47% of women are thought to have pelvic floor issues, such as chronic pelvic pain.

Chronic pelvic pain can have multiple causes. It can be a symptom of another disease, or it can be a condition in its own right.

If your chronic pelvic pain appears to be caused by another medical problem, treating that problem may be enough to eliminate your pain.

However, in many cases, it's not possible to identify a single cause for chronic pelvic pain. In that case, the goal of treatment is to reduce your pain and other symptoms and improve your quality of life.

Endometriosis affects a staggering 80% of women who experience chronic pelvic pain.

For those who have endometriosis, the fact that chronic pelvic discomfort is a symptom and a common occurrence is not surprising.

It turns out that endometriosis and pelvic floor dysfunction frequently coexist.

Endometriosis can cause pelvic floor dysfunction because the growth of endometrial tissue outside the uterus can lead to pain, inflammation, and the formation of adhesions and scar tissue.

This can cause the pelvic floor muscles to become tight and painful, leading to pelvic floor issues such as muscle spasms, pain during intercourse, and urinary or bowel dysfunction.

Additionally, endometriosis can cause chronic pain, which can lead to the muscles of the pelvic floor becoming tense and overactive, causing further issues.

By treating the pelvic floor muscles and tissues, pelvic floor therapy can help alleviate these symptoms and improve the overall quality of life for individuals with endometriosis.

Those suffering from endometriosis can also experience dysfunction in their pelvic floor.

What is pelvic floor dysfunction?

Pelvic floor dysfunction is a common condition where you’re unable to correctly relax and coordinate the muscles in your pelvic floor to urinate or to have a bowel movement.

If you’re a woman or assigned female at birth (AFAB), you may also feel pain during sex, and if you’re a man or assigned male at birth (AMAB), you may have problems having or keeping an erection (erectile dysfunction or ED).

Your pelvic floor is a group of muscles found in the floor (the base) of your pelvis (the bottom of your torso).

If you think of the pelvis as being the home to organs like your bladder, uterus or prostate, and rectum, the pelvic floor muscles are the home’s foundation.

These muscles act as the support structure keeping everything in place within your body. Your pelvic floor muscles add support to several of your organs by wrapping around your pelvic bone.

Some of these muscles add more stability by forming a sling around your rectum.

Chronic pain can cause trauma to the muscles, ligaments, nerves, and fascia of the pelvis and abdominal wall.

This can result in pain in the pelvis, difficulty urinating, difficulty having bowel movements, painful sex, and pain with movement.

What is the role of pelvic floor physical therapy and can it help with endometriosis symptoms

Kegels and postpartum are probably the first things that come to mind if you've ever heard of pelvic floor physical therapy.

Perhaps you’ve heard tales about how a postpartum sneeze or chuckle can cause leaking, or urine incontinence. And, perhaps you’ve gone through this yourself.

However, did you know that pelvic floor physical therapy isn't just for women who have just given birth? And, it's more than just kegel exercises.

Pelvic floor physical therapy is a treatment approach that uses the principles of physical therapy to provide a structured, effective and safe reconditioning of pelvic floor muscles.

The goal of the treatment is to improve the strength and function of pelvic floor muscles and alleviate pain, weakness, and dysfunction in the muscles.

During the treatment, a skilled physical therapist accesses the muscles through the rectum or vagina and makes manipulations them to improve their strength and functioning.

The therapist may either stretch the muscles if they are short and contracted or apply resistance to improve strength if they are weak and dysfunctional.

Pelvic floor therapy directly targets the pelvic floor and can improve symptoms related to endometriosis.

Research shows that those with endometriosis have improved pain relief when treated with pelvic floor physical therapy.

By addressing any dysfunctions or imbalances in the pelvic floor, this therapy can help alleviate pelvic pain, discomfort, and reduced mobility caused by endometriosis.

It can also help with endometriosis-related issues such as urinary and bowel problems, pain during intercourse, and muscle spasms.

Pelvic floor physical therapy combines exercises, stretches, manual techniques, and behavior modification to improve quality of life.

Physical therapists trained in pelvic floor therapy use a combination of manual therapy techniques, exercises, and lifestyle modifications to help improve pelvic health and alleviate endometriosis symptoms.

This non-invasive and holistic approach can help individuals with endometriosis manage their symptoms and improve overall quality of life.

It can also complement other treatments such as medication, surgery, and hormonal therapy.

Pelvic floor exercises to try

When to seek professional help

Sometimes a person’s pelvic floor muscles can be too tight.

There are several signs that may indicate that your pelvic floor muscles are too tight:

  1. Pain or discomfort: If you experience pain or discomfort in your pelvic region, it may be a sign that your pelvic floor muscles are too tight. This pain can be felt in the lower back, hips, or genitals.

  2. Urinary or bowel issues: If you have frequent urination, urinary incontinence, or bowel problems, it may be due to tight pelvic floor muscles.

  3. Sexual dysfunction: If you experience pain during intercourse, it could be a sign that your pelvic floor muscles are too tight.

  4. Muscle spasms: If you feel involuntary muscle contractions in your pelvic region, it could indicate that your pelvic floor muscles are too tight.

  5. Reduced mobility: If you have difficulty moving or performing physical activities due to pelvic pain or discomfort, it may be a sign of tight pelvic floor muscles.

If you suspect this is the case for you, or you’re unable to find your pelvic floor muscles, or have problems making progress, you should see a pelvic floor physiotherapist, or health professional.

You should also seek professional help if you’re experiencing symptoms such as:

  • needing to urgently or frequently go to the toilet to pass urine or bowel motions

  • having accidental leakage of urine, bowel motions, or wind

  • finding it difficult to empty your bladder or bowel

  • having pain in the bladder, bowel or in your back near the pelvic floor area when exercising the pelvic floor, or during intercourse.

Finding a physiotherapist specializing in pelvic floor therapy may be overwhelming and challenging.

At ELANZA, we are creating a platform where you will be able to access all the top specialists and a team of professionals to help you manage your endometriosis care.

If you would like to be one of the first people in the world to access our new platform, sign up here.


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