How Pelvic Floor PT helps Endometriosis

In Endometriosis, Female Pelvic Pain by pelv_admin16 Comments

Endometriosis is a common contributing factor to pelvic pain. Just to give you an idea of its prevalence: in laparoscopic procedures done to uncover possible causes of pelvic pain, endometriosis was found 80% of the time. The good news is that endo-related pelvic pain can be successfully treated with the proper pelvic floor PT!

But, I’m getting ahead of myself. First, in this blog post, I’m going to tackle how endo can either cause or impact pelvic pain, then I’ll explain how pelvic floor PT can successfully manage endo pain.

What is Endometriosis?  

Endometriosis is a condition where tissue like that which lines the inside of the uterus (known as endometrial tissue) grows outside of the uterus, most commonly in the abdominal cavity. This tissue can implant on any surface within the abdominal cavity including the ovaries, bladder, rectum, and along the abdominal/pelvic wall.

Commonly reported symptoms of endometriosis are painful cramping one to two weeks prior to menstruation, pain during menstruation, pain with sexual intercourse, pain in the location of the bladder, painful bowel movements and infertility.

Now, just how endo causes pain is the topic of much research, but here is a rundown of one theory:

Normally, when a woman is not pregnant, her endometrial tissue builds up inside her uterus, breaks down into blood and tissue, and is then shed during her period. Endometrial tissue growing outside the uterus goes through a similar cycle; it grows, breaks down into blood and tissue, and is shed once a month. Researchers believe that one reason for the pain that endo produces is that the endometrial tissue produces chemicals that may irritate the nearby tissue, as well as some other chemicals that are known to cause pain. In addition, because this tissue isn’t inside the uterus, it can’t leave the body the way a woman’s period normally does, so it can build up and wreak havoc.

The most common way that physicians diagnose endometriosis is using a laparoscopic procedure where a camera is inserted through a small incision in the abdomen. In addition, transrectal or transvaginal ultrasound, CT scans, and contrast MRIs can be used. In more advanced stages of the disease, endometriosis can be detected with a pelvic exam.

A few lines of treatment currently exist for endometriosis, including medication, hormone therapy and surgery. (See the list below for a more detailed look at these different treatment options.)

A spectrum of pain levels exist among women with the condition ranging from completely asymptomatic to relatively minor to severely debilitating symptoms. Interestingly, there has been no correlation made between the severity of the endometriosis disease process and the degree of pain a person experiences.

Endometriosis and the Pelvic Floor

Endometriosis can impact the pelvic floor musculature in a variety of ways.

For one thing, as I mentioned above, endometriosis tends to bleed with menstruation, often leading to inflammation, scar tissue and adhesion formation inside the abdominal and pelvic cavity. (Adhesions are fibrous bands of scar tissue that can attach to organs, muscles, and fascia.)

This can set up an unhealthy environment within the pelvic floor because the decrease in pelvic and abdominal organ/muscle/fascia mobility can lead to decreased circulation, tight muscles, myofascial trigger points, connective tissue dysfunction and pain.

In addition, people that have undergone laparoscopies for diagnoses and/or removal of affected tissue have now undergone additional trauma to the abdomen, which in turn can lead to increased pain in that area. For instance, the abdominal muscles have a very close relationship with the pelvic floor muscles and when there is trauma or irritation as a result of surgery, trigger points can form.

Subsequently, these abdominal trigger points can cause pain in the abdomen and can also refer pain to areas in the pelvis that can cause increased tension of the pelvic floor muscles. The result oftentimes is the creation of a vicious pain cycle where muscle tension creates pain, which creates more muscle tension (plus trigger points plus connective tissue dysfunction)–all of which creates…you guessed it, even more pain.

So on top of dealing with all of the symptoms that already come with endometriosis, a patient can develop a host of secondary pelvic floor dysfunction. Indeed, for some patients, the majority of their pain is actually due to the secondary pelvic floor symptoms themselves.

The good news is that pelvic floor PT can successfully treat symptoms associated with endometriosis, both the primary symptoms and the secondary pelvic floor symptoms.

PTs can help to manage the symptoms of endometriosis such as painful menstrual cramping, abdominal discomfort, pelvic floor pain, and painful intercourse by:

  • treating connective tissue dysfunction,
  • treating myofascial trigger points,
  • mobilizing viscera (gentle manual therapy techniques aimed at releasing adhesions and restoring the proper mobility of the internal organs, such as the uterus, bladder, colon and small intestine),
  • correcting postural and movement dysfunction (often when we are in pain not only does it change our muscle tone but it causes us to move and posture ourselves differently than we typically would. For instance, we slouch or place unequal weight on one lower extremity),
  • and providing patients with the information and advice they need to take charge of their bodies.

Here’s is an example of how I’ve put these strategies into action as a pelvic floor PT: I treated a patient who had been dealing with an endo diagnosis for five years, let’s call her Annie. After undergoing several laparoscopic procedures for endometriosis removal, Annie continued to suffer with abdominal, vaginal ,and lower back pain. Her surgeon ruled out endometriosis as the primary cause of these symptoms and suggested a trial of six to eight weeks of pelvic floor PT to see if it could help relieve her pain.

While treating Annie, I uncovered myofascial trigger points and connective tissue dysfunction in her abdomen, hip, low back and adductors, not to mention significant hypertonus and trigger points in her internal pelvic floor musculature.

By treating these objective findings, after 12 weeks Annie began working part time. Prior to seeking PT, she had been on disability for one and a half years. After about six months of treatment, although she still had occasional flare ups of her symptoms, Annie’s daily pain subsided. Ultimately, she was able to manage her occasional flare ups on her own. As a result, she regained her quality of life, and began to exercise and socialize again.

While PT does significantly help patients diagnosed with endo, I want to stress that it will not be able to get rid of the endometrial deposits or change the disease process. So it’s important that women who have or think they have endometriosis be followed by a physician. A multidisciplinary team of health care providers is absolutely the best approach for management of endometriosis because there are so many different ways that it can affect a woman’s life.

Great endometriosis resources: a global forum for news and info.

Endometriosis Foundation of America

The Endometriosis Association

Endometriosis: My Life with You: Amazing blog by 20-something dealing with endo!

If you have any further questions about endometriosis and pelvic floor PT, please leave them in the comment box below. Also, please share your experiences with endometriosis and PT in the comment section! We look forward to hearing from you!



  1. This totally reflects my experience with endo and pelvic floor pain. The endo was excised; my reproductive organs removed; and still I experienced excruciating pelvic pain. Then I found a pelvic floor PT and after many treatments I’m feeling so much better.

    1. Hi Isabel!

      Thank you so much for sharing your experience with us! We love success stories!


  2. Thank you for this post! I have a history of endometriosis, have had four laparoscopies, and am now being treated for chronic pelvic pain. Endometriosis has been almost completely ruled out as a current cause of my pain. I have struggled to understand how I can still feel just as much pain as I had with endometriosis, but now there is no active disease present. I have been doing pelvic floor physical therapy and seen a lot of improvement in my pain. Through my physical therapist and reading about it, I am beginning to understand the connection between endometriosis and chronic pelvic pain, and how PT can help. This post makes it very concise and easy to understand. Thank you!

    1. Thank you for sharing your experience Sarah! I’m so happy to hear that PT is helping you!

      All my best,

  3. I am having the Marina fitted next week. Is this going to alleviate the severe pain I am experiencing more frequently of late? I am not very familiar with the Marina and I would like to know if anyone has any feedback on how this has helped or hindered them. Thank you

    1. Hi Jean,

      I’m sorry, but without more details on your condition, we can’t respond to your question. But, I will say this, if you’re not familiar with the Mirena, before having it implanted, you should do your research and make sure you are comfortable with all of the potential benefits, risks/side effects!

      Best to you!

  4. Great article Allison! Where can people find a list of MDs that treat endometriosis is the US?

  5. My name is Lisa Martin. I have been suffering with sever pelvic pain for several years now, and have had two laparoscopic surgeries for removal of endometriosis. After the surgeries, I still found myself in significant pain on a daily basis. I was then put on Lupron for5 months, and throughout the treatment was still in pain and suffered with awful side effects. I was finally sent to a urologist and was diagnosed with pelvic floor dysfunction and muscle spasms. I went to my first physical therapy. Session yesterday, and am hoping it will lead to me finally getting my life back! It’s helpful to hear so many success stories…Wish me luck!

  6. Hi Allison!
    I’m a PT student researching PT interventions for endometriosis. This post is wonderful and really gives insight to our role in treating this disorder. Is there a way you could share your resources for your treatments? It’s difficult to find much in the way of validated research and I’d love to delve deeper into the topic. Thanks in advance!

    1. Dear Jess,

      Thank you for your interest in the blog post!

      The treatment approach described in the post is based mainly on clinical evidence that we find in our practice. As you alluded to in your comment, the literature is lacking in research in this area. In addition to clinical evidence, I took some of the treatment concepts from Beal’s theory on viscerosomatic reflex. In addition, the following article titled “Screening for Musculoskeletal Causes of Pelvic Pain” might be of interest:”

      Please let me know if I can do anything more to help!

      All my best,

  7. Hello Allison,
    Thank you for sharing this information. I am suffering from endometrosis from last few months, have already gone under laparoscopy which has worsen my case. From last 6 months I am feeling bad pain around my left overy and lower abdomen. This pain remain 24hours and doesn’t go.
    I am not able to find natural ways or exercises to overcome this. O request for help from you or anybody if possible. Need help urgently since this pain has completely changed my life. I am undergoing lot of depression due to the pain I feel always. Please suggest the best option to get rid of the pain.

    1. Hello Sonali,

      I am sorry to hear about your circumstances. I would advise that you see a local pelvic floor therapist. Where are you located? I may be able to recommend a therapist in your area.

      All my best,


  8. It’s really a nice and useful piece of info. I am happy that you simply shared this helpful information with
    us. Please stay us up to date like this. Thanks for

  9. Thank you, thank you, thank you. I had very involved surgery for endo and did not recover well. I had to leave a job I loved, plus suffer 2+ years of horrible to merely annoying pain, often as if I were being stabbed from the inside out.

    I’ve tried many things on my own. The best two were long distance walking (working up to 10+ miles as many times per week as possible) and eliminating all refined sugar, which means a whole lot of cooking at home. Together this was more than a part-time job but it finally got me human again. Pain is its own issue, but worse, pain makes me dumb and leaves me exhausted.

    I spoke with three doctors, all of whom told me flatly there was no way pain could be caused by the aftermath of surgery. One suggested psychotherapy, thinking I must be anxious or depressed, not that there was something physically wrong.

    Yesterday was my first visit to a PT. She asked great questions, understood what I was talking about, and did not treat me like a crazy woman. That alone was huge. But of more lasting value, she was able to identify some of what is going on, could trigger what is normally random pain, and has a plan to address it. She points out there are likely multiple things going on and has a scar tissue specialist lined up for when I am done with the PT.

    It is, of course, too early for me to know if this will work or how well it will work out for me. It sounds as if the next two months will be painful and icky, but my poor body will finally get the care it needs as I learn how to support it in healing. It also sounds like I may be doing Yoga for the rest of my life. This is not so bad. Two hours of Yoga a week for maintenance would sure leave room for a lot more in my life than walking 14 miles every Saturday.

    There is one type of pain that confuses everyone. When I fly, the take off and the flight itself are fine, but from about 11,000 or 10,000 feet down to landing it feels like I am being torn apart inside. Recovery is at least two weeks. Even driving down from Donner Pass, which is a quick plunge on a highway from 7,000 feet to almost sea level, I was in a concerning level of pain with multi-day recovery. Has anyone else run across information about this, or have experience to share? My former and I hope some day future career gets derailed if I cannot fly internationally perhaps twice a year, plus multiple domestic flights each year.

    I wish my doctors had known about PT for this condition. Considering how common this seems to be, it seems like every OB/GYN in the country should have to take a class on when a referral is appropriate, and even which questions to ask women with endo, since often I think people are shy to volunteer symptoms. …especially when we get shut down that what we say is “impossible,” when we are the ones living in our bodies. It’s 2016, people, come on!

    It is not easy to describe how fantastic it is to have hope again. I want my life back. My family sure wouldn’t mind my getting better either.

    Thanks again for great information.

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