Pelvic floor physical therapy can be a great source of treatment for those with endometriosis as well as Pelvic Floor Dysfunction or PFD. Patients with endometriosis often have PFD as a result of pelvic muscles being constricted due to years of pain and inflammation. Endometriosis lesions (if in the pelvic cavity) largely disrupt or affect the pelvic floor, because as we know, endometriosis exists outside of the uterus; it could be anywhere within the pelvic cavity, thus causing pain in the lower abdomen and pelvis. The muscles surrounding the pelvic floor are thought to be stuck in fight-or-flight mode, leaving the patient in chronic pain. To correct this, a physical therapist will try different relaxation techniques specific to the patient’s needs, as well as strengthening muscles that have not been used in a while. Contrary to popular belief, pelvic floor physio goes beyond just strengthening and relaxing muscles.
A common symptom of endometriosis and PFD is urinary incontinence, which is the loss of bladder control- otherwise known as leakage of some sort. This can occur in men and women, but more so with women who have PFD and/or endometriosis. Some women may have trouble urinating or have unintentional leakage- meaning they cannot hold it. There are numerous urinary incontinence types, but I am only going to elaborate on a few. The first is urge incontinence. This is when there is a strong urge to urinate but leakage happens before making it to the bathroom. With this type specifically, the pt will give certain resources to help “train” your bladder and pelvic muscles because as we know by now, they all work together. Urinary frequency can also happen as a result of pelvic floor dysfunction. Frequently urinating throughout the day and/or night can actually cause problems not only to the bladder, but to the pelvis, urethra, and even the digestive system. For example, I’m sure your parents told you growing up to use the bathroom before leaving the house, so as a disciplined child, you did. Just like many others, that habit continued into adulthood and by this time it was routine. But what you may not have noticed was that your body became accustomed to this habit. With time, the pelvic floor becomes tight and the brain sends signals saying it’s time to go, so naturally you go to the bathroom. There are plenty of strategies given to control bladder function: bladder and urge suppression strategies, programmed urination methods, and lifestyle changes, such as diet. Urinary incontinence is very serious in the pelvic floor PT world because the possibility of endometriosis being on the bladder can widely disrupt your life.
A physical therapist can also help with digestive/bowel issues, orthopedic issues, and sexual trauma or pain. Internal work is done by a physical therapist because many women with endometriosis and/or PFD suffer from pain with sexual intercourse. It is important to note that this is not the only reason why an internal exam might be completed. Much like a pelvic exam, the physical therapist will use his/her finger to manipulate the pelvic muscles. This routine, with time, will hopefully make it easier for women to participate in pain free sex. Another way to help with painful sex is using dilators. Though uncomfortable, they are used to determine mobility, trigger points, and muscle spasms. The goal is to make the next pelvic exam or routine pap smear less excruciating.
A major misconception with endometriosis and pelvic floor dysfunction is that it is common/normal within women, therefore causing society to believe it is not a debilitating disease. Although few women can function normally with either disease, the majority of women cannot but are forced to due to society’s lack of research, funding, knowledge, and advocacy. Fear of pain and discomfort pushes women away from pelvic floor physical therapy. However, as stated above, the practice has been known to lessen the symptoms of both diseases. It is important to start the conversation about endometriosis and pelvic floor dysfunction because the miniscule amount of awareness surrounding women’s health can be detrimental to women worldwide. This is our reality. My reality.
About the author
Hi! My name is Brea! I am a volunteer Endometriosis Patient advocate for the American End of Endo project.
I was diagnosed with endometriosis & pelvic floor dysfunction in December 2021 through laparoscopic excision surgery. Since then, my endometriosis has been removed & my symptoms are manageable-more so than they were before. I go to pelvic floor PT every week to further assist in my pelvic floor problems-which in my case has definitely improved.
Now I help spread awareness for endo by shining light on what endometriosis actually is & how symptoms can drastically affect ones life. By spreading awareness, we are standing up for other endo patients who are not receiving adequate care and resources that should otherwise be given.