How is Endometriosis Treated? A Pelvic Floor PT’s Approach
If you've been diagnosed with endometriosis or you have been wondering whether your symptoms could mean you have endo, learning more about how endometriosis is treated can be very helpful.
With endometriosis affecting so many people, it's important that more information is published so everyone can know as much as they can about the condition.
What is Endometriosis?
Endometriosis is a chronic inflammatory condition where tissue similar to the uterine lining grows outside of the uterus.
These lesions have been found on the ovaries, fallopian tubes, bladder, bowels, and in some cases, even higher in the abdomen.
How Endometriosis Is Typically Treated
Excision surgery is the gold standard of endometriosis treatment.
This involves a laparoscopic surgery where the endo lesions are cut or carved out of the affected tissues.
Excision surgery has the highest long-term results for endometriosis symptoms. For less invasive treatment options, many patients try anti-inflammatory drugs, diet modification, hormonal birth control, and hormonal modulators.
Another very useful option for treatment and symptom management is pelvic floor physical therapy.
Where Pelvic Floor PT Fits In
Pelvic floor physical therapy is a great option to address symptoms associated with endometriosis.
While pelvic PT cannot cure endo, it can help reduce symptoms and improve your quality of life. The best part about pelvic floor PT is that it is non-invasive and does not require drugs or hormone therapy.
A specialized pelvic floor therapist is able to help alleviate symptoms commonly associated with endometriosis by using:
Hands on manual therapy
Guided exercises and stretches to alleviate aches and pains
Nervous system regulation to decompress the body’s response
Red light therapy to lower inflammation
Modifications to improve bladder and bowel function
What a Pelvic Floor PT Evaluation Looks Like
Your first pelvic floor physical therapy evaluation for endometriosis is an opportunity to better understand your symptoms, how they may be impacting your daily life, and how your whole body may be contributing to your pain.
1. Your history and symptoms
First, you will sit down with your pelvic floor physical therapist and talk through your history.
She will ask questions about your endometriosis diagnosis, previous surgeries or excision procedures, pain symptoms, and any other pertinent medical history.
You will also discuss how your symptoms impact your everyday life, including pain with your period, ovulation, bowel movements, urination, intercourse, exercise, or prolonged sitting.
Your therapist may ask about your pain patterns, previous treatments, and what activities or positions make your symptoms better or worse.
This conversation helps your therapist understand the bigger picture and create an evaluation that is specific to you and your goals.
2. Your objective examination
Your therapist will then perform a thorough objective exam to assess how your body is moving and identify potential contributors to your symptoms. This may include:
Postural assessment: Looking at your standing and sitting posture, alignment, and how you hold tension throughout your body.
Movement analysis: Assessing how your spine, pelvis, hips, and other areas of your body move during functional movements.
Breathing and abdominal assessment: Looking at your breathing patterns, rib cage movement, and how your abdomen and diaphragm may be contributing to pressure management and pelvic floor function.
Musculoskeletal assessment: Evaluating your hips, low back, pelvis, abdominal wall, and other areas that may be contributing to or compensating for pelvic pain.
Hands-on assessment: Gentle manual assessment of muscles, connective tissue, and areas of tension or tenderness to help identify restrictions that may be contributing to your symptoms.
Your therapist will explain what she is assessing throughout the process and answer any questions you may have.
3. Internal pelvic floor assessment, if appropriate
If deemed appropriate and you feel comfortable, your pelvic floor physical therapist may perform an internal vaginal exam/pelvic exam.
This is not required for your evaluation or treatment, and your consent is always necessary.
An internal exam can help your therapist assess pelvic floor muscle tone, tenderness, strength, coordination, and the ability of the muscles to relax.
Many individuals with endometriosis experience pelvic floor muscle overactivity or increased muscle tension, which may contribute to pain with intercourse, pelvic pain, bowel movements, or other symptoms.
4. Your first treatment session
You will likely receive some hands-on treatment during your first session, depending on your symptoms, findings, and comfort level.
This may include gentle manual therapy to the abdomen, hips, low back, pelvis, or other areas of the body that may be contributing to your pain.
Treatment may also include breathing techniques, gentle movement, nervous system downregulation, or exercises designed to help you connect with and relax your pelvic floor.
5. Your personalized treatment plan
At the end of your evaluation, your therapist will review her findings with you and answer any questions you may have. Together, you will create a personalized treatment plan based on your symptoms, goals, and lifestyle.
This may include:
Hands-on manual therapy.
Pelvic floor relaxation and coordination exercises.
Hip, spine, and pelvic mobility or strengthening.
Breathing and pressure management strategies.
Education on pain, movement, and symptom management.
A personalized home exercise program.
Recommendations for the frequency and duration of your visits.
While pelvic floor PT cannot cure endometriosis, it absolutely can help with symptom reduction and improve your quality of life.
Common Pelvic Floor Findings in People With Endometriosis
Every person with endometriosis is different, and your symptoms and physical therapy findings will be unique to you.
However, there are some common patterns we may see during a pelvic floor physical therapy evaluation for endometriosis.
Overactive or Tight Pelvic Floor Muscles
One of the most common findings in people with endometriosis is an overactive pelvic floor. This means the pelvic floor muscles may have difficulty fully relaxing, even when you are not consciously contracting them.
Chronic pelvic pain can cause the pelvic floor muscles to tighten or guard as a protective response.
Over time, these muscles may remain in a heightened state of tension, which can contribute to additional pain and difficulty relaxing.
An overactive pelvic floor may contribute to symptoms such as:
Pain with vaginal penetration or intercourse.
Pelvic pressure or aching.
Pain with bowel movements or urination.
Difficulty relaxing during bowel movements.
Pain with prolonged sitting.
Difficulty tolerating exercise or certain movements.
Trigger Points and Muscle Tenderness
Your pelvic floor muscles, just like the muscles in your neck, shoulders, or back, can develop areas of increased tension and tenderness called trigger points.
These areas may be sensitive to touch and can sometimes contribute to pain in the pelvis, abdomen, hips, or low back.
During your evaluation, your physical therapist may assess for tenderness and increased muscle tone in the pelvic floor and surrounding muscles.
Fascial Restrictions and Connective Tissue Tension
Endometriosis, previous abdominal surgery, inflammation, and chronic pain can all contribute to changes in how the tissues of the body move and feel.
Your therapist may assess for areas of tension or restricted mobility in the abdominal wall, pelvis, hips, glutes, and inner thighs. These areas are all connected through muscles, fascia, and connective tissue, and restrictions in one region may influence how another area moves or feels.
For individuals who have undergone laparoscopic excision or other abdominal surgery, scar tissue and changes in abdominal wall mobility may also be relevant findings.
Muscle Guarding and the Pain-Tension Cycle
Pain can cause your muscles to tighten as a protective response. When this happens repeatedly, the muscles may become more sensitive and have difficulty returning to a relaxed state.
This can create a cycle:
Pain → Muscle guarding → Increased muscle tension → More sensitivity and discomfort
This does not mean that pelvic floor tension is the cause of all endometriosis pain. Endometriosis is a complex condition, and pain can have multiple contributing factors. However, addressing pelvic floor overactivity and surrounding muscle tension may help reduce some of the musculoskeletal contributions to your symptoms.
Other Findings We May Assess
Depending on your symptoms and goals, your pelvic floor physical therapist may also evaluate:
Breathing patterns and diaphragm function.
Hip and low back mobility.
Abdominal wall strength and coordination.
Pelvic floor relaxation and coordination.
Bowel and bladder habits.
Pelvic Floor Physical Therapy Treatment for Endometriosis
There are many treatment options available in pelvic floor physical therapy for people with endometriosis. Because every person's symptoms, history, and treatment goals are different, your plan will be individualized to your body and what you need most.
Our approach combines hands-on manual therapy, movement, and education to help address the musculoskeletal contributors to your pain and improve how you feel in your everyday life.
Manual Therapy
Hands-on treatment may be used to address areas of muscle tension, tenderness, and restricted tissue mobility. Depending on your symptoms and findings, this may include:
Abdominal wall and connective tissue: Gentle manual therapy to the abdomen to address areas of tension, sensitivity, and restricted mobility. This may be especially relevant for individuals with abdominal scar tissue following surgery.
Inner thighs and hip muscles: Treatment to the adductors and surrounding hip musculature, which may become tight or tender in response to chronic pelvic pain.
Glutes and low back: Manual therapy to surrounding muscles that may contribute to pelvic tension, hip discomfort, or pain with movement.
Pelvic floor muscle release: When appropriate, gentle internal vaginal or rectal manual therapy may be used to assess and address pelvic floor muscle tension, tenderness, and trigger points. Internal treatment is never required and is performed only with your informed consent.
The goal of manual therapy is to help improve tissue mobility, reduce muscle guarding, and make movement more comfortable.
Gentle Movement and Exercise
Movement is an important part of endometriosis care. Depending on your symptoms and tolerance, your physical therapist may prescribe gentle exercises to help improve circulation, mobility, strength, and overall function.
Your program may include:
Gentle pelvic and hip mobility.
Breathing and pelvic floor relaxation exercises.
Low-impact movement to improve circulation and reduce stiffness.
Gradual strengthening to support your pelvis, hips, and whole body.
Exercise modifications to help you stay active without unnecessarily aggravating your symptoms.
Exercise will be progressed at a pace that feels appropriate for your body. The goal is to help you feel more confident moving and participating in the activities you enjoy.
Red Light Therapy
Red light therapy may be incorporated into your treatment plan as an adjunct to hands-on care and movement to help reduce pain. It uses specific wavelengths of light to target tissues and is being studied for its potential effects on inflammation, pain, and tissue healing.
Education and Home Exercise
Understanding your symptoms and how your body responds to pain is an important part of treatment. Your therapist may provide education on pelvic floor relaxation, breathing, posture, movement strategies, and ways to modify activities that may be aggravating your symptoms.
You will also receive a personalized home exercise program to help you continue working toward your goals between visits.
Your Treatment Is Unique to You
There is no one-size-fits-all approach to endometriosis pelvic floor physical therapy. Some people may benefit from gentle manual therapy and relaxation, while others may need a gradual return to exercise, scar tissue work, or a combination of approaches.
Working Alongside Your Medical Team
At Cappuccino Physical Therapy, we believe that endometriosis care is most effective when your medical team works together. Endometriosis is a complex condition that can impact many aspects of your physical and emotional well-being, and pelvic floor physical therapy is one important piece of comprehensive care.
We work alongside your medical team to help you receive individualized, coordinated care. When appropriate and with your permission, we can communicate with your:
Endometriosis surgeon or gynecologist.
Pain management physician.
Primary care physician.
Mental health therapist.
Registered dietitian.
Other healthcare providers involved in your care.
Collaboration may include sharing relevant evaluation findings, discussing your treatment goals, and helping your providers understand how your musculoskeletal symptoms may be impacting your daily life.
Where to Find Pelvic Floor PT for Endometriosis in Thousand Oaks
You don't have to navigate endometriosis alone.
Endometriosis is a complex disease that can impact so many aspects of your life. From pelvic pain and painful periods to bowel and bladder symptoms, pain with intercourse, and difficulty exercising, your symptoms deserve to be heard and understood.
At Cappuccino Physical Therapy, we are here to help you understand your body, address the musculoskeletal contributors to your symptoms, and work toward feeling more comfortable and confident in your everyday life.
Whether you have recently been diagnosed with endometriosis, are preparing for excision surgery, recovering from surgery, or have been living with symptoms for years, pelvic floor physical therapy may be an important part of your care.
You deserve care that is specific to you.
If you suspect you have endometriosis or are looking for support managing your symptoms, we would love to help.
Give us a call today to schedule your pelvic floor physical therapy evaluation.
