Pelvic Floor Therapy for Endometriosis: Can It Help Me?

Pelvic Floor Therapy for Endometriosis:

Pelvic floor therapy is a form of physical therapy that can help improve the strength and function of the pelvic floor muscles. Pelvic floor therapy for endometriosis can help reduce pain.

What are the Pelvic Floor Muscles?

The pelvic floor muscles support the main organs in the pelvic cavity. These muscles include the large levator ani (pubococcygeus, puborectalis, and iliococcygeus) and the smaller coccygeus. The pelvic floor muscles perform several vital functions, such as contracting and relaxing for urination and defecation, supporting vaginal childbirth, aiding blood flow during orgasm, and supporting the pelvic organs.

Where are They Located?

The pelvic floor muscles attach to the pelvis and spine, providing core stability to the body. You can feel the pelvic floor muscles by tightening the vaginal opening, urethra, and anus. These muscles can work automatically but are also under voluntary control.

What Can Happen with Pelvic Floor Muscle Disorders?

Pelvic floor muscle disorders can mean the muscles are too weak or too tight, as both conditions can cause problems. Weak muscles can lead to urinary and/or fecal incontinence, pelvic organ prolapse after menopause, anal incontinence, and stress incontinence. Muscles that become too tight can cause constipation, pelvic and back pain, painful intercourse, and difficulty urinating or defecating.

How are Pelvic Floor Muscles Involved in Endometriosis?

Chronic pelvic pain is one of the main symptoms of endometriosis. This pain can cause the pelvic floor to contract, leading to pelvic floor dysfunction. These dysfunctions can persist even after the original pain subsides, leading to pelvic floor spasms, painful intercourse, and pain during urination or defecation. Researchers believe that endometriosis can also change the way the brain perceives pain. In this case, the continuous pain impulses from endometriosis lesions cause an increased muscle reflex in the pelvic area, leading to muscle tension and pelvic floor dysfunction.

Endometriosis is also characterized by adhesions (scarring) between adjacent endometriosis lesions and even on other organs. This leads to inflammation and pain. In severe cases, adhesions can result in a frozen pelvis, one of the most severe forms of the disease.

Does Pelvic Floor Therapy Help with Endometriosis Pain?

Pelvic floor therapy includes various strengthening exercises, stretching, and lifestyle changes to improve the pelvic floor muscles' function. Women experiencing pelvic, abdominal, or back pain that interferes with daily activities should consult an experienced physical therapist to determine if the pelvic floor muscles play a role and take corrective measures. Pelvic floor therapy can also help reduce "referred pain" symptoms. Referred pain means pain felt in other parts of the body, such as the back or abdomen, while the main cause is in the pelvic floor muscles.

A study found that pelvic floor therapy was helpful in improving pain symptoms after six sessions in 63% of patients with endometriosis.

What Does a Typical Pelvic Floor Therapy Session Include?

A typical pelvic floor therapy session begins with an open discussion about your medical history, current symptoms, and diagnosis. The therapist will also ask about your daily routine and personal and professional activities. Then, they will prescribe simple exercises for a preliminary assessment. Physical therapists can evaluate the pelvic floor muscles in various ways, including external observation, movements, and an internal exam, depending on your description of pain and comfort levels. Subsequent sessions may include improving the strength and mobility of the back, pelvis, abdomen, and posture. Pelvic floor therapy goes beyond Kegel exercises. The therapist may focus on improving the mobility of your pelvic floor muscles rather than strengthening them. Other exercises include breathing techniques, stretching, and coordination. The therapist will also teach you basic exercises you can do at home.

Is Pelvic Floor Therapy a Cure for Endometriosis?

It is important to emphasize that pelvic floor therapy does not cure endometriosis. Laparoscopic deep excision surgery is the only standard treatment for the disease. However, pelvic floor therapy can help improve pain symptoms by enhancing muscle mobility and coordination.

1. Muallem, J., Velho, R. V., Netzl, J., Sehouli, J., & Mechsner, S. (2022). Pelvic floor hypertension: possible factors for pelvic floor tenderness in endometriosis patients—a pilot study. BMC Women's Health, 22(1), 1-10. https://doi.org/10.1186/s12905-022-01836-8
2. Mansfield, C., Lenobel, D., McCracken, K., Hewitt, G., Appiah, L., & Lenobel, L. C. (2022). Impact of Pelvic Floor Physical Therapy on Function in Adolescents and Young Adults with Biopsy-Confirmed Endometriosis at a Tertiary Children's Hospital: A Case Series. Journal of Pediatric and Adolescent Gynecology, 35(6), 649-654. https://doi.org/10.1016/j.jpag.2022.09.006
3. Hunt, J. B. (2019). Pelvic Physical Therapy for Chronic Pain and Dysfunction Following Laparoscopic Excision of Endometriosis: Case Report. The Internet Journal of Allied Health Sciences and Practice, 17(3), Article 10. https://doi.org/10.46743/1540-580X/2019.1684
4. Wójciak, R. W., Stompór, R., & Paprocka-Borowicz, M. (2022). Physiotherapy Management in Endometriosis. International Journal of Environmental Research and Public Health, 19(23), 15869. https://doi.org/10.3390/ijerph192315869