Physical Therapy for Endometriosis
by Dr. Sarah Shimanek, PT, DPT, WCS, PRPC
Endometriosis is a complex condition often accompanied by chronic pelvic pain. This pain arises from a combination of factors affecting the nervous, musculoskeletal, psychological, genitourinary, gastrointestinal, and gynecologic systems.
Managing endometriosis-related pain is far from simple. Most individuals benefit from a multifaceted approach that may include pharmacological treatments, surgery, acupuncture, nutrition, behavioral and sleep modifications, psychotherapy, and physical therapy.
The Role of Pelvic Floor Physical Therapy
Pelvic floor physical therapy is a specialized branch of physical therapy that focuses on healing within the pelvic region. Physical therapists who specialize in treating endometriosis are highly trained and certified in pelvic health.
A pelvic floor physical therapist will conduct a thorough, holistic evaluation, beginning with an in-depth discussion of your daily routines, symptoms, and treatment goals. This is followed by a physical examination tailored to those goals.
A comprehensive physical examination should include:
Abdominal and fascial assessment – Evaluating the tissues surrounding the organs for tension or restrictions.
Posture assessment – Identifying any musculoskeletal imbalances that may contribute to pain.
Pelvic floor assessment – Conducted externally and, with consent, intravaginally, to evaluate muscle function and identify potential dysfunctions.
Understanding the Pelvic Floor and Myofascial Trigger Points
The pelvic floor refers to a group of muscles at the base of the pelvis, spanning from the pubic bone to the tailbone and sit bones. These muscles extend internally to support pelvic and abdominal organs and play a critical role in bowel, bladder, and sexual function.
Individuals with pelvic pain due to endometriosis often have myofascial trigger points in the pelvic floor, fascia, and surrounding ligaments. A trigger point is a hypersensitive area that disrupts motor function, autonomic responses, and visceral organ function.
A trained pelvic floor therapist can identify and treat these trigger points using transvaginal manual therapy and visceral therapy. Studies show that these treatments can reduce pain and improve both physical and mental function in 80% of individuals with endometriosis.
Additional Benefits of Pelvic Floor Therapy
Beyond manual therapy, a pelvic floor physical therapist will prescribe individualized exercises aimed at:
Modulating the nervous system’s response to pain.
Enhancing physical activity and endurance.
Minimizing bone density loss.
Addressing associated bowel, bladder, or sexual dysfunction through targeted behavioral and exercise recommendations.
Finding a Pelvic Floor Physical Therapist
Pelvic floor physical therapy is a valuable addition to any endometriosis treatment plan and can have a profound impact on managing chronic pain. You can find a trained pelvic floor physical therapist through resources such as:
When seeking care, be sure to ask about a therapist’s experience and success in treating individuals with endometriosis.
Sources:
Mazur-Bialy A, Tim S, Pępek A, et al (2024). Holistic Approaches in Endometriosis - as an Effective Method of Supporting Traditional Treatment: A Systematic Search and Narrative Review. Reproductive Sciences, January 2024.
Goodwin D, Carey E (2023). How to manage endometriosis-associated pain. Contemporary OBGYN, April 2023.