Do pelvic floor therapy and endometriosis go together? Can pelvic floor PT help with endometriosis? Women with endometriosis consist of a special group of 1 in 10 women worldwide who may need extra support when it comes to pain management, organ displacement, and regaining natural movement.
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Endometriosis is a chronic inflammatory condition with multiple pathways for its expression, including genetics, retrograde menstruation, inflammation and the microbiome. It affects 11% of women, and its primary symptoms are pelvic pain and infertility due to endometrial tissue growing outside of the uterus where it does not belong and which the immune system cannot clean up properly.
Does endometriosis cause tight pelvic floor muscles? Continue reading to find out.
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What is the pelvic floor?
The pelvic floor is a muscle group that has two main functions (2). The first is to support the abdomen viscera including the bowels by acting as a “floor”. The second is to act as a constrictor to the urethral, anal and vaginal orifices.
But what do they actually do?
They help to stabilize the core which is quite important. They work with your abdominal and back muscles to stabilize your pelvis and the organs housed there. They also help to control abdominal pressure, such as when lifting, straining or doing physical activity. For those of you struggling, you will notice that it may not be easy to even stand up or sit down, as the pelvic floor muscles and core are activated during most any physical activity.
The muscles are involved in the act of urination and pooping. Sometimes, those with overactive bladders, chronic cystitis or constipation actually also have weak pelvic floor muscles.
As you age, having a strong pelvic floor is important to maintain balance and strength in order to avoid falls.
Pelvic floor therapy for endometriosis?
Let’s look at a few specific ways that endometriosis can impact the pelvic floor muscles.
1 Adhesions restrict normal movement
Many women with endometriosis develop adhesions, made of fibrinogen, which can stick to the reproductive organs and even the organs further north in the body. These adhesions can shift organs and restrict movement. It is not uncommon for endometriosis to be found on the bowels, intestines or even the diaphragm.
These adhesions can cause the delicate reproductive organs to move out of place and twist. As a result, you may unconsciously begin to move differently or tense up and experience muscle spasms.
2. Pain can increase pelvic muscle tension
The recurring pain (from painful menstruation or even from the pulling of adhesions) can also cause increasing levels of muscle tension in this sensitive region.
When you are in pain or scared, where do you clench up in your body? Many women find that the pelvic region is a tightly wound ball of stress from the pain and stress of endometriosis and other outside contributing factors.
This tension can cause difficulty with normal bowel movements, during sex, balance problems and muscle weakness. Not to mention that these issues can over time wreak your confidence in your body and spur mental health concerns such as anxiety and depression.
3. Movement distortions over time add up
Over time, these muscle dysfunctions can cause problems. They can cause perpetual muscle tightness and discomfort from tension. It can cause trouble with feeling relaxed in anytime or intimate situations. The tension can also lead to additional pelvic floor weakness, which can lead to problems with mobility, balance and endurance.
4. Post-surgery exacerbation of pelvic muscle floor weakness
Many women with endometriosis have the gold-standard tool for diagnosing the condition, a surgery called laparoscopy. To note, for some, this surgery is a short diagnostic tool and for others it can be a major hours long surgery to remove adhesions and cysts. Some may bonce back quite well from surgery and others will need a long recovery time. In some European countries, pelvic floor therapy is a given post-pregnancy and post-reproductive surgery, but in the US most are not aware or given the opportunity for this resource post-surgery.
Surgery post-laparoscopy can cause pelvic floor weakness or pain and discomfort or make current situations worse.
5. Pregnancy and post-birth complications
Pregnancy transforms a woman’s body. Muscles, tendons and joints are given new flexibility for a time and move in new ways. The pelvic floor is responsible for helping to contain the additional weight of the baby but also for labor and delivery. Given that many women these days have cesarean section births (c-section) the pelvic floor has even more to recover from.
Throw endometriosis on top of this and you may find yourself with a years or decades of pain, tension, muscle weakness and feel hopelessly without answers.
6. Other symptoms requiring help
Many women may find that they experience incontinence after surgery, pregnancy or even intense exercise (like high impact sports or weight training). Incontinence can be a sign that the pelvic floor muscles aren’t working properly and need further assessment and reprogramming.
What does pelvic floor physical therapy do?
Pelvic floor physical therapy is a specialty practice among physical therapy with focuses on the pelvic floor and abdominal muscles.
It can help women with issues such as (3):
- Frequent urination or feelings of needing to urinate
- Pelvic pain
- Pain with sex
- Pain post pregnancy or post surgery
- Abdominal separation
Can pelvic floor PT help with endometriosis?
Pelvic floor physical therapy can help to assess, diagnose and treat musculoskeletal issues women experience with endometriosis. There has even been research done that studied women in a specialized exercise setting with endometriosis and found that the specialized movement helped to significantly decrease pain and poor movement. (1)
Can Kegel exercises help endometriosis?
While kegel exercises have gained wide popularity for ways to treat weak pelvic floor muscles, for some women, the exercise is not advised. Many women do the exercise the wrong way, which can cause problems. Also, according to Dr. Bri Grogan, DPT, kegels aren’t even the most effective way to strengthen and stretch the pelvic floor muscles and she doesn’t consider them to be the gold standard. (4)
Biomechanical and musculoskeletal assessment
Women may find restorative healing through medical imaging and biomechanical diagnostic tests. The results of the tests could help pinpoint the most optimal treatment path for her in conditions such as incontinence, prolapse and pain. (5)
Further, the literature advocates for the proper assessment of women’s pelvic pain and to refer out (my words, to physical therapists) when appropriate. (6)
Relaxation skills physical examination
A pelvic floor physical therapist can assess the muscles ability to relax or not relax at the proper time in a certain situation. This insight can give clues to the impediment as well as inform the treatment plan.
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Home care accessories
There are things you can do at home to educate yourself further and improve your pelvic floor health. For one, you could practice breathing properly or do a pelvic floor workout from a reliable source (more on that below). For another, you could have some basic exercise equipment for doing at home workouts.
Pelvic floor health workout
If you are experiencing pain or discomfort, Dr. Bri Grogan is a Doctor of Physical Therapy and a wealth of knowledge when it comes to women’s pelvic floor issues. Dr. Grogan’s book, Lady Bits: Understand Your Body, Elevate Your Health, and Reclaim Your Spark Naturally describes her journey and describes pathways to her healing. A must-read for anyone experiencing pelvic floor pain or discomfort.
Here is one of her online workouts for the pelvic floor:
Products for pelvic health
There are a lot of products on the market ranging from wands to kegel devices to at home skiing fitness equipment that portend they will help improve your pelvic health. I would recommend discussing this with your pelvic floor physical therapist for their recommendation for your particular situation, and research further on your own as well. Don’t jump into a new exercise without doing your due diligence because what works for one may not work for you.
At the very least, I recommend a gym mat! I like this cushion-soft fitness mat.
If you feel stuck in your healing journey, take time to consider strengthening your pelvic floor muscles. Don’t neglect caring for your body, mind and spirit! Wishing you light and life 🙂
Additional research citations
- Awad E, Ahmed HAH, Yousef A, Abbas R. Efficacy of exercise on pelvic pain and posture associated with endometriosis: within subject design. J Phys Ther Sci. 2017 Dec;29(12):2112-2115. doi: 10.1589/jpts.29.2112. Epub 2017 Dec 7. PMID: 29643586; PMCID: PMC5890212.
- Raizada V, Mittal RK. Pelvic floor anatomy and applied physiology. Gastroenterol Clin North Am. 2008 Sep;37(3):493-509, vii. doi: 10.1016/j.gtc.2008.06.003. PMID: 18793993; PMCID: PMC2617789.
- Skinner, Morganne. Everything You Need to Know About Pelvic Floor Physical Therapy (PFPT) for Endometriosis. EndoFound Blog. https://www.endofound.org/everything-you-need-to-know-about-pelvic-floor-physical-therapy-pfpt-for-endometriosis.
- https://themomfeed.com/brianne-grogan-dpt/ podcast.
- Lucente V, van Raalte H, Murphy M, Egorov V. Biomechanical paradigm and interpretation of female pelvic floor conditions before a treatment. Int J Womens Health. 2017 Aug 3;9:521-550. doi: 10.2147/IJWH.S136989. PMID: 28831274; PMCID: PMC5548279.
- Harm-Ernandes I, Boyle V, Hartmann D, Fitzgerald CM, Lowder JL, Kotarinos R, Whitcomb E. Assessment of the Pelvic Floor and Associated Musculoskeletal System: Guide for Medical Practitioners. Female Pelvic Med Reconstr Surg. 2021 Dec 1;27(12):711-718. doi: 10.1097/SPV.0000000000001121. PMID: 34807882.