Endometriosis & the Pelvic Floor: Understanding the Connection
Endometriosis and pelvic floor dysfunction often go hand in hand.
Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside of the uterus, often contributing to pelvic pain, abdominal pain, painful periods, and pain with sexual activity. But the effects of endometriosis don’t necessarily stop at the reproductive organs.
The pelvic floor muscles can also become involved.
What Does Endometriosis Have to Do With the Pelvic Floor?
In a cross-sectional study examining pelvic floor function in people with endometriosis, 93.3% of participants reported pain, while 75% demonstrated increased muscle tone in the levator ani, a group of muscles that make up part of the pelvic floor.
Additionally, 50.4% had impaired pelvic floor relaxation along with decreased muscle strength and endurance.
While this was a relatively small study, these findings are consistent with what can be seen clinically in people experiencing endometriosis-related pelvic and abdominal pain.
Pain Can Change How the Pelvic Floor Functions
When someone experiences ongoing pelvic pain, the pelvic floor muscles may respond by becoming guarded or overactive.
Think about what happens when you experience pain—you may unconsciously tense your muscles to protect an area of the body. When this happens repeatedly, the pelvic floor can have difficulty fully relaxing.
Over time, this may contribute to:
- Pelvic pain
- Pain with intercourse
- Abdominal or hip discomfort
- Difficulty relaxing the pelvic floor
- Urinary or bowel symptoms
- Muscle weakness or reduced endurance
- Difficulty with daily activities
Importantly, pelvic floor dysfunction isn’t always about weakness. Sometimes the muscles are too tense, poorly coordinated, or unable to relax appropriately.
How Can Pelvic Floor Physical Therapy Help?
Pelvic floor physical therapy can be an important part of managing symptoms associated with endometriosis.
Treatment can be useful both before and after surgery, as well as for people choosing conservative management.
Depending on the individual’s symptoms and goals, pelvic floor physical therapy may address:
- Pelvic floor muscle tone and relaxation
- Breathing and pressure management
- Pelvic and abdominal mobility
- Muscle coordination and endurance
- Pain management
- Movement patterns
- Scar mobility following surgery
- Education about the pelvic floor and nervous system
A pelvic floor physical therapist can also help identify areas of dysfunction that may be contributing to symptoms and affecting daily life.
Your Pain Is Worth Addressing
Endometriosis can have a significant impact on quality of life, and pelvic pain shouldn’t simply be something you learn to live with.
While pelvic floor physical therapy does not treat or remove endometriosis lesions, it can be an important component of a multidisciplinary approach to managing the musculoskeletal symptoms associated with the condition.
If you’re experiencing endometriosis-related pelvic pain, abdominal pain, painful sex, or difficulty relaxing your pelvic floor, working with a pelvic floor physical therapist may be one piece of your overall care team.
Your pelvic floor is part of the bigger picture—and it deserves to be evaluated.
References: https://pubmed.ncbi.nlm.nih.gov/37042996/