So, you’ve been diagnosed with endometriosis. You might have chronic pelvic pain, digestive issues like diarrhea or constipation, fatigue, and bloating…. all of which might have worsened during your period. Maybe you’ve already had an excision surgery to remove the endometrial lesions. Maybe you’re waiting for surgery. Maybe you’re trying to manage your symptoms through hormonal birth control. Maybe you don't know where to start.

Where does pelvic floor physical therapy come in? We can’t cure endometriosis, so what’s the point? Pain is the most common complaint among individuals diagnosed with endometriosis.  It can be tempting to attribute all pain to the presence of endometrial lesions… but then how do you explain continued pain or symptoms following excision surgery, or after finding a hormonal birth control option that decreases your symptoms? The truth is, although endometrial lesions may be the primary cause of pain, there may be more factors contributing that help explain these continued symptoms. These factors may include our musculoskeletal system (our muscles, connective tissue, and joints) or an extra-sensitive nervous system (our brain, spinal cord, and nerves). Both of these systems can be heavily influenced by our activity, work, behaviors, and habits, and even by chronic pain itself–and this is the bread and butter of what pelvic floor PTs treat! So, even if you no longer have endo, you may still be struggling with the ways endometriosis changed your body, your nervous system, and your behaviors. 

Pelvic PTs take a very holistic approach to our assessments, meaning we might look at everything from how you breathe, how you sit on the toilet (yes, the Squatty Potty is for almost everyone!), the mobility and strength of your spine, pelvis, and hips… and lots more. While every person’s symptoms and experiences are unique, here are some common things we find:

1. A pelvic floor that doesn’t relax and lengthen!! When you’re in pain or frequently curled in a fetal position, your muscles tend to tense and shorten, leading to tightness and dysfunction. This can make it difficult to empty your bowels and bladder, cause pain with sexual activity, and can increase pelvic and low back pain. With your consent, we assess the pelvic floor with one gloved finger externally and internally (via vagina or rectum) to check how coordinated, flexible, and strong your pelvic floor is. We can treat a tense and tender pelvic floor in many ways, including manual therapy, pelvic floor stretches and breathing techniques, and with tools like dilators at home. We also check the surrounding body areas - like your hips and spine - to identify any muscle or fascial tension and/or joint restrictions that might be contributing to what’s happening with your pelvic floor. 

1. A nervous system that’s on high alert. We have two primary states of our autonomic nervous system: our sympathetic (“fight or flight”) and parasympathetic (“rest and digest”) systems. Ideally, there is a balance between these systems, but it’s not uncommon to find a sympathetic system that’s dialed “up” and a parasympathetic system dialed “down” in folks dealing with chronic pain or illness such as endometriosis. There’s a significant diagnostic and treatment delay for people with endometriosis, so chances are your body has spent a long time yelling, “Danger!” And just because you’ve had excision surgery doesn’t mean your body and brain suddenly feel safe. Signs you might be dealing with this include having trouble sleeping, poor digestion, a higher resting heart rate, difficulty regulating mood, and increased overall pain. Again, this is treatable! As physical therapists, we can help stimulate your vagus nerve (which dials “up” the parasympathetic “rest and digest” system) via manual therapy techniques, teach you stretches to do at home, discuss ways to optimize your sleep, and work on stress management. Managing any mental health concerns like depression or anxiety and working with a talk therapist can be very helpful here too. Even laughing with your friends can help your nervous system! 

As with anything, there is a lot of interplay between our musculoskeletal and nervous systems and we don’t treat any body part in isolation. For example, a tense pelvic floor might hurt when pressed on, and your brain perceives this sensation as a threat and will try to protect you… but likely by tensing those muscles further. Endometriosis is a traumatic disease that often creates a cycle of pain and fear. Working to break the cycle of pain and fear with a pelvic floor PT can help achieve lasting improvement in symptoms. After all, you are a whole human being and not a walking, talking, pelvis! And you’re certainly more than your disease.

Ultimately, pelvic floor physical therapists are there to  assess your individual needs and identify the causes of your symptoms and create a plan to address what we find. I often tell my clients that no “perfect” home program exists, because everybody has a unique set of needs and ability to continue the work at home. So don’t fear - I won’t ask you to do a million stretches or exercises every day in addition to all the other life things! 

We’re here to support YOU and hope to be a part of your journey!