Endometriosis is a chronic condition that affects approximately 1 in 10 women of reproductive age, causing pain and discomfort that can significantly impact daily life. Despite its prevalence, endometriosis is often misunderstood or underdiagnosed, leading many to suffer in silence. One of the most significant aspects of managing this condition is addressing pelvic floor dysfunction, which often accompanies it. As a pelvic floor physical therapist, I’m here to provide an overview of endometriosis, the underlying causes and risk factors, its symptoms, and how pelvic floor therapy can help manage the associated pain and dysfunction.
What is Endometriosis?
Endometriosis occurs when tissue similar to the lining of the uterus (known as the endometrium) grows outside the uterus. This tissue behaves in the same way as uterine lining—it thickens, breaks down, and sheds with each menstrual cycle. However, because it’s outside the uterus, there’s nowhere for the blood and tissue to exit, which leads to inflammation, scarring, and adhesions (bands of fibrous tissue). Over time, these adhesions can cause pain, internal damage, and even fertility issues.
While endometriosis is commonly associated with painful periods, it can cause a range of symptoms that affect both physical and emotional well-being, impacting not only the reproductive organs but also the bowel, bladder, and in rare cases, even the lungs.
Causes and Risk Factors
The exact cause of endometriosis remains unclear, but several factors are believed to contribute to its development. Potential causes include genetics, as endometriosis tends to run in families, and immune system dysfunction, which may prevent the body from clearing endometrial-like tissue outside the uterus.
Certain risk factors increase the likelihood of developing endometriosis, including:
Family history: Having a first-degree relative (mother, sister) with endometriosis increases the risk.
Early onset of menstruation: Starting periods before age 11 may increase the risk of developing endometriosis.
Short menstrual cycles: Menstrual cycles shorter than 27 days and heavy periods may contribute to a higher risk.
Never giving birth: Individuals who have never been pregnant may have a higher risk of endometriosis.
Anatomical abnormalities: Conditions like uterine abnormalities or blocked menstrual flow can also increase risk.
While these factors can increase the likelihood of endometriosis, many individuals with the condition have no clear risk factors, and some without these factors may still develop the disease.
Symptoms of Endometriosis
The symptoms of endometriosis can vary greatly between individuals, but some of the most common include:
Pelvic Pain: One of the hallmark symptoms, often felt around the time of menstruation. Pain can be severe and can also occur at other times during the month.
Dyspareunia (Painful Intercourse): This pain, often deep in the pelvis, can affect sexual relationships and is a common complaint among those with endometriosis.
Pain with Bowel Movements or Urination: If endometriosis involves the bowel or bladder, it can lead to discomfort or pain during these activities.
Menstrual Abnormalities: Heavy, irregular, or painful periods are often experienced.
Fatigue: Chronic fatigue is common, likely linked to both the pain and inflammation caused by endometriosis.
Infertility: Approximately 30-50% of people with endometriosis may experience difficulty getting pregnant, though this is not always the case.
Bloating: Many individuals with endometriosis experience bloating, which can exacerbate the discomfort.
Digestive Issues: These can include diarrhea, constipation, and nausea, which are often linked to endometriosis when it affects the bowel.
Lower Back Pain: Another common symptom, often linked to the pelvic pain caused by endometriosis.
Diagnosing Endometriosis
Getting a diagnosis of endometriosis can be a lengthy process, with the average time to diagnosis taking seven years. This is due to its symptoms varying between women, and the common misconception that period pain is normal. While doctors may suspect endometriosis based on symptoms and history, a definitive diagnosis usually requires laparoscopy, a minimally invasive surgery to visualize endometrial tissue. Imaging like ultrasounds or MRIs can help assess the disease’s extent but can't confirm the diagnosis.
Pelvic Floor Physical Therapy for Endometriosis
While pelvic floor physical therapy (PFPT) can’t cure endometriosis, it plays a crucial role in managing symptoms and improving overall quality of life. Pelvic floor PT’s specialize in symptom management, helping to alleviate pain, improve mobility, and reduce dysfunction related to the pelvic floor.
One of the key goals of PFPT is to address the internal and external tissue restrictions that often develop due to chronic pain, cramping, and scarring from endometriosis. Over time, many individuals with endometriosis experience increased muscle tone and trigger points in the pelvic floor, which can worsen pain and dysfunction.
Here’s how PFPT can help:
Tissue Mobilization: Pelvic PTs use manual therapy techniques to free the fascia, muscles, and organs from restrictions that may be caused by endometriosis-related inflammation or after excision surgery. This helps restore mobility and reduce pain.
Pain Management: Pelvic PTs work with patients to down-regulate overactive muscles and calm the Central Nervous System. We assess muscle tone and teach techniques to relax the pelvic floor, addressing the hyperactive response many people with chronic pain experience.
Self-Care Techniques: Pelvic PTs educate patients on how to perform self-massage of the abdomen and pelvic floor to optimize mobility, relieve tension, and promote healing. These techniques empower patients to manage discomfort on their own between visits.
Exercise & Breath Work: Pelvic PTs provide individualized exercises to improve pelvic floor strength and mobility, alongside breathing exercises to help manage pain, reduce muscle tension, and improve relaxation.
Scar Tissue Recovery: After laparoscopic surgeries to address endometriosis, PFPT can aid in healing by reducing scar tissue restrictions, preventing adhesions, and promoting better healing and tissue flexibility.
Patient Support: One of the most important aspects of pelvic floor therapy is the time and attention Pelvic PTs give their patients. On average, we spend about an hour with each patient per visit, offering a safe space for patients to feel heard, supported, and advocated for. This personalized care is especially valuable for those who feel overwhelmed or intimidated by the challenges of living with endometriosis.
Ultimately, PFPT provides a holistic, patient-centered approach to managing endometriosis symptoms and improving overall pelvic health. While it’s not a cure, it can significantly enhance recovery, reduce pain, and promote a better quality of life.
Lifestyle Tips for Managing Endometriosis
While medical treatments are vital, lifestyle changes can also make a difference in managing endometriosis:
Diet: An anti-inflammatory diet, rich in vegetables, fruits, and omega-3 fatty acids, may help reduce inflammation and pain. Avoiding processed foods and excessive dairy might also benefit some individuals.
Eliminating environmental toxins: Reducing exposure to hormone disruptors found in common products like plastics, skincare items, and cleaning supplies. Making simple swaps, such as using a metal water bottle and choosing cleaner makeup or shampoo brands, can have a significant impact over time.
Stress Management: Chronic stress can exacerbate symptoms. Techniques such as mindfulness, deep breathing exercises, and relaxation can help manage stress and reduce flare-ups.
When to Seek Professional Help
If you're experiencing symptoms of endometriosis, it’s essential to speak with a healthcare provider. Early diagnosis and treatment can significantly improve outcomes. If you have:
Severe pelvic pain
Pain during intercourse or bowel movements
Difficulty getting pregnant
Urinary symptoms like pain or urgency
Consider seeing a PFPT, who can help address pain, pelvic floor dysfunction, and improve your quality of life.
Endometriosis is a complex and often painful condition, but it is manageable with the right treatment plan. Pelvic floor physical therapy offers significant benefits for those dealing with pelvic pain, urinary issues, and painful intercourse related to endometriosis. By seeking a multidisciplinary approach, including physical therapy, individuals can find relief and improve their overall well-being.
References:
American College of Obstetricians and Gynecologists. (n.d.). Endometriosis. Retrieved February 10, 2025, from https://www.acog.org/womens-health/faqs/endometriosis?utm_source=redirect&utm_medium=web&utm_campaign=otn
Endometriosis Foundation of America. (n.d.). Endometriosis Foundation of America. Retrieved February 10, 2025, from https://www.endofound.org/
International Pelvic Pain Society. (2023). Endometriosis [PDF]. Retrieved February 10, 2025, from https://www.pelvicpain.org/images/pdf/Patient%20Info%20Handouts%202023/Endometriosis%202023.pdf
National Institute of Child Health and Human Development. (n.d.). Endometriosis. U.S. Department of Health and Human Services. Retrieved February 10, 2025, from https://www.nichd.nih.gov/health/topics/endometriosis
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