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Pelvic therapist helping woman with exercises

Endometriosis and Pelvic Floor Physical Therapy

What is endometriosis?

Endometriosis is a chronic condition that affects about 10% of women worldwide (World Health Organization, 2023). It is characterized by the endometrium (lining of the uterus) growing outside the uterus and on surrounding pelvic organs, such as the ovaries, fallopian tubes and sometimes even outside the pelvic organs. This misplaced tissue can cause significant pain, inflammation and scar tissue formation. Some of the common symptoms of endometriosis include:

  • Pelvic pain: often associated with menstrual periods that is usually more severe than typical period cramps that may begin before and extend several days after a period
  • Menstrual irregularities: Heavy bleeding during periods, or bleeding between periods
  • Pelvic floor dysfunction: pain with intercourse, difficulty with bowel movements and/or urgency
  • Bowel and bladder issues: common symptoms include urinary frequency and urgency, constipation and bloating

Living with Endometriosis

Endometriosis can significantly impact one’s quality of life, but a well-rounded approach with various strategies can help to manage the condition:

  • Medical treatment: to manage hormonal levels, pain management, discuss surgical options
  • Regular exercise: can help to reduce pain and improve overall well-being
  • Healthy diet: a dietician can provide recommendations on anti-inflammatory foods to manage the symptoms
  • Support groups: connecting with others who have endometriosis can provide social and emotional support
  • Pelvic floor physical therapy: to manage pelvic floor dysfunction and pain

How can pelvic floor physical therapy help?

In women with endometriosis, pelvic pain often leads to pelvic floor dysfunction where muscles become overly tight or weak, contributing to other symptoms. A qualified pelvic floor therapist can help to identify the causes of pelvic floor dysfunction and treat the symptoms accordingly. Some of the interventions in pelvic floor physical therapy include:

  • Manual therapy: pelvic floor PTs are trained in techniques to reduce muscle tension, break-up scar tissue adhesions, and improve soft tissue mobility to alleviate pain within the pelvic region.
  • Therapeutic Exercises: targeted muscle activation and strengthening tailored to individual needs with the aim of restoring optimal muscle function and balance within the whole body
  • Neuromuscular Re-education: including patient education of relaxation techniques to down-regulate stressed systems, addressing postural awareness to decrease muscle tension and patterns of tension. Biofeedback is another option used to provide real-time feedback to teach patients about proper control of their pelvic floor muscles.

Overall, research and clinic experience have shown that pelvic floor physical therapy can offer benefits for women with endometriosis (Awad et al, 2017).

What can you do?

While endometriosis is a complex and challenging condition, incorporating pelvic floor physical therapy into the overall treatment plan can help significantly with pain management (Mansfield, 2022). By addressing underlying pelvic floor dysfunction, pelvic floor physical therapy offers a non-invasive approach to reducing pain and improving quality of life as part of a well-rounded treatment plan. A qualified pelvic floor physical therapist can help women with endometriosis determine the best course of action to address your symptoms. You can reach out to our Pelvic Health Navigator at (402) 717-7358 or visit our website for more information.

References

World Health Organization. (2023, March 23). Endometriosis. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/endometriosis. Accessed May 20, 2024

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.

Mansfield C., Lenobel D., McCracken K, Hewitt G, Appiah LC (2022). Impact of pelvic floor physical therapy on function in adolescents and young adults with biopsy-confirmed endometriosis at a tertiary children's hospital: A case series. Journal of Pediatric and Adolescent Gynecology, Volume 35, Issue 6, (Pages 722-727). https://doi.org/10.1016/j.jpag.2022.07.004.

Chun Li Kok, PT, DPT
Chun Li Kok, PT, DPT

Chun Li Kok, PT, DPT is a physical therapist with CHI Health.

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