Pelvic Floor Physical Therapy for Endometriosis 

Endometriosis is a complex, full-body disease that affects an estimated 1 in 10 women worldwide. Unfortunately, many of those seeking a diagnosis face long delays — symptoms are often dismissed as “bad cramps” or just another “heavy period,” leading to an average 10-year delay in receiving proper care and treatment. Far too often, patients are told their pain is “all in their head,” when in fact, nothing could be further from the truth.

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Endometriosis occurs when tissue similar to the lining of the uterus (endometrial-like tissue) grows outside of the uterus. Unlike the uterine lining that sheds each month, this tissue behaves differently — it can attach to organs, cause inflammation, form scar tissue, and lead to chronic pain, infertility, and organ dysfunction. Endometriosis has a wide range of symptoms (often mimicking other diseases or chronic illnesses) which can make diagnosis more difficult. As with any disease, endometriosis affects everyone differently, however some of the most commonly reported symptoms include: 

• Pelvic pain - especially before or during your period 

• Pain with sex 

• Painful or irregular bowel movements (chronic constipation, diarrhea, or alternating bowel habits) 

• Heavy or irregular menstrual bleeding 

• Chronic back, hip, leg or abdominal pain

• Bloating or abdominal fullness (also known as "Endo belly")

• Fatigue or low energy 

• Difficulty getting pregnant or infertility

• Chronic pain that continues outside of your menstrual cycle 

• Overactive bladder, painful urination or urinary urgency 

• ​Pain with exercise 

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The ASRM (American Society for Reproductive Medicine) classification system rates endometriosis from minimal (Stage I) to severe (Stage IV) based on the number, depth, and location of lesions and adhesions. However, it’s important to note that staging reflects fertility impact, not symptom severity — meaning someone with “mild” endometriosis can still experience severe, life-altering pain.

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Additionally, the long-held retrograde menstruation theory which suggests that menstrual blood flows backward through the fallopian tubes into the pelvic cavity, allowing endometrial-like cells to implant and grow outside the uterus, is now considered outdated and incomplete. It oversimplifies the disease by focusing solely on menstrual backflow and the uterus, leading many patients to spend years on birth control without addressing the underlying condition.

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Endometriosis is a multifaceted, inflammatory disease that requires awareness, validation, and a multidisciplinary approach to care — not dismissal or delay.​​​​​​​​

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Endometriosis Treatment 

​Hormones, birth control pills, pain medications, diet, and lifestyle changes cannot cure endometriosis, as the exact origin and cause of the disease remains unknown. The only definitive way to diagnose endometriosis is through a surgical procedure called a laparoscopy, and the most effective treatment is excision surgery. Excision surgery, performed by a trained surgeon, involves carefully removing endometriosis lesions or abnormal tissue from the body and is considered the gold standard for treatment. In contrast, endometrial ablation—a procedure that uses heat or cold to destroy the uterine lining—is a superficial approach that only addresses symptoms temporarily. Ablation has a high recurrence rate and can negatively affect fertility, which is why it is not recommended as a treatment for endometriosis.

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It’s important to understand that while excision surgery is the most effective treatment for removing endometriosis lesions, it may not eliminate all of your pain. Pain can originate from multiple sources, including the pelvic floor muscles, nerves, and blood vessels. Additionally, many people with endometriosis also experience related conditions such as vulvodynia, interstitial cystitis, irritable bowel syndrome or disease, or fibromyalgia, which can contribute to ongoing discomfort. A multidisciplinary approach is often needed to address all pain generators and improve overall quality of life - this is where pelvic floor physical therapy can help. ​​​​

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Why Pelvic PT Helps With Pelvic Pain Caused by Endometriosis 

Pelvic pain from endometriosis often comes not only from inflammation and tissue changes, but also from how the surrounding muscles respond—tightening, guarding, and becoming painful over time. Pelvic floor physical therapy helps address these layers of pain by gently releasing muscle tension, improving mobility of pelvic tissues and organs, and calming the nervous system’s pain response. Through individualized assessment, manual therapy, myofascial release, nervous system regulation, postural & movement training, and self-care education, pelvic PT can help reduce pelvic pain and support your overall comfort and quality of life.

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Why Pelvic PT Helps With Bladder & Urinary Issues Caused by Endometriosis 

Endometriosis can sometimes irritate the bladder and surrounding pelvic tissues, leading to symptoms like urinary urgency, frequency, or bladder pressure. Pelvic floor physical therapy can help by addressing muscle tension, inflammation, and nerve sensitivity that contribute to these bladder symptoms. Through gentle internal & external manual therapy, down-training exercises and retraining of the pelvic floor and bladder connection, pelvic PT helps calm the urgency signals and improve bladder control. The goal is to restore balance in the pelvic region so you can go about your day without constantly worrying about finding the nearest bathroom.

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Why Pelvic PT Helps with Bowel Issues Caused by Endometriosis 

Endometriosis can affect how the pelvic organs move and communicate, often leading to bowel symptoms such as constipation, diarrhea, or painful bowel movements. Pelvic floor physical therapy helps by improving coordination and relaxation of the muscles that support bowel function. Through manual therapy, visceral mobilization, pelvic floor muscle retraining, Diaphragmatic breathing techniques and postural and behavioral strategies, therapy can reduce tension, improve motility, and make bowel movements feel more complete and comfortable. By restoring balance to the muscles and nerves in the pelvis, pelvic PT can help you feel more in control and less restricted by unpredictable bowel symptoms.

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Why Pelvic PT Helps with Pain with Sex Caused by Endometriosis 

Pain with sex is a common but often overlooked symptom of endometriosis. In response to ongoing inflammation and pain, the pelvic floor muscles can tighten and become overly protective, making intimacy uncomfortable or even painful. Pelvic floor physical therapy helps by addressing the muscle tension, scar tissue, and nerve sensitivity that often develop from chronic pelvic inflammation. Through gentle internal and external manual therapy, pelvic PT helps release these tight muscles and improve blood flow and tissue mobility. Therapists will also guide you through relaxation and breathing techniques to retrain the pelvic floor to respond more calmly and comfortably. Over time, this helps decrease pain, increase flexibility, and restore confidence and comfort with intimacy.​​