A Physiotherapist’s role in Endometriosis.

A (very) brief rundown of the basics:

Endometriosis affects 1 in 9 women* (and those who identify as gender diverse or non-binary). It is a condition where tissue similar to the uterus lining (endometrium) is found in other areas of the body, most commonly the pelvic organs (uterus, bladder or bowel). There are a wide variety of symptoms, and each woman’s experience with endometriosis will differ. Some, all, or none of the following may be experienced:

  • Pain in your pelvis, lower back or abdominal region
  • Irregular, heavy and/or painful periods
  • Fatigue
  • Ovulation pain
  • Painful sex
  • Changes, pain or difficulty with bladder and bowel function
  • Infertility
  • Pelvic floor dysfunction

Endometriosis is diagnosed through laparoscopy surgery, where a biopsy on a tissue sample is taken. It may be diagnosed as mild, moderate or severe (or stages 1-4). However, the severity of diagnosis does not necessarily correlate to the severity of symptoms.

There is no cure for endometriosis, and there is much to be done in terms of research to improve the knowledge and treatment options health care providers can offer.

The role of pelvic floor physiotherapy in endometriosis

Where we come in. While we can’t cure endometriosis, we do have treatment techniques that can help you to manage your symptoms better. Often endometriosis is present in the pelvic organs (bladder, bowel, uterus), and therefore can affect the function of these organs, and the function of the pelvic floor muscles. It is common (not always) for those with endometriosis to have pelvic floor muscles that are tense and painful. As your pelvic floor muscles play a vital role in sexual, bladder and bowel function, it is possible that these muscles are partially responsible for some of your symptoms and pelvic floor dysfunction, including:

  • Internal pelvic pain, such as pain with intercourse or penetration
  • Bladder dysfunction, such as urgency/frequency, difficulty with emptying, pain, leakage
  • Bowel dysfunction, such as constipation, urgency, pain, difficulty emptying
  • External pelvic pain/lower back pain/abdominal pain
  • Persistent pain

A pelvic floor physiotherapy assessment is likely to include extensive questioning of your pelvic floor health, as well as a physical assessment which may involve an internal vaginal assessment.

Physiotherapy treatment options will vary depending on the individual’s symptoms and goals. Management and treatment options we may suggest include:

  • Pelvic floor relaxation training
  • Manual release work to the pelvic floor and surrounding muscles (internal and external muscles)
  • Bladder training
  • Bowel training
  • Breathing techniques
  • Stretching and appropriate strengthening exercises
  • Pain education and management strategies

Physiotherapy can help to reduce pain, improve bladder and bowel function and improve your pelvic floor muscle function. The goal of physiotherapy is to help provide you with strategies to manage your symptoms. 

Other Management of Endometriosis

Those with endometriosis will often require a multidisciplinary team to help treat the condition and manage symptoms. A good GP and gynaecologist who has specialised in endometriosis is vital to optimising outcomes. Management options may include:

  • Laparoscopic surgery to remove the affected tissue
  • Medications (including pain medications, hormone therapy etc)
  • Psychology
  • Pain management
  • Physiotherapy
  • Physical/exercise therapy
  • Dietician
  • Sexual therapist/sexologist
  • Natural therapies/lifestyle management

Interesting Facts:

  • It takes an average of 6.5 years to receive a diagnosis (often longer).
  • Period pain is NOT normal.
  • Although endometriosis is normally found in the pelvic organs, it has been found in muscles, joints, and the brain.
  • Getting pregnant or having a hysterectomy will NOT cure endometriosis. 

If you are suffering from endometriosis and have not tried pelvic floor physiotherapy, look into it – it can not cure endometriosis, but it may assist with symptoms and reduce pain and dysfunction. See below for some national groups that have further information and links to support groups you may find useful.