Tackling Endo: Managing Endometriosis with Pelvic Floor Therapy

Living with endometriosis can feel overwhelming, especially when severe pelvic pain disrupts your daily life. You've probably tried different treatments, but you might not know that physical therapy for endometriosis can be a game-changer for managing your symptoms. The good news? You don't have to rely only on surgery or hormones to feel better. Physical therapy, combined with other treatments, offers a natural approach that can significantly reduce your pain and help you reclaim your life. Whether you're newly diagnosed or have been managing endo for years, understanding how pelvic floor therapy works is key to taking control of your symptoms.

What is endometriosis?

Endometriosis (or "endo") is a disease that causes tissue from inside your uterus, called endometrium, to grow outside of it. It can form small patches called lesions on your ovaries or bladder. In more serious cases, it can grow deep into other organs, like your bowels and abdominal wall. 

Types of endometriosis

There are three main types of endometriosis:

• Superficial endometriosis: Small patches on the surface of organs
• Ovarian endometriosis: Cysts filled with old blood (called endometriomas)
• Deep infiltrating endometriosis: Tissue that grows more than 5mm deep into organs

Understanding your type helps your doctor plan the best treatment approach.

Can endometriosis cause pelvic pain? 

Yes, pelvic pain and abdominal pain are the most common symptoms of endometriosis. This pain often gets worse during your period and around ovulation time. 

You might also experience:

• Painful sex
• Painful bowel movements
• Pain when urinating
• Digestive problems
• Trouble getting pregnant

In severe cases, endometriosis can cause life-threatening problems like bowel blockages and serious internal bleeding.

What does endometriosis pain feel like? 

Every person experiences endo pain differently. This depends on where the tissue grows and how much there is. Most people describe intense cramping sensations, sometimes in the uterus and sometimes on the side around the ovary during ovulation. Bloating, frequent and/or painful urination and indigestion are also common. Sometimes pain will radiate into your hip, or down the back of the leg.  In many cases, people with endometriosis are completely debilitated during the beginning of their menstrual cycle and during ovulation, and may be confined to their beds with heating pad and painkillers until the worst is over. 

Occasionally people report endometriosis without pain, but this is rare and usually only discovered when investigating causes of infertility. Most often the symptoms start with the onset of menstruation, and worsen over time. Unfortunately, despite symptoms often starting early in life, it can take many years to receive a diagnosis. . 

How is endometriosis diagnosed?

The “gold standard” of diagnosis is exploratory surgery to look for endo lesions and then test samples to make sure they are endometrial tissue. However, this is an invasive and expensive way to diagnose the disease. Also, it is possible to have the test come back negative but still have the disease,  depending on where biopsies are taken.

Often, doctors make an initial diagnosis based on:

• Your symptoms
• A pelvic exam
• Ultrasound or MRI scans

Imaging for endometriosis can be challenging, because it does not always show up clearly depending on where the disease is present, but physicians can look for signs that organs are not moving freely in the pelvis (endo tends to stick things together). They also look for “chocolate cysts” aka“endometriomas” which are ovarian cysts filled with blood instead of other fluid. 

If you're experiencing symptoms, find a doctor who understands endometriosis. Don't give up if the first doctor dismisses your concerns.

Does endometriosis cause painful sex?

Yes, endometriosis commonly causes painful sex. Here's why this happens:

Endo often affects the bladder, ovaries, and tissues behind the vaginal wall. When these areas are pushed against during sex, it causes pain. 

Even without the presence of endo in these areas, having severe cramps or other pelvic pain can cause the pelvic floor to clench tightly. These tense muscles can cause pain during sex and even painful orgasms. The muscles try to contract but go into spasm instead. 

Remember, not everyone with endo has painful sex. And many people have painful sex without having endo. If you're experiencing pain during sex, physical therapy can help.

What is the relationship between PCOS and endometriosis?

PCOS (polycystic ovarian syndrome) and endometriosis are different conditions, but people often confuse them. Both can cause fertility problems, and it's possible to have both conditions at the same time.

Understanding PCOS

PCOS is a hormonal disorder with three main features:

• Irregular or skipped periods
• Excess androgen (male hormone) production
• Small cysts on the ovaries

Key Differences Between PCOS and Endometriosis

Pain patterns:

• PCOS: Some people have pain from cyst ruptures or menstrual cramps, but pain isn't the main symptom
• Endometriosis: Severe pelvic pain is the hallmark symptom

Period patterns:

• PCOS: Irregular or skipped periods are common
• Endometriosis: You may have completely regular periods with no ovulation problems

Other symptoms:

• PCOS: Weight gain, acne, and increased facial/body hair growth
• Endometriosis: These symptoms don't typically occur

The hormone connection

Both conditions involve hormonal imbalances, but in different ways:

• PCOS: Connected to higher androgen levels (male hormones like testosterone and DHEA)
• Endometriosis: Linked to higher estrogen levels

Since these conditions work differently, they need different treatment approaches. If you have both, your healthcare team will need to address each condition separately.

What are the treatment options for endometriosis? 

The best approach to treating endometriosis is holistic treatment that's tailored to you. This means using multiple strategies together for better results. 

Are there non-surgical ways to manage endometriosis pain? 

Medications

Hormonal birth control: Often, patients are put on hormonal birth control to try and stop periods, which can help reduce symptoms, but are not always well-tolerated and do not actually slow or stop the progression of endometriosis.

Androgenic hormone treatment: A different class of medications, called androgenic hormone drugs, can help to treat the disease and slow its progression. These drugs are synthetic “weak male hormones” that work to suppress luteinizing hormone (LH) and follicle-stimulating hormone (FSH) which in turn reduce estrogen and progesterone production in the ovaries. These types of drugs can actually shrink endo tissue outside of the uterus, and slow the progression of the disease. However, these medications are not safe for use during pregnancy or while producing breast milk, and can have side effects. Examples include Lupron, Orlissa, and Danazol. 

Pain medications: Endometriosis pain can be severe and debilitating. If you have severe endo, it is important to have adequate pain management options available, which can include medications.

What are the surgical options for endometriosis? 

Surgical treatments: 

• Ablation: The surgeon burns away the surface of each patch of endo tissue. This works well for milder cases.
• Excision surgery: The surgeon removes as much endo tissue as possible. This is more effective for severe cases.

Are there ways to manage endometriosis pain that don't involve medications or surgery?

Other treatments for endo include pelvic floor physical therapy, which highly effective for managing pain. This is especially true for symptoms like pain during sex, urination, and bowel movements. 

Multiple studies show that pelvic floor physical therapy significantly reduces pelvic pain. It also improves daily function for both adults and teens with endometriosis. The therapy includes manual techniques and muscle relaxation methods.

Physical therapy for endometriosis helps improve:

• Sleep quality
• Work performance
• Relationships
• Overall quality of life

Lifestyle factors also play a big role in managing endo symptoms, and work best when combined with other treatments:

• Diet modifications
• Stress management techniques
• Regular exercise (when possible)
• Sleep hygiene

How can PT work alongside other treatment approaches? 

In addition to the treatments noted above, physical therapy can help patients improve the way they use their core muscles, which is often dysfunctional from a lifetime of frequent abdominal pain. Core weakness can also contribute to related back and hip pain issues. It’s important to note that physical therapy cannot cure endometriosis, but it’s a powerful tool for managing symptoms. For severe cases of endometriosis, PT works best alongside other treatments like surgery or hormone therapy to provide relief.

Can endometriosis be cured?

While there isn't a complete cure for endometriosis yet, many people successfully manage their symptoms. With the right treatment plan, you can get back to living your life without severe symptoms disrupting your daily activities. Scientists are also starting to pay more attention to the condition, so there is hope for better treatment options in the future. 

If you are experiencing symptoms that sound like endometriosis, find a doctor who understands the disease and listens to you so you can explore your options. And if you are experiencing pelvic pain, don’t delay; reach out to a pelvic floor physical therapist today and get the help you need!