Endometriosis is a condition where tissue similar to uterine lining grows outside of the uterus. It can lead to symptoms like pelvic pain, heavy periods, and infertility. According to the World Health Organization (WHO), endometriosis affects about 10 percent of women of childbearing age.

Different treatment options can be used to manage symptoms and improve quality of life. That includes over-the-counter pain medications, hormone therapies, and sometimes surgery. However, these treatments aren’t always enough to find relief.

Pelvic floor physical therapy may help when other options don’t.

Pelvic floor physical therapy is commonly used to treat issues that affect the pelvic floor muscles. That includes things like:

  • chronic pelvic pain
  • constipation
  • incontinence
  • painful intercourse

It can also be used to treat endometriosis.

Pelvic floor physical therapy can help improve the function, flexibility, and strength of the pelvic floor muscles. It teaches your muscles how to coordinate and relax, which can ultimately help ease symptoms of endometriosis.

This hands-on therapy includes a variety of external techniques such as:

  • trigger point therapy
  • deep tissue massage
  • pelvic floor exercises
  • joint mobilization

The therapist may also incorporate internal techniques to help pelvic muscles relax.

There’s no cure for endometriosis. However, working with a pelvic floor physical therapist can provide the following benefits:

Relieve endometriosis pain

Excision surgery is often used to treat endometriosis. It involves surgical removal of endometrial-like tissue.

But surgery alone might not be enough to relieve endometriosis pain.

Pelvic floor physical therapy can help re-train pelvic muscles so they’re able to relax and coordinate contractions. This helps reduce spasms and improve symptoms like:

  • pelvic pain
  • back pain
  • painful urination
  • painful bowel movements

This type of therapy is also used to help relieve other pelvic pain disorders such as vulvodynia and pudendal neuralgia.

Reduce painful sex

The tightening of the pelvic floor muscles that occurs with endometriosis can make vaginal penetration difficult. When this happens, you might experience painful intercourse or pain when using a tampon.

Working with a pelvic floor physical therapist to help reduce spasms and relax your pelvic muscles can help make sex less painful.

Alleviate abdominal bloating

Excessive bloating is another symptom often associated with endometriosis. “Endo belly” can occur when inflammation causes a buildup of endometriosis tissue, and tightening of the pelvic floor leads to distention of the abdomen.

Pelvic floor tightening can also lead to constipation, which can also contribute to bloating. You might experience this if you have other conditions like uterine cysts or fibroids.

Pelvic floor physical therapy helps reduce inflammation, constipation, and spasms, which can improve distention.

If uterine cysts or fibroids are causing bloating or swelling, you may need surgery to reduce the size of your abdomen.

You’ll likely need to schedule multiple sessions with a pelvic floor physical therapist in order to achieve results.

The first session is typically a consultation. Therapy isn’t one-size-fits-all, so your therapist will ask questions to help them understand your experience and what you hope to accomplish through therapy. You’ll discuss:

  • your symptoms
  • your medical history
  • how endometriosis affects your day-to-day life

You can also expect your therapist to complete a pelvic floor muscle assessment. This may happen during the initial consultation or a follow-up appointment. This is an internal examination comparable to a pelvic exam. Your therapist will assess the strength of your pelvic floor muscles and then develop a program that’s specific to your needs.

From there, depending on your individual needs, ongoing therapy sessions might include:

  • manual therapy to separate endometrial scar tissue
  • internal physical therapy
  • stretches
  • yoga or pilates
  • breathing exercises
  • strengthening and coordination exercises
  • skin rolling or deep tissue massage

Pelvic floor physical therapy also goes beyond each session. Your therapist will recommend an individualized home exercise program. Continuing to practice pelvic floor exercises outside of each session helps further your progress.

These home exercises typically focus on strength and flexibility. They might include things like Kegel exercises as well as yoga and Pilates. Your therapist might also suggest vaginal dilation exercises to stretch and relax the vagina. This helps relieve pain associated with sexual intercourse or tampon use.

The length of a physical therapy program depends on the severity of your condition and symptoms.

One retrospective study found that 63 percent of women living with endometriosis experienced less pain after six sessions with a pelvic floor therapist. Another small study found that women living with endometriosis experienced less pain and improved posture after completing an 8-week pelvic exercise regimen.

Your pelvic floor physical therapist will work with you to determine the best course of therapy for you.

Ask your doctor or gynecologist for a referral to a pelvic floor physical therapist. Your connections in the endometriosis community may also provide their recommendations as well.

You can also use the American Physical Therapy Association’s Find a PT directory to locate a pelvic floor physical therapist in your area. This directory provides information on areas of expertise and credentials.

Questions to ask a pelvic floor physical therapist include:

  • Do you use internal or external pelvic floor muscle exercises, or a combination of both?
  • Is pelvic floor physical therapy painful?
  • How often will I need treatment, and how long do sessions last?
  • What should I wear to therapy?
  • Do you accept health insurance? Do you offer payment plans?
  • What percentage of your patients have endometriosis?
  • What kind of equipment do you use during sessions?

Most health insurance providers cover pelvic floor physical therapy. Contact your insurance company to determine which specialists are in network. This can help you figure out your out-of-pocket costs for pelvic floor physical therapy.

Endometriosis is a lifelong condition that might require medication and surgery to relieve symptoms. Sometimes, though, physical therapy is also part of the healing process.

A pelvic floor physical therapist can help train your pelvic muscles to coordinate and relax. This can reduce pelvic pain, as well as other distressing symptoms such as back pain, urinary pain, and pain during sex.