How Pelvic Floor Therapy Can Support Women with Endometriosis
March is National Endometriosis Awareness Month. Endometriosis is a condition that occurs when the endometrium grows outside of the uterus in the pelvic and abdominal areas, causing inflammation, pain, and adhesions in the pelvic area. Endometriosis can also cause muscles in the pelvis to tighten, spasm, and thicken as they respond to tension patterns from the condition, causing pelvic floor dysfunction. Pelvic floor therapy can help alleviate pelvic floor symptoms related to endometriosis, reducing endometriosis-related pelvic pain and pelvic floor muscle tightness, minimizing “endo belly” occurrence, addressing urinary and bowel issues, and helping make sex less painful through targeted reconditioning of the pelvic floor muscles.
Pelvic Floor Muscle Anatomy
The pelvis is lined with pelvic floor muscles, which steady the bony outlet of the pelvis, support the organs of the pelvis, and stabilize connected joints like the hip and sacroiliac joint. The pelvic floor muscles form a sling shape that connects the front, back, and sidewall of the pelvis, extending from the tailbone to the pubic bone within the pelvis.
The pelvic floor muscles support the vagina, rectum, urethra, bowel, uterus, and bladder. Muscular bands called sphincters encircle the urethra, vagina, and anus as they pass through the pelvic floor. When the pelvic floor muscles contract, these internal organs are lifted, and the sphincters tighten the openings of the vagina, anus, and urethra. The pelvic floor muscles support bowel, bladder, and sexual function as well as provide stability to the entire pelvic area.
What is Endometriosis?
Endometriosis affects 1 in 10 reproductive-aged women. It is a condition that occurs when the endometrium (the lining of the uterus) grows outside of the uterus in the pelvic and abdominal areas. Endometriosis can grow on the ovaries, fallopian tubes, intestines, bladder, and lining of the pelvis. The tissue thickens, breaks down, and bleeds during the menstrual cycle, but becomes trapped, which can inflame and irritate surrounding tissue, develop scar tissue, and lead to abnormal bands of fibrous tissue that cause pelvic tissues and organs to stick to each other, called adhesions.
Symptoms of endometriosis can include painful periods, pain in the lower abdomen that travels to the back and down the legs, pain with sex, pain with bowel movements and urination, pelvic pain outside of periods, and infertility. While some women have severe pain with endometriosis, other women may be asymptomatic or have mild symptoms. The severity of symptoms does not correlate to how much endometriosis is present.
Endometriosis creates an environment of inflammation, scar tissue, and adhesions within the pelvic and abdominal cavities. This can contribute to the formation of myofascial trigger points in the pelvic floor, hip, back, and abdominal muscles, which can refer pain and create connective tissue dysfunction. Endometriosis can also cause muscles in the pelvis to tighten, spasm, and thicken as they respond to tension patterns from the condition. This causes pelvic floor dysfunction, a condition in which you are unable to correctly relax and coordinate the muscles in your pelvic floor. Tightness, shortening, and/or scarring of the pelvic floor muscles due to endometriosis can also make intercourse painful as the pelvic floor muscles become tense and overactive, making vaginal penetration difficult.
Endometriosis-related tightness in the pelvic floor can contribute to excessive bloating, known as “endo belly.” This is because the tight pelvic floor muscles cannot provide the support to the abdomen as they were designed to, and trigger points in the abdomen and pelvic area can cause spasms, all of which can contribute to outpouching or ballooning out of the belly in extreme bloating.
Pelvic Floor Therapy for Endometriosis
Pelvic floor therapy can help alleviate pelvic floor symptoms related to endometriosis. Pelvic floor therapy provides structured, effective, and safe reconditioning of the pelvic floor muscles with the goal of improving their strength, flexibility, and function and alleviating pain, weakness, and dysfunction. Pelvic floor therapy can improve endometriosis-related pelvic pain and pelvic floor muscle tightness, reduce “endo belly” occurrence, address urinary and bowel issues, and help make sex less painful.
Pelvic floor therapy can include external techniques like trigger point therapy, deep tissue massage, joint mobilizations, and targeted pelvic floor stretching and strengthening exercises. At the start of treatment, a female pelvic floor physical therapist performs a biomechanical and musculoskeletal assessment and internal exam (depending on the comfort level of the patient) to evaluate how the patient moves and walks, her posture and breathing, where core areas of pain are, and assess the overall condition, strength, coordination, and alignment of the pelvic floor muscles. The internal exam involves gently assessing the different layers of the pelvic floor to assess muscle spasm and tone, mobility, tissue rigidity, and pain trigger points.
Pelvic floor therapy can help re-train the pelvic floor muscles to be able to relax and coordinate contractions, reducing pain, muscle spasms, and related pain, like pelvic and back pain or painful urination or bowel movements. Physical therapy can teach patients to relax the protective response of the pelvic floor muscles in response to pain spasms, using manual therapy and breathing techniques to loosen and relax the pelvic floor muscles.
The therapist also implements stretching exercises to open the hip and pelvic area, core strengthening, trunk and spine flexibility exercises, and possibly vaginal dilation exercises. The therapist stretches pelvic floor muscles if they are tight, short, or contracted to elongate the muscles or applies resistance to improve strength if the pelvic floor muscles are weak. The therapist may also incorporate myofascial release and gentle massage to address adhesions and scar tissue from endometriosis or due to endometriosis-related surgery that limit movement and pelvic floor extensibility.
One research study noted that 63% of women living with endometriosis experienced less pain after six sessions with a pelvic floor therapist. Another study found that women living with endometriosis experienced less pain and improved posture after completing an 8-week pelvic exercise regimen.
Endometriosis is a challenging condition that can cause significant pelvic pain and pelvic floor dysfunction. A physical therapist can be a key part of your medical care team to help reduce endometriosis symptoms and improve your quality of life!
