How Pelvic Floor Physical Therapy Can Support Women Living with Endometriosis

Endometriosis affects approximately 1 in 10 women of reproductive age, yet many still struggle for years before receiving a diagnosis. As pelvic floor physical therapists, we work with women every day who have been told that painful periods, painful sex, and chronic pelvic pain are “just part of being a woman.” They are not. They go through so many tests just to be told, "All tests are negative."

Pelvic floor physical therapy can play a powerful role in helping women with endometriosis reduce pain, improve function, and reclaim their quality of life.

Understanding Endometriosis

Endometriosis occurs when tissue similar to the lining of the uterus grows outside of it—commonly on the ovaries, fallopian tubes, pelvic ligaments, and surrounding structures. This can lead to:

• Painful periods

• Chronic pelvic pain

• Pain with intercourse

• Pain with bowel movements

• Infertility

• Low back or hip pain

• Bloating and digestive discomfort

Over time, the nervous system and surrounding muscles can become sensitized, creating persistent tension and guarding in the pelvic floor.

That’s where pelvic floor physical therapy comes in.

The Pelvic Floor’s Role in Endometriosis Pain

The pelvic floor is a group of muscles that sit at the base of the pelvis. These muscles support the bladder, bowel, and uterus and are essential for bladder and bowel control, sexual function, and core stability.

When someone has ongoing pelvic pain, the pelvic floor often responds by tightening protectively. Over time, this tension can become chronic. The muscles may develop trigger points, decreased mobility, and difficulty relaxing. This can contribute to:

• Painful penetration

• Difficulty fully emptying the bladder or bowels

• Constipation

• Ongoing pelvic pressure

• Increased pain even outside of menstrual cycles

In many cases, the muscular component of pain persists even after medical or surgical treatment of endometriosis lesions.

How Pelvic Floor Physical Therapy Helps

Pelvic floor physical therapy addresses the musculoskeletal and nervous system components of endometriosis-related pain. Treatment is individualized and may include:

1. Manual Therapy

Gentle internal and external techniques help release muscle tension, improve tissue mobility, and reduce trigger points in the pelvic floor, hips, abdomen, and low back.

2. Nervous System Regulation

Chronic pain can keep the body in a constant “fight-or-flight” state. Breathing techniques, graded exposure, and pain education help calm the nervous system and decrease hypersensitivity.

3. Mobility and Movement Training

Restricted movement in the hips, spine, or abdominal wall can contribute to pelvic tension. Targeted mobility and strengthening programs improve overall function and reduce strain.

4. Scar and Adhesion Management

For women who have had laparoscopic surgery, C-sections, or other abdominal procedures, physical therapy can help improve scar mobility and reduce restriction.

5. Education and Empowerment

Understanding pain changes everything. Learning how pain works, what is happening in your body, and how to manage flare-ups gives women tools and confidence.

A Collaborative Approach

Endometriosis care works best when providers collaborate. Pelvic floor physical therapy complements care from OB-GYNs, pain specialists, excision surgeons, and mental health providers. We are one piece of a comprehensive plan focused on restoring function and improving quality of life.

You Deserve More Than “It’s Normal”

Painful periods are common. They are not normal. If you are living with endometriosis, know that your pain is real—and there are options beyond medication and surgery alone. Pelvic floor physical therapy offers a whole-body, evidence-informed approach to reducing pain and improving daily life.  If you’re curious whether pelvic floor physical therapy could help you, reach out. Relief is possible—and you don’t have to navigate this alone.