The role of pelvic floor physiotherapy in endometriosis treatment

8 July

Written By Jacinta

Endometriosis is a condition that can cause chronic pain and significantly impact an individual’s quality of life. Pelvic physiotherapy can play an important complementary role in managing symptoms to help improve day-to-day comfort and overall quality of life.

Whether you’ve been formally diagnosed, or are exploring a potential diagnosis, understanding how women’s health physiotherapy can fit into your treatment plan is an important way to address your condition and symptoms holistically.

What is endometriosis?

Endometriosis is a condition where tissue similar to the lining of the uterus grows in other parts of the body (Endometriosis Australia 2023). Endometriosis most often affects the reproduction organs (ovaries, fallopian tubes) but can be found in other areas including the bladder, bowels, and other tissues in the pelvic region. Endometriosis can cause inflammation and scarring, which can lead to painful ‘adhesions’ of pelvic tissues and organs.

This endometrial tissue behaves similarly to the uterine lining, thickening and shedding with each menstrual cycle. However, because it can’t exit the body, this tissue can cause inflammation, cysts, scar tissue and adhesions. Left untreated, this can disrupt normal pelvic function and lead to complications including pelvic floor dysfunction [link to PFD blog].

Endometriosis symptoms

Given that endometriosis can impact various organs and tissues within the pelvis, symptoms can vary widely among individuals. Some people experience little–to-no symptoms, while others may experience severe pain.

The most common symptoms across the board include:

Pelvic pain [link to PP blog] especially during menstruation
Pain during intercourse
Pain during urination or defecation
Heavy menstrual bleeding, irregular menstruation, or bleeding between periods
Digestive issues including bloating, nausea and diarrhoea
In some cases, fertility can be affected due to the impact on reproduction organs

We also know that symptom severity doesn’t necessarily reflect the extent of the condition. Someone with minimal endometriosis may experience significant pain, while someone with severe endometriosis may experience no symptoms.

Endometriosis diagnosis

Currently, the gold standard for a definitive diagnosis of endometriosis is a laparoscopic procedure, including biopsy and destruction of endometriosis lesions. Other methods may be used in the absence of surgery, to provide a suspected or clinical diagnosis.

Unfortunately, endometriosis diagnosis is often delayed. According to Endometriosis Australia, it takes 6.5 years on average for those living with endometriosis to actually receive a diagnosis (with surgical intervention being the only diagnosis option).

Pelvic floor physiotherapists cannot diagnose endometriosis, however we can help manage symptoms and support you in the process of seeking a diagnosis.

Endometriosis treatments

Currently there is no cure for endometriosis, but various treatments can help to manage the condition and symptoms.

Medical treatment

Pain relieving medication (eg ibuprofen) is often used to help manage pain symptoms

Hormonal therapies (eg contraceptive pill) can regulate or suppress the hormonal fluctuations that trigger the growth of endometrial tissue.

Medications can of course come with side effects, and may not be appropriate or the preferred option for an individual.

Surgical treatment

Surgery may be recommended to give a ‘formal diagnosis’ and to remove the endometrial tissue, particularly in more severe cases

Surgery can provide significant relief for some, plus it removes up to all endometrial tissue present. However it isn’t always a long term solution as the tissue can grow and return over time.

Allied treatment: including physiotherapy, acupuncture, Traditional Chinese Medicine, exercise, and diet modifications

These treatments, while not necessarily treating the underlying cause, can play an important complementary role in helping to manage symptoms and improve overall quality of life.

GPs are often the first point of contact for those with suspected endometriosis, and therefore are instrumental in identifying symptoms, prescribing medication, and providing referrals to relevant specialists or services.

There is no single ‘best treatment’ for endometriosis. Individuals will each have a unique experience and response to treatment, therefore finding the right combination of approaches is essential.

Can physiotherapy help with endometriosis?

Pelvic physiotherapy can play an important role in managing a range of endometriosis symptoms, particularly when it comes to pelvic pain and muscle dysfunction.

Following a discussion about your health history and your symptoms, we can assess the pelvic floor (and pelvic region more generally) to identify potential symptom triggers and dysfunction. We can use this information to determine treatment techniques to help manage pain and address other symptoms including bladder or bowel dysfunction.

Some of the most common techniques we use include:

Manual therapy (massage, dry needling, mobilisation etc.)
Targeted stretching, mobility and relaxation
Breathwork (to help regulate the nervous system and encourage appropriate connection between pelvic floor and breath)

By improving pelvic floor muscle function, we can improve mobility and strength, improve bladder, bowel and sexual function, and reduce the impact of endometriosis on your day-to-day life.

For those who undergo surgery to diagnose and/or remove endometrial tissue, physiotherapy is also an important part of post-operative care. Initially, supporting recovery, and then working on building strength, endurance and coordination. This can help to reduce post-operative pain, prevent long-term complications, and optimise the success of the surgery itself.

Physiotherapy management, alongside medication, offers an adjunct for managing chronic pain, again helping to improve the overall effectiveness of your treatment.

Why choose Papaya Clinic for pelvic physiotherapy?

At Papaya Clinic, we specialise in treating a wide range of pelvic health issues, including the challenges that come with endometriosis.

Our team work closely with gynaecologists, obstetricians, and urologists to ensure you receive highest standard of care.

As an integrated women’s health clinic, we take a holistic approach to managing endometriosis. While the specifics will vary between individuals, we have a range of services that can be tailored to you, including

Clinical exercise (Pilates, resistance training)
Acupuncture and Traditional Chinese Medicine
Naturopathy
Clinical and Sports Nutrition
Remedial massage

This collaborative approach allows us to address your range of symptoms from multiple angles, providing a comprehensive and truly tailored treatment plan.