Pelvic Floor Therapy for Endometriosis & Adenomyosis
Treating pain at its source — beyond lesions alone
Understanding the hidden drivers of pelvic pain
Why Pelvic Floor Therapy Matters
Endometriosis‑related pain is often sustained by muscle tension, nerve sensitization, and altered pain processing — not just visible disease. Pelvic floor therapy targets these contributors to help reduce pain, improve function, and support long‑term recovery.
Pain is not only from lesions
Endometriosis pain often persists due to muscle hypertonicity, nerve sensitization, and central nervous system changes — even after surgery.
High overlap with pelvic floor dysfunction
The majority of patients with endometriosis experience dyspareunia, pelvic pain, or bowel and bladder symptoms linked to pelvic floor dysfunction.
Central and peripheral sensitization
Chronic pain can alter how the nervous system processes signals, amplifying symptoms across the pelvis, bladder, bowel, hips, and low back.
Improves function, not just symptoms
Therapy targets movement, breathing, posture, and muscle coordination — restoring daily function and quality of life.
More than exercise — a targeted pain-focused approach
What is Pelvic Floor Therapy?
Pelvic floor therapy is a specialized form of physical therapy that focuses on the muscles, fascia, nerves, and movement patterns of the pelvis and core. Treatment is guided by a detailed assessment of how these systems interact with pain, posture, breathing, and daily movement.
It is not limited to strengthening — many patients with endometriosis have overactive or shortened pelvic floor muscles, not weak ones. In these cases, therapy prioritizes relaxation, lengthening, coordination, and nervous system regulation rather than forceful exercise.
Symptoms that often share a muscular and nervous system origin
Common Symptoms It Addresses
Endometriosis-related pelvic floor dysfunction can present in many ways, often overlapping with bladder, bowel, sexual, and musculoskeletal symptoms. Pelvic floor therapy helps identify and address these interconnected pain patterns rather than treating each symptom in isolation.
Why pelvic pain often persists even when disease is treated
How Endometriosis Affects the Pelvic Floor
Endometriosis can change how muscles, nerves, and connective tissue behave over time. Ongoing inflammation and pain signaling may lead to protective muscle patterns and nervous system sensitization that continue to drive symptoms, even when lesions are removed.
Inflammation & guarding
Persistent inflammation leads to protective muscle tightening. Over time, this guarding can limit mobility, reduce blood flow, and perpetuate pain even outside of menstrual cycles.
Myofascial trigger points
Localized muscle knots can reproduce pelvic, vaginal, rectal, or bladder pain. These points often refer pain to other areas, making symptoms feel widespread or difficult to localize.
Viscerosomatic cross‑talk
Pain signals from organs (uterus, bowel, bladder) can sensitize nearby muscles and nerves. This cross‑communication explains why organ pain is frequently felt in muscles, joints, or surrounding tissues.
Central sensitization
The brain and spinal cord become more reactive, lowering pain thresholds across the pelvis. As a result, even normal movement, touch, or pressure may be perceived as painful.
Tools used to address pain, movement, and nervous system regulation
What Pelvic Floor Therapy May Include
Treatment is tailored to each patient’s symptoms, exam findings, and pain drivers. Care often combines hands-on techniques, movement retraining, and nervous system support rather than a single intervention.
Manual Therapy
Hands-on techniques are used to reduce tissue restriction, calm pain signaling, and improve mobility of muscles and connective tissue that have become protective or sensitized over time.
- Myofascial release
- Trigger point release
- Scar tissue and connective tissue mobilization
- Visceral mobilization when appropriate
Muscle Coordination & Motor Control
This phase focuses on restoring normal muscle timing and coordination so the pelvic floor can respond appropriately to daily movement rather than remaining constantly tense.
- Down‑training overactive pelvic floor muscles
- Improving relaxation and lengthening
- Coordinating pelvic floor with breathing and movement
Nervous System Regulation
Because chronic pelvic pain often involves heightened nervous system reactivity, therapy includes strategies that help reduce pain amplification and improve tolerance to movement and touch.
- Addressing central sensitization
- Breathing strategies to calm the nervous system
- Education around pain processing
Posture & Movement
Postural and movement patterns can either offload or perpetuate pelvic pain, making whole‑body mechanics an important part of treatment.
- Rib cage and diaphragm mechanics
- Core and hip integration
- Reducing compensatory movement patterns
Clearing up a common misconception
Pelvic Floor Therapy vs. “Kegels”
Pelvic floor therapy is frequently misunderstood as strengthening alone. In endometriosis care, the goal is often to reduce muscle tension, restore coordination, and calm pain pathways — not add force.
| Pelvic Floor Therapy | Kegels |
|---|---|
Focuses on relaxation, coordination, and muscle length rather than strength alone | Focus on strengthening only, without assessing baseline muscle tone or pain sensitivity |
Addresses pain drivers such as muscle tension, guarding, and nervous system sensitization | May worsen pain when pelvic floor muscles are already tight or overactive |
Uses an individualized assessment based on symptoms, exam findings, and pain patterns | Applies a one-size-fits-all approach regardless of symptom pattern or diagnosis |
Considers nerves, fascia, posture, breathing, and overall movement mechanics | Target muscles alone, without addressing nervous system involvement or biomechanics |
Integrated care, delivered through an individualized process
How Pelvic Floor Therapy Fits Into Your Care
Pelvic floor therapy complements medical and surgical treatment by addressing muscular and nervous system pain generators that fall outside the scope of medication and excision alone. Care is delivered through a structured, consent-based process that adapts to each patient’s symptoms, exam findings, and nervous system sensitivity. Pelvic floor therapy works best when integrated with:
Expert excision surgery (when indicated)
Medical management (when appropriate)
Treatment of overlapping pain conditions
GI and bladder evaluation when symptoms overlap
Patient education and long‑term support
Care should feel safe, not overwhelming
Supporting the Whole Pain Picture
Pelvic floor therapy is not about pushing through pain. Treatment is collaborative, trauma‑aware, and adjusted in real time based on your physical responses and nervous system tolerance. If you have been experiencing pelvic pain that has continued despite treatment, pelvic floor therapy may be an important next step. Our team can help determine whether this approach fits into your overall care plan.
Common concerns we hear from patients
Frequently Asked Questions
Questions about pelvic floor therapy are common — especially for patients who have already tried multiple treatments. These answers address the most frequent concerns we encounter.
Do I need pelvic floor therapy if I’m having surgery?
Often, yes. Surgery treats endometriosis lesions, but pelvic floor therapy addresses muscle tension and pain sensitization that surgery alone does not.
Is internal work required?
Not always. Treatment is individualized, discussed in advance, and only performed with clear consent.
Can pelvic floor therapy help with pain during intercourse or pelvic exams?
Yes. Therapy can help reduce muscle guarding and pain sensitivity that contribute to discomfort with penetration or exams.
Can pelvic floor therapy help if imaging is normal?
Yes. Many drivers of pelvic pain — including muscle hypertonicity, myofascial trigger points, and nervous system sensitization — do not appear on ultrasound or MRI.
How long does it take to see improvement?
This varies. Some patients notice changes within a few sessions, while others need a longer course depending on pain duration and complexity.
What if I’ve already tried physical therapy before?
Pelvic floor therapy for endometriosis is specialized and differs from general physical therapy. Even if prior therapy was not helpful, this approach may still be appropriate.