7 years.
That is the average time it takes for a person to be diagnosed with endometriosis. So when a patient comes in and says, “I’m in excruciating pain from my endometriosis and have tried everything, how will pelvic floor therapy help when nothing else has?” One of the first things I want them to know is that pelvic floor therapy can absolutely help your pain, but it may not be what you initially expect.
So first of all, what exactly is endometriosis?
The inside of a woman’s uterus is lined with endometrial tissue called the endometrium. With each menstrual cycle, your body grows a new endometrium to prepare for a fertilized egg. Endometriosis is a condition in which endometrial tissue also grows outside the uterus.
Endometrial tissue growing in these areas does not shed during a menstrual cycle like healthy endometrial tissue inside the uterus does. The buildup of abnormal tissue outside the uterus can lead to inflammation, scarring, and painful cysts. It can also lead to a buildup of fibrous tissues between reproductive organs that causes them to “stick” together. This contributes to the extreme pain that patients with endometriosis experience.
So how does therapy help if nothing else has?
Most of the time, patients have already seen multiple doctors (and truthfully, sometimes, have had their pain dismissed). They’ve gone through different birth control options, tried heating pads, pain meds, maybe even some period-focused remedies. But pelvic floor therapy approaches endometriosis from a different angle—literally and figuratively.
One primary thing we do in pelvic floor therapy is assess your musculoskeletal system and pain response patterns. We look at how your body reacts to chronic pain and how it guards against it. That guarding, which often shows up in your pelvic floor muscles, can actually amplify your pain. So, our job is to assess soft tissue mobility, identify any adhesions caused by endometriosis, and help release tension and improve movement in those tissues.
We also look at how your body is moving overall, especially if there’s hypermobility involved. Many people with endometriosis also deal with generalized hypermobility or even Ehlers-Danlos Syndrome (EDS), which means their joints move a little more than they should. That can make the pelvic floor work overtime, and therapy helps reduce that extra strain through targeted strengthening and support.
But one of the best parts about pelvic floor therapy for treating pain associated with endometriosis is that it allows the patients to take back some of the control that has been taken from them. This includes learning:
- how to manage flares,
- how to support your body in between them,
- and how to recognize patterns.
Those solutions can include:
- breath work,
- gentle soft tissue release techniques like using a pelvic wand,
- or learning self-massage techniques for your abdomen.
We also discuss bowel and bladder habits since endometriosis often affects those organs. We discuss helpful strategies for healthy elimination and comfort, with the understanding that nutrition is part of the picture, too.
And sometimes, yes, that might mean talking about things like sensitivity to dairy or gluten or exploring whether magnesium might help with muscle relaxation. We encourage patients to bring those ideas to their doctors and explore what might provide the best results.
So, if you’re wondering how pelvic floor therapy is different from everything else you’ve tried, it’s because it addresses you as a whole person, not just a list of symptoms. We treat the body’s response to pain, not just the pain itself.
What Does a Pelvic Floor Therapy Session Look Like?
First, you should never feel pressured to participate in an internal exam.
A lot of people don’t realize that pelvic floor therapy can include an internal assessment, and understandably, that can feel intimidating. Especially for someone with endometriosis, who may have had painful exams or painful intimacy in the past, it’s crucial that nothing ever feels rushed or forced.
I usually don’t do an internal exam on the first visit—unless the patient has had one before and gives clear, informed consent. There’s still so much we can do in that first session without needing to go internal immediately. We can assess posture, breathing patterns, abdominal mobility, movement habits, and so much more.
If we talk about an internal exam, I explain everything: what it is, why it might be helpful, and what to expect. It’s not mandatory, and it’s not the only way to make progress. Sometimes, it helps speed things up or give more real-time feedback, but if a patient is anxious or not ready, we absolutely respect that. In fact, if someone feels scared or tense, we probably won’t get helpful information anyway. Ethically, consent is everything.
Consent is ongoing, too. Just because someone says yes at the beginning of a session doesn’t mean they can’t change their mind halfway through. You never have to do anything that makes you uncomfortable, and that includes internal work.
Your comfort, your safety, and your ability to feel in control are the most important parts of healing. That’s when therapy works best—when you feel safe enough to trust your body again.
What Else Can Pelvic Floor Therapy Help Address?
What often surprises people is how much we focus on the nervous system. Chronic pain like endometriosis doesn’t just affect the muscles or the organs. It also rewires how your body perceives pain. Your nervous system starts to respond faster, louder, and longer to signals that wouldn’t normally hurt. That’s called central sensitization, and it’s a big reason why endometriosis pain can feel overwhelming.
In therapy, we work on calming those overactive signals. That might include breathing exercises to tap into the parasympathetic nervous system or strategies like paced movement and body scanning to help your brain re-learn what “safe” feels like again. We’re helping the brain and body relearn that they don’t need to be in fight-or-flight mode all the time.
We also often incorporate techniques like myofascial release or visceral mobilization. These are gentle, hands-on techniques to release tension around the abdomen and pelvic organs. If you’ve had surgery, like a laparoscopy for endometriosis, we’ll also check for any scar tissue that could be limiting mobility or pulling on nearby structures. These little restrictions can cause bigger pain patterns; sometimes, a small release makes a big difference.
The Emotional Side of Endometriosis
Let’s not forget that this condition can deeply affect someone’s identity, relationships, and daily life. There’s grief, frustration, and sometimes even shame around a body that doesn’t feel like it’s “working.” That’s why part of our role as pelvic floor therapists is just listening. We’re not here to rush through a checklist—we’re here to understand your story.
A lot of patients come in after years of being told their pain wasn’t real or that it was “just part of being a woman.” That invalidation leaves a mark. So even if we’re doing stretches or breathwork or mobility drills, what we’re also doing is helping you feel heard, respected, and in control again.
Your comfort matters. Work with Janette at Spooner Ahwatukee to address your pain, schedule an appointment today.
References:
Johns Hopkins Medicine. (n.d.). Endometriosis. https://www.hopkinsmedicine.org/health/conditions-and-diseases/endometriosis