Pelvic Floor Physical Therapy for Endometriosis

Pelvic floor physical therapy is a specialized type of treatment which focuses on the saddle muscles of the human body (the ones in contact with a saddle as a human sits upon an equine). These muscles are small and often overlooked, yet they play an enormous role in the bodily functions of urination, defecation, and sex! While traditional physical therapy is sought after for treatment of muscular pain, spasm, and decreased function for the entire body, pelvic floor physical therapists treat the delicate muscles of the perineum to discern why pelvic pain occurs, with special concern about how an individual can pee, have a bowel movement or engage in sex. Many of our patients have physical ailments associated with these essential bodily functions (for instance, chronic urinary infections, constipation/diarrhea, and pain with various types of sexual activity are all commonly treated by pelvic floor PT's).

How can pelvic floor PT help people with endometriosis?

Because many people with a diagnosis of endometriosis have pain with urination, bowel complaints ranging from constipation to loose stools, and difficulty tolerating sex, they are often in need of relaxation and stretching of their pelvic floor muscles, abdomens, and lumbar spines. When a person has chronic pain in these regions of their bodies, they often unconsciously close down their muscles in this area, leading to pain and difficulty opening their pelvic floors for these most basic and necessary activities. Pelvic floor PT entails soft tissue releases to all of the areas close to the pelvic floor to allow the muscles to lengthen to their fullest ability; It also teaches patients with chronic pain to tap into their muscular holding patterns via biofeedback and expression of where the pain is located to further enhance the patient's own healing process.

What are your experiences helping people with endometriosis?

Those diagnosed with endometriosis have unique and specific factors which impact their lives. The first and foremost physical complaint of those with endo is pelvic, low back, or abdominal pain. I find that they require a softer touch in therapy because of their heightened pain response, which has usually escalated over a span of years. But the more salient feature of endo is the psychological component of the diagnosis. People with endo often have a deep sense of shame that the hormone most associated with fertility and sexuality, which is estrogen, has been shown to ramp up their pain and symptoms. These people also may have challenges with their sexuality, as it is often associated with pain. The brain has already made the connection between pain and the thrill of sex, so it takes time, lots of hands-on work and talking through the pain to unravel where a life of pleasurable sex can resume with our endo patients. But the good news is, we have found that this approach works.

What's the biggest misconception about pelvic floor PT?

I have spoken with countless other medical professionals who reply to this question when I tell them that I am a pelvic floor physical therapist with: "So you teach people to do Kegel exercises, right?" Kegel exercises are for strengthening the pelvic floor. They are blindly prescribed by so many gynecologists and urologists, when more often than not, many people have TIGHT pelvic floors and performing Kegel exercises will likely worsen their pain and symptoms. Part of what a pelvic floor PT will do is to perform an internal vaginal or rectal muscular assessment of what the muscles of the pelvic floor are actually doing! Many people are tight in this region, or they are weak, or they are BOTH. A good pelvic floor PT should help any individual understand what these muscles should be doing for minimal pain and maximum function. While it is frustrating that there is such a dearth of awareness of the pelvic floor, I find it encouraging that more and more people are asking about it and want to know more!

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