Managing Endometriosis Pain with Pelvic Floor Physical Therapy

9/1/2025
Close up image of a woman placing her fingers on the hip bone and ribcage on both sides of her body demonstrating ribcage mobility in relation to lower core activation.

Endometriosis is more than just “bad cramps.” Its a chronic condition where tissue similar to the lining of the uterus grows outside of the uterus, causing pain, inflammation, and sometimes fertility issues. One often overlooked part of managing endometriosis-related pain is addressing how it affects the pelvic floor muscles– and that is where pelvic floor physical therapy (PFPT) comes in.

As a pelvic floor physical therapist, my goal is to help patients first understand the why behind their symptoms and then help them reduce pain, improve function, and reclaim quality of life often times more than what they realized through our signature L-S-P Method (check out our website home page for more info on this). Here’s how I approach treating endometriosis-related pelvic pain.

 

Understanding the Pain Pattern

Many people with endometriosis develop chronic pelvic pain, pain with sex (dyspareunia), pain with bowel movements, or urinary issues; such as leakage or urgency. Over time, the body can respond to this oncoming pain by tightening the pelvic floor muscles in an effort to protect itself (my brain imagines the pelvic floor curling up in the fetal position). This creates what feels like a never-ending cycle where tight muscles lead to more discomfort and more discomfort leads to even tighter muscles.

During your first visit, I listen closely to your history and symptoms, assess your posture, breathing, core function, and gently evaluate your pelvic floor muscles. This cam be completed either externally or internally, depending on your comfort level. 

 

Manual Therapy for Muscle Tension

Chronic pain can cause the pelvic floor muscles to stay in a guarded or tightened state (protecting itself). Through gentle manual therapy, I work on releasing tight or overactive muscles both externally (hips, abdomen, low back) and internally (vaginal or rectal, if appropriate). This helps reduce muscle guarding and improves blood flow to the area. All of this is not done in one session, this is a progressive process over the span of weeks, to help keep your nervous system in check and not feeling like it is running from a bear.

Techniques may include:

  • Trigger Point Release
  • Scar Tissue Mobilization (especially after surgery)
  • Visceral mobility for organ mobility and alignment

 

Breathwork and Nervous System Regulation

Pain isn’t just physical—it’s also tied to the nervous system. I teach diaphragmatic breathing to help calm the body’s “fight or flight” response and relax the pelvic floor. I preach this to every patient that the foundation for any sort of movement is how you breathe; if you are not breathing properly the rest of the system cannot coordinate or support you in your tasks. This type of breathing can reduce pain intensity and improve muscle coordination over time. I have also found that it helps individuals I treat feel more in-tune with their bodies. 

 

Stretching and Gentle Movement

Targeted stretches for the hips, back, and pelvis can help reduce tension and improve mobility. I also recommend gentle movement practices like yoga or walking, tailored to how you’re feeling that day. Consistency (not intensity) is key. If you are one that loves HITT workouts or fast-paced tasks that is totally ok too, but also recognize the season your body is in and how taking a small step back from the HITTs every day to maybe 2-3 per week to still give you the endorphins you are looking for but also the reset your body may be asking for. 

 

Education and Empowerment

Understanding your body is powerful. I educate patients about how endometriosis affects the muscles and nerves in the pelvic region and provide tools to manage flares. This might include:

  • Using a heating pad to provide relaxation
  • Gentle self-massage techniques to help with scar tissue formation
  • Modifying movement or posture to reduce strain on the abdomen/pelvis
  • Checking in with how much fluid you intake a day to help with tissue nutrients
  • Recommendations for pelvic support such as a pelvic wand

 

Collaboration with Your Healthcare Team

Pelvic floor PT is just one piece of the puzzle. I firmly believe that no one person can fix all of one person's problems, that a team approach is valuable to have. This is why I often collaborate with gynecologists, pain specialists, surgeons, chiropractors, and nutritionists to ensure you’re getting well-rounded care. If surgery (like excision) is part of your plan, physical therapy can help prepare for and recover from it more smoothly. Just like if someone needed shoulder or knee surgery, they would receive physical therapy; the same is true for endometrial surgery/pelvic floor care. 

 

Final Thoughts

Endometriosis pain can feel isolating, but you're not alone—and you don’t have to “just live with it.” Pelvic floor physical therapy offers a non-invasive, supportive path toward relief. Every treatment plan is individualized, and progress may be slow, but if it's meaningful, then it’s totally worth it. With the right support, your body can begin to feel safe and strong again.

If you’re dealing with endometriosis-related pain, consider reaching out to our team. You deserve care that addresses your whole body—not just the symptoms.

 

 

~Dr. Sara Panek PT, DPT, PCES

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