How pelvic physiotherapy can help

2016, Responses from: Leanne Wait

How does pelvic floor physiotherapy actually help in women with Endometriosis, and what are the mechanics behind some of the muscular causes of pelvic pain that physios treat?


Leanne Wait: This is a great question because the role of the muscles and pelvic health physio (who provide pelvic floor physiotherapy) is often poorly acknowledged. Women with endometriosis experience pain for many reasons and the reasons and science behind how this all fits together is complex and can be confusing. So let’s take a closer look at some of the mechanisms of pain that physiotherapy can help with.

  • When you live with persistent pain for more than 3-6 months we know that the nerves transmitting the signals go through a process of ‘wind up’ where they become more and more sensitive. As a result of this the surrounding nerves which may go to other tissues like the bladder or bowel or to muscles and joints also become very sensitive and can react by either causing pain in that organ/area or other symptoms like bloating, urgency, painful bowel motions or pain with sex. When the nerves become sensitive our tissue responds differently so that things that are not normally painful become painful and things that usually would hurt, hurt much more than they used to. This process is called ‘central sensitisation’.
  • Living with pain also means you live with your body in protection mode all the time. This is like your body being on alert all the time which can cause muscle guarding, altered breathing patterns, an inability to relax and disturbed sleep patterns and even anxiety and poor coping.
  • We also know that the pelvic floor muscles respond to any imminent or potential threat by contracting and squeezing. A threat could be something stressful, pain, a scary movie, a fright etc. Often when you have persistent pain the pelvic floor muscles stay contracted and switched on and in most cases you don’t realise it is happening. Overtime this can lead to a ‘hypertonic’ or ‘overactive’ pelvic floor where the muscles don’t release and relax. This can cause pain internally that can be felt in the vagina but also with in the pelvis and abdomen. This is also often part of the reason that sex is painful.
  • Surgery to resect endometriosis does not address the likes of ongoing signals from other sensitive structures like the bowel or bladder or muscles. These often still need to be addressed to support your overall wellbeing and a good long term outcome as they can still cause pain despite the removal of the endometriosis.

Physiotherapy can help in many cases but each person presents with a mixture of similar but different signs and symptoms and we all have different goals of what we would like to change or achieve.

  • My patients all learn about pain and the nerves and the signals they send and how our body/brain tries to protect us. There is very good scientific evidence that suggests even learning about pain reduces pain. We also recommend things like TENS and exercise and teach better breathing and relaxation to help settle the sensitive nerves.
  • Pelvic health physios also assess all the systems in the pelvis like bladder, bowel, vagina muscles and nerves to see how much they may be contributing to pain. Even constipation can trigger more pain because after a long period of pain the nerves of the bowel may also be very sensitive. Likewise, sensitive bladder nerves can cause urgency, bladder pain or even incontinence that can often be managed much better with the help of a pelvic health physio.
  • We also assess for and treat tight sore muscles including the pelvic floor muscles. For this you may be given stretches, pelvic floor relaxation exercises or the muscles may require massage and release soft tissue work.
  • Sometimes we also do scar release work or deep abdominal or visceral work to release any tight structures that maybe pulling or adhered causing pain.
  • If you have problems with sexual function pelvic health physio can also help with this in many ways depending on the reason. Often at some point we will teach you how to use trainers(dilators) which can be very effective to help you get used to the muscles stretching without your muscles responding with pain.
  • As you may now see we have a large scope but there is ‘no one size fits all’. Individual symptoms require individual care.
  • The key can be as simple as adding things gradually and doing a bit more and a bit more slowly to avoid triggering a pain response. This could be with various treatments or even exercise. Often I see women who are told to exercise so they start walking on hills fast for an hour when they have been inactive for a long time – then they hurt so they stop when in reality ‘motion is lotion’ – as long as you start at the right level for it not to hurt or trigger hurt. Also when adding things to your recovery apply the same principles. Add one stretch for a few days and see how you feel after doing several times then add or try another take it slowly it generally has taken awhile for your symptoms to develop so they are likely to also take time to recede.

Pelvic health physios are great listeners, we spend a lot of time listening to our patients, caring for their well-being and being a great source of support and encouragement. I hope this has given you some insight into how we may help you.

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