How Can Pelvic Floor Physical Therapy Help If You Think You Might Have Endometriosis?

Endometriosis, or “endo,” is a chronic inflammatory condition where tissue similar to the uterine lining grows outside of the uterus. It commonly affects the ovaries, fallopian tubes, ligaments, bowel, bladder, and the lining of the pelvis.

It is also commonly misunderstood.

Many of the people we see at Empower PT have spent years being told their pain was “normal,” that they just had a “low pain tolerance,” or that birth control was the only option. While medical management is incredibly important (and we work closely with OB-GYNs and other specialists), pelvic physical therapy plays a huge role in improving quality of life.

What Are the Signs You Might Have Endometriosis?

While only a physician can diagnose endometriosis (often via laparoscopic surgery though research is now making advances in less intrusive diagnostic methods), common symptoms include:

• Painful periods that interfere with work, school, or daily life

• Pain with intercourse, arousal, or pain in the area of the vulva outside of sexual stimulus

• Pain with bowel movements or urination, especially around your cycle

• Changes in bowel habits and IBS symptoms which can be associated with different phases of your cycle

• Chronic pelvic pain (not just during your period)

• Low back, hip, or tailbone pain that may fluctuate with your cycle

• Bloating (“endo belly”)

• Struggling with fertility 

• Fatigue and brain fog

  
  

If your symptoms are shaping how you move, work, exercise, or connect with your body, that’s a sign your body needs support and should not be brushed aside.

Why Might Traditional PT Not Have Helped?

Many people with endometriosis seek out pelvic physical therapy, which is an important and appropriate step.

That said, endometriosis is not simply a tight pelvic floor. And while internal pelvic floor treatment can be valuable, it is rarely the only piece of the puzzle.

Endometriosis is a whole-system condition. If treatment focuses only on internal muscle release, improvements may feel temporary, especially when you return to exercise or daily demands. If pelvic floor coordination is addressed without looking at bowel dysregulation, pain with bloating, distension, and other bowel changes may continue. If muscle tension improves but a sensitized nervous system is not supported, flares can still feel unpredictable.

At Empower PT, we approach endometriosis-related pain as an integrated system that includes:

• Pelvic floor coordination (both relaxation and strength when appropriate)

• Orthopedic contributors such as hip mobility, rotational control, and glute strength

• Bowel and bladder mechanics

• Abdominal wall tension and scar mobility, particularly after surgery

• Nervous system regulation and pain science education

• Strategies for inflammation management

• Progressive, strength-forward loading to build overall capacity

Internal treatment can absolutely play a role, but meaningful, lasting change usually happens when we address the body as a whole.

Our goal is not simply symptom reduction. It is helping you build resilience and confidence so that movement, exercise, work, and intimacy feel more predictable and supported.

How Would Empower PT Assess Someone With Suspected Endometriosis?

Our evaluations are one full hour, one-on-one. We start by listening.

We may ask:

• When did your pain first begin? Was it gradual or sudden? Has the intensity, location, or pattern changed over time?

• Do your symptoms follow your menstrual cycle, or do they occur throughout the month?

• What does your period actually feel like — cramping, sharp pain, pressure, heaviness, nausea, fatigue? How many days does it significantly impact you?

• Have you noticed bowel changes such as constipation, diarrhea, painful bowel movements, bloating, or symptoms that worsen around your cycle?

• Do you experience bladder symptoms like urgency, frequency, burning, or discomfort with urination?

• Are there orthopedic symptoms like hip pain, low back pain, tailbone pain, or pain that radiates into the legs, especially if it fluctuates with your cycle?

• Are there specific movements, positions, or activities that flare your symptoms, such as walking, lifting, sitting, exercise, or stress? What tends to calm them?

• Do you experience pain with intercourse, tampon use, or pelvic exams?

• How are these symptoms affecting your ability to train, work, travel, care for your family, or feel comfortable in your body?

  
  

From there, we assess:

• Breathing patterns and ribcage mobility, since pressure management directly impacts both pelvic pain and bowel symptoms

• Core coordination, abdominal wall tension, and how your system manages load during movement

• Hip mobility, rotational control, and glute strength, especially if you’re experiencing hip, low back, or tailbone pain

• Pelvic floor tone, strength, and coordination (internal exam only if you consent), looking at both overactivity and how well the muscles lengthen and contract

• Abdominal, visceral, and scar mobility, particularly if you’ve had laparoscopic surgery

• Bowel and bladder mechanics, including how you generate and manage pressure during defecation and urination

• Nervous system sensitivity, pain patterns, and overall movement tolerance

  
  

Often, people with endometriosis have a pelvic floor that is overactive and protective. We frequently begin with down-training, coordination, and graded exposure to movement and eventually loading so that day to day life becomes more manageable.

How Empower PT Treats Endometriosis-Related Pelvic Pain

A typical session may include:

• Nervous system regulation strategies and breathwork to improve pressure management and reduce protective tension

• Pelvic floor coordination work, focusing on how the muscles lengthen, respond to pressure, and work in relationship with the diaphragm and abdominal wall

• Gentle manual therapy to the abdomen, hips, pelvic floor, or surgical scars when appropriate

• Assessment and retraining of bowel mechanics and defecation strategies if bowel symptoms are present

• Hip and trunk mobility work to address orthopedic contributors such as low back, tailbone, or rotational pain

• Gradual loading of the hips, core, and full body to improve overall movement tolerance

• Education around pacing and understanding flare patterns

  
  

The focus is on improving how your whole system works together so that symptom management is supported by better coordination, strength, and movement capacity over time.

What Does Healing Look Like?

Endometriosis is a chronic condition, and the gold standard for long-term symptom improvement is excision surgery performed by a skilled specialist. Physical therapy does not replace medical care or surgery. Instead, it works alongside it, whether you are preparing for surgery, recovering from it, or managing symptoms while exploring your options. Our work focuses on improving how your body responds to the condition itself and, when applicable, to surgical intervention.

Healing may mean reducing the overall intensity and frequency of pain, improving bowel comfort, and decreasing discomfort with intimacy or pelvic exams. It often involves increasing tolerance to sitting, walking, lifting, and exercise while restoring more coordinated breathing, pressure management, and movement patterns. Over time, many people notice that flares feel less severe, less unpredictable, and less disruptive to daily life.

Some individuals begin to notice changes in muscle tension, bowel symptoms, or movement tolerance within the first four to six weeks. Building strength, coordination, and nervous system resilience tends to unfold more gradually, particularly if symptoms have been present for years.

The goal is not to promise a cure. It is to help your system become more adaptable, more resilient, and better supported both before and after medical treatment.

Simple Starting Exercise for Endometriosis-Related Pelvic Tension

One foundational movement we often begin with is a seated 360-degree breathing drill using a resistance band for feedback.

Sit upright in a chair with both feet flat on the floor and your spine supported but not rigid. Wrap a light resistance band around your lower ribcage and hold the ends gently in front of you so you can feel the band expand.

Inhale slowly through your nose and allow your ribcage to widen into the band — front, sides, and back. Let your abdomen soften and expand naturally. Think of the breath moving down into your pelvis without pushing or straining.

Exhale slowly through your mouth and feel the ribcage gently recoil as the band softens. Allow the abdominal wall and pelvic floor to respond naturally rather than actively tightening.

Repeat for 2 to 3 minutes without forcing the breath or bracing your core.

The goal is not to “tighten,” but to restore coordination between the diaphragm, abdominal wall, pelvic floor, and ribcage while reducing protective tension.

Our Pelvic Health Services and What Our Clients Say

Many people with endometriosis come to us after years of feeling dismissed or told their pain was “normal.” One client shared:

“Empower PT has given me more clarity and support around my endometriosis than any other healthcare experience I’ve had. They take the time to truly listen, explain what’s happening in my body, and move at a pace that feels safe and sustainable. For the first time, I feel like I have a team that understands the complexity of this condition and knows how to work with it.”

If you’re dealing with painful periods, pelvic pain, or suspected endometriosis, you don’t have to navigate it alone.

You Deserve Comprehensive Support

Endometriosis is complex. Managing it involves managing hormones, inflammation, surgery, lifestyle changes, stress, and the nervous system. Pelvic physical therapy cannot remove endometrial lesions, but it can dramatically improve how your body responds to them.

When we address muscle guarding, improve mobility, build strength progressively, and calm a sensitized nervous system, people often move from surviving their cycles to living their lives again.

If you suspect endometriosis or are struggling with pelvic pain, we would be honored to support you. Head to our contact page and fill out the form to get started.