Endometriosis

Endometriosis is a condition where tissue similar to the lining of the uterus grows outside the uterus. This tissue can cause inflammation, pain, and irritation within the pelvis and may affect areas such as the ovaries, fallopian tubes, bowel, bladder, and surrounding tissues.

Endometriosis affects people differently. Some women experience mild symptoms, while others live with significant pain that affects exercise, work, relationships, and everyday life.

Although endometriosis itself cannot be cured through physiotherapy, pelvic health physiotherapy can play an important role in managing symptoms, improving movement, and helping women regain control over their bodies.

Common symptoms of endometriosis

Symptoms can include:

• Painful periods
• Chronic pelvic pain
• Pain during or after sex
• Pain with bowel movements
• Pain with bladder filling or emptying
• Abdominal discomfort or bloating
• Fatigue
• Difficulty exercising due to pain
• Lower back, hip, or pelvic muscle pain

The severity of symptoms does not always match the amount of endometriosis present. Some women with significant symptoms may have minimal disease seen on scans, while others with visible endometriosis may have fewer symptoms.

How does endometriosis affect the pelvis?

Endometriosis can create inflammation and irritation within the pelvic region. Over time, this may contribute to:

• Increased sensitivity of pelvic tissues
• Pelvic floor muscle tension
• Reduced movement and mobility
• Protective muscle guarding
• Changes in how the nervous system processes pain

These changes can continue even after surgery or medical treatment, which is why rehabilitation can be an important part of recovery.

How is endometriosis assessed?

A pelvic health physiotherapist will take time to understand:

• Your pain patterns
• Menstrual symptoms
• Previous diagnosis or surgery
• Exercise levels
• Bladder and bowel symptoms
• How symptoms affect your daily life

Assessment may include:

• Pelvic floor muscle assessment where appropriate
• Assessment of muscle tension and relaxation
• Movement and posture assessment
• Discussion of pain triggers and management strategies

How can pelvic health physiotherapy help?

Treatment is individualised and may include:

Managing pelvic floor muscle tension

Many women with endometriosis develop increased pelvic floor muscle activity due to ongoing pain.

Treatment may include:

• Relaxation techniques
• Breathing exercises
• Gentle mobility work
• Improving pelvic floor coordination

Pain management strategies

Physiotherapy can help you understand pain responses and develop strategies to reduce sensitivity and improve function.

Improving movement and exercise confidence

Pain can lead to reduced activity, which may affect strength and overall wellbeing.

Your physiotherapist can guide you with:

• Safe exercise progression
• Strength training
• Mobility work
• Returning to activities you enjoy

What other treatments may be involved?

Endometriosis management is often multidisciplinary and may include:

• Medication
• Hormonal treatments
• Specialist gynaecology input
• Surgical treatment where appropriate
• Psychological support for chronic pain management

Physiotherapy works alongside these approaches to support overall recovery.

Living with endometriosis

Endometriosis can have a significant impact, but symptoms can often be managed with the right combination of medical care, rehabilitation, and self-management strategies.

A specialist pelvic health physiotherapist can provide a confidential assessment to help you understand your symptoms and develop a plan tailored to your goals.