Specialised physiotherapists can play a crucial role in reducing the pain experienced by women suffering from endometriosis – a condition with growing public awareness, prompting a rise in qualified Pelvic Floor Physiotherapists.

According to the International Pelvic Pain Society, Endometriosis is an invisible, incurable disease when tissue that is similar to the lining of the uterus (endometrium) grows in other parts of the body and causes chronic inflammation or scarring.

While surgery is often required, in some cases, where pelvic pain is caused by scar tissue and adhesion, physiotherapy can help.

“A person with Endometriosis often has secondary Pelvic Floor Muscle Dysfunction,” says Pelvic Floor Physiotherapist, Rachel Fitt.

“The body’s protective response to pain is for muscles to tighten, causing dysfunction. A tight and tense muscle, overtime, can develop trigger points, or tender areas, that can refer pain into the lower abdomen, lower back, gluteals, hips and thighs. This pain can mimic endometriosis symptoms.”

Those who have Pelvic Floor Dysfunction & Endometriosis may suffer from the following symptoms;

• Pelvic Pain
• Dyspareunia (pain during sex)
• Bladder Urgency
• Frequent Urination
• Urinary Incontinence
• Dysuria (pain emptying your bladder)
• Constipation
• Bowel Urgency

Unfortunately, there remains a stigma associated with pelvic floor dysfunction, which is most often linked to pregnancy and post-birth.

“Even with the growing number of Pelvic Floor Physiotherapists in Australia, women still do not know we exist.

“So yes, women believe their symptoms need to be investigated further, with surgery.

“Often women with endometriosis have no signs of endometriosis when investigated but still suffer from immense pain. This is very typical of someone with chronic pain.

“These women should be seeing a Pelvic Floor Physiotherapist for functional re-training and desensitisation.

“I do my best to review all my endometriosis patients both pre and post op to address any pelvic floor muscle pain, bladder and bowel dysfunction, in the hope this may make their surgery more successful. “

Specialised Pelvic Floor Physiotherapists can help women with endometriosis by:

• Treating muscular dysfunction
• Functional retraining for biomechanics, posture and muscle guarding
• Establishing good bladder and bowel habits
• Exercise program
• Pain education

All Physiotherapists have a role in identifying Pelvic Floor Dysfunction and endometriosis symptoms, however a Pelvic Floor Physiotherapist, or a Physiotherapist with post-graduate qualifications to treat the Pelvic Floor is more suitable.

“The best way to assessing one’s pelvic floor is to perform an internal examination which requires further training.

“All physiotherapists are equipped with exercise and rehab knowledge so could definitely help with exercise, functional retraining and pain desensitisation.

“It is important physiotherapists without these extra qualifications refer to someone who does to co-treat together.”

Ms Fitt says she chose to specliase in women’s health to help empower women with information on conditions that aren’t openly spoken about.

“Women suffer from debilitating conditions that impact their quality of life in silence. When they come into clinic I love seeing their reactions and relief when I can provide a diagnosis and treatment plan. Every patient is different and unique which I really enjoy.”

For physiotherapists wanting to enter the field, Ms Fitt says professional development is key.

“We are constantly learning in the women’s health and Pelvic Floor space.

“There is always new research coming out about these conditions. It is important to stay up to date with all the information both from a Physiotherapy perspective but also from a medical perspective.

“Endometriosis is better treated with a multi-disciplinary approach. Develop relationships with local acupuncturist’s, naturopath’s, dieticians, pain specialist, psychologist’s, gynaecologists, etc.”

Ms Fitt says education is crucial in increasing awareness of endometriosis treatment options and pain management strategies.

“I think we need to be educating teenagers about periods, period pain, endometriosis, PCOS etc.

“If we can identify women at a younger age that have endometriosis the more effective our treatment may be in preventing chronic pain.

“There is a fantastic program running in South Australia called Periods, Pain and Endometriosis Program (PPEP Talk). How fantastic would it be if this was run in all schools.

“Social media has also been a fantastic resource to educate women.”

While physiotherapy can aide some pain symptoms, it's important to note that it won't stop or slow down the rate at which endometriosis grow, with excision surgery remaining the gold standard of overall treatment.

For those people wanting to investigate pain management through physiotherapy, Ms Fitt says it's important to feel completely ready. 

“Physiotherapy is not a passive treatment; it requires patients to invest time and energy into home programs to retrain habits.

“However, the earlier someone sees a physiotherapist the sooner they can commence treatment to decrease symptoms and pain.”

Ms Fitt says it’s important for physiotherapists to equip their patients with as much knowledge as possible, in order to encourage at-home treatment.

“Understanding why they are in pain is so important.

“Chronic pain can be very complex, and it is important patients are equip with knowledge.

“I also recommend patients ask their health professional if they usually treat patients with endometriosis.

“Like anything, if you don’t see it regularly you aren’t as skilled in treating it.

“As a patient, if you are not happy with your health professional or want another opinion, you have every right to seek further advice.

“Endometriosis is a complex pain condition.

“No one person will ‘cure’ your symptoms. You need a good multi-disciplinary team to work together and case mange you to ensure treatment goals align to achieve the best outcome.”