By Endometriosis and pelvic floor dysfunction are both common yet often misunderstood conditions affecting many women – and they frequently occur together. If you’re struggling with pelvic pain, bladder or bowel symptoms, painful intimacy, or unexplained muscle tension in your lower abdomen, it could be a sign of a pelvic floor problem, possibly linked to endometriosis. Working with a pelvic floor specialist and a female surgeon experienced in both conditions can make a profound difference in managing symptoms and improving quality of life. While these issues may seem unrelated at first glance, the connection between them is increasingly supported by both research and clinical experience.
What is Endometriosis?
Endometriosis occurs when tissue similar to the lining of the uterus grows outside the womb, often on the ovaries, bladder, bowel, or pelvic walls. It affects 1 in 7 Australian women by the age of 44 and symptoms can range from mild to debilitating. These include chronic pelvic pain, painful periods, fatigue, and fertility issues.
What is Pelvic Floor Dysfunction?
The pelvic floor is a group of muscles and connective tissues that support the bladder, uterus, bowel, and vagina. Pelvic floor dysfunction refers to problems with these muscles – either too tight, too weak, or poorly coordinated. Common signs include pelvic pain, constipation, urinary urgency, painful intercourse, and a sensation of heaviness or bulging in the pelvis.
How the Two Conditions Are Connected
There are several reasons endometriosis and pelvic floor dysfunction often occur together:
- Chronic Pain Response: Living with long-term endometriosis pain can lead to involuntary clenching or tightening of the pelvic floor muscles. Over time, this muscle guarding can cause a secondary pelvic floor problem that persists even when the original endometrial lesions are treated.
- Inflammation and Nerve Irritation: Endometrial implants can irritate nerves and pelvic structures, causing a heightened pain response and muscle dysfunction. This can lead to sensitisation of the pelvic nerves and muscles, contributing to ongoing dysfunction.
- Bladder and Bowel Involvement: Many women with endometriosis experience symptoms like urinary urgency, incomplete emptying, and painful bowel movements – signs that point to pelvic floor dysfunction, especially when lesions are near the bladder or rectum.
- Surgical Scarring and Adhesions: Repeated surgeries for endometriosis can lead to scar tissue and adhesions that restrict normal pelvic movement and affect pelvic floor muscle function.
Symptoms to Watch For
If you have endometriosis and are still experiencing pain or other issues even after treatment, it’s worth considering whether a pelvic floor problem is contributing. Symptoms of overlap may include:
- Ongoing pelvic or lower back pain
- Pain during or after intercourse
- Constipation or straining during bowel movements
- Bladder urgency, frequency, or leakage
- A feeling of tightness or pressure in the pelvic area
Why a Multidisciplinary Approach Matters
Treating endometriosis and pelvic floor dysfunction often requires a team approach. This may include a gynaecologist, pelvic floor specialist, physiotherapist, and sometimes a female surgeon who understands the nuanced ways these conditions interact. Surgery can address endometrial lesions, while pelvic floor therapy focuses on muscle retraining, relaxation, and coordination.
Treatment Options
- Pelvic Floor Physiotherapy: A cornerstone of treatment, focusing on manual therapy, stretches and exercises, breathing techniques, and education to help restore normal muscle function.
- Microenergy Acoustic Pulses: Microenergy acoustic pulses (MAP) therapy is a non-invasive treatment that uses sound wave technology to help reduce pelvic pain, improve blood flow, and relax hypertonic pelvic floor muscles. Emerging evidence suggests it may offer relief for women with endometriosis-related pelvic floor problems by targeting both muscular tension and inflammation.
- Surgical Management: In cases where endometrial lesions or pelvic prolapse is causing significant symptoms or structural issues, a skilled female surgeon can perform laparoscopic surgery.
- Pain Management: Including medications, nerve blocks, or cognitive behavioural therapy to help break the cycle of chronic pain and muscle tension.
- Lifestyle Support: Diet, stress management, and gentle movements like yoga or Pilates may support overall pelvic health.
Getting the Right Support for Your Pelvic Health and Comfort
If you’ve been treated for endometriosis but your pain or symptoms haven’t gone away, it may be time to explore whether you’re also experiencing a pelvic floor problem. The two conditions often overlap, and recognising this connection can be a turning point in your treatment journey. Working with a pelvic floor specialist – ideally who is a trusted female surgeon – offers a comprehensive approach tailored to your needs. You don’t have to manage this alone. With the right support, a better quality of life is absolutely possible.