Endometriosis & the Pelvic Floor: What You Need to Know

What is Endometriosis?

Endometriosis is an inflammatory condition where endometrial-like tissue grows outside of the uterus. It is a common condition, 10% of women have endometriosis and frequently have an 8- 10 year delay of diagnosis. So many women live with the condition for years before they are diagnosed.

Endometriosis symptoms can include:

• Pelvic floor dysfunction
• Bowel, bladder, and sexual dysfunction
• Bloating/ distension/ constipation
• Low back pain
• Hip, groin, and/or abdominal pain
• Painful intercourse
• Painful periods and/or ovulation
• The feeling of pulling or tension in the abdomen is because endometriosis causes adhesions, which cause tissues or organs to stick together

The pelvic floor muscles are almost always affected ( about 70%) in women who have endometriosis because the pelvic organs literally sit on the third layer of pelvic floor muscles, the levator ani.

In addition, due to the inflammation and pain, the pelvic floor muscles become tight in an effort to protectively guard the area.

This becomes a perpetual cycle of inflammation, irritation, and pain. It becomes a situation where there are several overlapping conditions going on at the same time. For example, the presence of endometriosis itself, pelvic floor dysfunction, and musculoskeletal imbalance (many women with endo “grip” their muscles as a response to pain and develop trigger points).

What to Know About Endometriosis Surgery

The decision to pursue surgery for endometriosis is personal, multifactorial, and largely a quality-of-life decision. If surgery is part of your journey, the most important thing to know is that not all surgical approaches are equal.

Excision surgery is the gold standard — not ablation. Excision removes endometrial tissue at the root rather than burning the surface, which produces more permanent and complete results. The quality of the outcome depends heavily on the surgeon’s specific training and volume of endometriosis cases.

When evaluating surgeons, ask:

• What percentage of your practice is endometriosis?
• How many excision surgeries have you performed?
• What is your specific training in endometriosis excision?

Nancy’s Nook is an excellent patient-led Facebook group and resource library for finding qualified excision specialists and doing your research before committing to a provider.

Why Pelvic Floor Physical Therapy Matters — Before and After Surgery

Pelvic floor physical therapy should be the first line of conservative treatment for endometriosis — and it remains essential regardless of whether surgical intervention is part of your plan.

Surgery can address the endometrial lesions, but it does not resolve the pelvic floor dysfunction, muscle tension, trigger points, and adhesions that have developed over years of inflammation and pain. These overlapping conditions need to be treated directly — and that’s where pelvic floor PT does its most important work.

At Pelvicore, we help women with endometriosis reduce pain, prevent flares, and build a home management program that gives them real control over their symptoms. You don’t have to just manage this.