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What is Endometriosis

The endometrium is the inner lining of the uterus. This layer of tissue changes throughout the menstrual cycle, and it's what sheds during periods. Endometriosis occurs when normal endometrial tissue implants abnormally in locations other than inside the uterus.

Despite being located in an unusual place, the endometrial tissue (endometrial implant) still responds to natural cyclic hormonal fluctuations. This means that it thickens, secretes hormones, and experiences cyclic sloughing of menstrual material - just like the tissue in the uterus. As a result, the symptoms of endometriosis vary depending on how much hormone production is affected and where the implant has spread.

Typically, the abnormal sites of endometrium implants are in the pelvis:


Fallopian tubes



Soft tissue

More unusual sites include:

Surgical scars

Lungs and their covering (pleura)






Around spinal cord



Symptoms of Endometriosis

Endometriosis can be difficult to diagnose, as many of the symptoms are also associated with other conditions. However, there are a few key things to look out for. Some women don't experience any symptoms at all, but when they do occur, they depend on the site of the endometrial implant. Common complaints include pain in the pelvic region - which can vary depending on your menstrual cycle - and heavy periods. Other symptoms include:

  • Pain during menstrual periods (dysmenorrhea)

  • Heavy or irregular bleeding

  • Pain in the pelvic region

  • Lower abdominal or back pain

  • Infertility

  • Pain or discomfort during intercourse (dyspareunia)

  • Pain on passing feces (dyschezia), often with cycles of diarrhea and constipation

  • Bloating, nausea, and vomiting

  • Pain in the groin

  • Pain on passing urine and/or increased urine frequency

  • Pain during exercise

  • Blood in sputum

  • Seizures that change in severity with the menstrual cycle

How Pelvic Physiotherapy can Help:

1. Improve Pain and Pelvic Symptoms related to bladder/bowel health

Endometriosis can cause a range of changes in the pelvic floor, including altering the mobility of internal organs, fascia and muscles. This change in function can lead to dysfunction of the pelvic floor muscles and tissues. Pelvic floor physio can help to normalize how the pelvic floor contracts and relaxes, which in turn can improve symptoms.

2.. Improve pain with Penetration (intercourse, menstrual aids) Endometriosis can often lead to spasms and tightness in the pelvic floor which can make inserting tampons (or a menstrual cup), or having intercourse very uncomfortable. Additionally, because endometriosis causes pain that persists over time, the central nervous system can become sensitized and start to sound the danger alarm at the slightest provocation.

A pelvic floor physiotherapist can help you understand and manage your pain better. This is achieved by helping to the pelvic muscles, leading to an improvement in overall pain levels. Additionally, this is done by retraining the brain to no longer associate pain with penetration, through a combination of manual therapy and exercises.

3. Improve bloating A common symptom of endometriosis is bloating and distension of the abdomen. As people continue to live with endometriosis, the cumulative effects of the condition on their connective tissue can result in alterations of how the body and brain sense the position (or proprioception) of internal organs. This is because the fascial layers can be affected by endometriosis, which can lead to changes in proprioception. Finding a Pelvic Health Physiotherapist who understands visceral mobilization is important, as these techniques help improve symptoms related to the fascia and connective tissues around the abdominal organs, relieving undue pressures placed on them.

If you are unsure of whether Pelvic Floor Physiotherapy will help with your symptoms and condition, we highly encourage you to contact us for a 15 minute Free Phone Consultation. One of our specialised Pelvic Floor Physiotherapists will discuss your concerns with you, and help you determine whether this is the best course of treatment for you.

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