Pelvic Floor Mythbusters: Endometriosis Edition

Fiona McMahon PT, DPT and Amy Stein PT, DPT

Featuring excerpts from Beating Endo by  Iris Kerin Orbuch, MD and Amy Stein D.P.T.

Welcome back to our Pelvic Floor Mythbusters series! We have explored the effects of prolonged sitting and pee holding and now it’s time to move on to endometriosis. With endo, there are so many different myths, concepts, and sorta truths, that we figured we would address them lightning round style so we can cover as much ground as possible.

Endometriosis (endo) comes with a lot of misconceptions and because of this, the time from symptom onset to official diagnosis and treatment is long. The diagnosis of endo can often take in excess of a full decade to get, which delays further intervention and prolongs suffering. It’s a huge deal and is the reason why Dr. Amy Stein, PT, DPT and Dr. Iris Orbuch, MD. set to the task of writing a book where they bust endo myths right, left, and sideways. Beating Endo goes into much more detail than we do here. If you wish to purchase it, you may here

So without further adieu, here is a list of myths and truths taken from Beating Endo:Beating Endo Cover!


Common Endo Myths

The abdominal and pelvic floor muscles are rarely affected by endometriosis.

False: Constipation, frequent urination or retention, Pain with vaginal penetration from endometriosis causes tightening of the abdominal and pelvic floor muscles; So too does assuming the fetal position which is our go to pose when we are in pain. Both contribute to tight abdominal and pelvic floor muscles which causes pain.

The pelvic floor and abdominal muscles do not cause bladder, bowel, sexual dysfunction or abdominal-pelvic pain in patients with endometriosis.

False: Tight pelvic floor muscles caused by years of straining or reflexive tightening due to pain, often cause a severe amount of pain which results in further tightening and shortening of the pelvic floor muscles. Good news is that pelvic floor physical therapy benefits most people who have been experiencing abdomino-pelvic or sexual pain and/or are straining due to ongoing bladder and bowel symptoms.

Hysterectomy is a cure for endometriosis.

False: Hysterectomy is neither a treatment nor a cure. By definition endometriosis consists of cells similar to those in the lining of the uterus but found outside the uterus. Only surgical ‘excision’ removes endometriosis cells.

Medical menopause is a cure for endometriosis.

False: Explanation: Just because your medicines give you hot flashes doesn’t mean your endometriosis is going away. The best treatment approach is to meet with an Endo specialist to discuss options, and in most cases PT management. As well surgical excision has much better results than ablation of Endometriosis.

There is no correlation between quantity of endometriosis and severity of disease.

Truth: Even if you have a minimal amount of endometriosis, you can be in debilitating pain with lots of symptoms and in most cases dietary changes, physical therapy and mindfulness practices can help manage a lot of your symptoms.

Teenagers are too young to have endometriosis.

False: Teenagers can have endometriosis and their endometriosis can cause debilitating symptoms.

Pregnancy is a cure for endometriosis.

False: Just plain no. Pregnancy does not cure endometriosis.

Ablation surgery is the same as excision surgery.

False: Not even close. Excision surgery is the proper treatment for endometriosis. Ablation surgery, burns the surface of the endometriosis lesion but leaves the bulk of endometrial implants behind.

Surprising Endo Facts:

Fact: Physical therapy (pelvic PT) can help many suffering from the many pains and symptoms of Endo, including back, abdominal and pelvic pain, bladder, bowel and sexual function.

Fact: The majority of patients with Endometriosis require pelvic floor physical therapy. Pelvic floor PT can be instrumental in the healing process and can help abdominal-pelvic pain, bladder and bowel urgency, frequency, retention, incomplete emptying, and any sexual pain related to the musculoskeletal system.

Truth: Painful bowel movements, constipation, diarrhea and bloating are symptoms of endometriosis as well as symptoms of pelvic floor dysfunction .

Truth: Painful sex is a symptom of endometriosis as well as a symptom of pelvic floor dysfunction.

Truth: 40 to 50% of women with unexplained infertility is caused by Endometriosis.

Truth: Teens with endometriosis often have acyclic pain, that is, pain at other times of the month rather than only during their period, in addition to cyclic pain.

Truth: Back pain is a symptom of endometriosis.

Truth: If your ultrasound is normal you can still have endometriosis.

Truth: roughly 10% of women have endometriosis. That’s close to 200 million women worldwide. Endometriosis is much more than just bad period pain. 1 in 4 women have pelvic floor dysfunction.

Truth: Endometriosis commonly affects the musculoskeletal system, and in many cases can be a primary contributor to one’s pain and symptoms..

Pelvic Health 101: Does my diet really matter?

By Fiona McMahon, DPT

Calories in should equal calories out, right? It turns out there’s a little more to health than that. Learn more about how diet can affect your pelvic floor. Get practical tips for integrating diet into the management of pelvic floor dysfunctions such as constipation, interstitial cystitis ( painful bladder syndrome), and many others.

veggiesOur next course, where you’ll learn all about nutrition and pelvic health from nutritionist Jessica Drummond, is Tuesday, November 3, at 7pm in our office!  First-time attendees will receive FREE copies of Amy’s DVD, Healing Pelvic and Abdominal Pain, and we provide snacks. We will also be tweeting the highlights of the seminars at @beyondbasicspt!

Pelvic Health courses are free to the public, but space is limited. Please sign up at  for an evening of informative information that will help you better manage your pelvic floor symptoms!

Hope to see you soon!

Photo Source:

Pelvic Health 101: Q&A with an Expert Panel

Fiona McMahon, DPT

Our expert panel class is a new addition to our PH101 course catalog and we are so excited! Join us October 27th at 7pm for an open question and answer format class with some of the world’s first and foremost medical experts in pelvic health.

Our guests will include Doctor of Physical Therapy and Founder of Beyond Basics, Amy Stein, Physical Therapist, DPT, BCB-PMD; Dr. Allyson Shirkhande, Urologist, Dr. David Kaufman, and Gynecologist Dr. Dena Harris. Please join us for this rare and invaluable opportunity to speak with these phenomenal doctors. Sign up early, this event will fill up fast! Men and women are both welcome. Sign up at: For those of you who don’t live in the area, but have questions for our experts, please leave your questions in the comment section of our post. We will try and get to as many as possible during the seminar and post the answers in a future blog!

Hope to see you there!


Gut Feelings

By Riva Preil

Individuals who have endured a spinal cord injury (SCI) often experience colorectal and anal sphincter dysfunction generally referred to as neurogenic bowel dysfunction (NBD).  NBD includes constipation (in up to 80% of individuals), fecal incontinence (in up to 75% of individuals), and abdominal pain.  In fact, approximately one-third of individuals who have sustained a SCI develop abdominal pain ten years or more post injury.

Approximately 50% of individuals who suffer SCI experience neuropathic pain, pain caused by damage or disease that affects the nervous system (refer to picture below regarding nervous system connections to the stomach).  The nature of this delayed onset abdominal pain is not fully understood.  Is the abdominal pain experienced by individuals with SCI neuropathic in nature or is it visceral (organ related) in nature similar to classic constipation and abdominal pain?  Practically speaking, if the abdominal pain experienced by patients post-SCI is similar to visceral chronic idiopathic constipation (CIC) experienced by able-bodied individuals, then the same treatment that benefits those with CIC can also benefit patients with SCI.

Researchers at the Aarhus University Hospital in Denmark recently explored this topic.  The study included 21 individuals who had sustained SCI and 15 individuals with CIC.  They used radiopaque markers to assess the gastrointestinal transit time (GITT) over the course of a week.  GITT reflects the colorectal transit time, also known as the amount of time it takes for food to pass from one end of the gastrointestinal system to the other end.

Although participants with SCI generally had longer GITT scores, there appeared to be very little association between GITT scores and pain levels.  Participants also rated their pain levels with an assessment tool called the Cleveland Constipation Score.  81% of patients with SCI and 93% of patients with CIC reported abdominal pain within the past month.  Approximately 50% of participants in both groups experienced increased postprandial (post-eating) abdominal pain.  This supports the theory that abdominal pain is of visceral origin.

Therefore, even though there is probably a neuropathic component to abdominal pain amongst individuals with SCI, it is likely that there is an even stronger visceral component.  This means that the same interventions that benefit individuals with CIC can also benefit patients with SCI who experience abdominal pain.

Fortunately, pelvic floor physical therapists are trained to treat bowel dysfunction.  Treatment includes ILU colon massage, diaphragmatic breathing, proper toileting position, and education on proper usage of pelvic floor muscles.  If your or someone you know experiences CIC or SCI related abdominal pain, please share the good news with them–physical therapy can help! We here at Beyond Basics Physical Therapy would be privileged to facilitate you along your road to recovery. Please contact us if you have any questions- we would love to have the opportunity to help.

Painful periods

Painful periods. It may not be just cramps.

Endometriosis is a disease that affects over five million women and adolescent girls in the United States.  It occurs when endometrial tissue, normally contained within the uterus, grows elsewhere in the body.  This tissue may migrate outside of the uterus and into the ovaries, vagina, bowel, bladder, rectum, and diaphragm.  During the menstrual cycle, endometrial tissue increases in blood vessels and surface area then sheds appropriately during menstruation.  For a woman with endometriosis, abnormal tissue growth outside of the uterus may also respond with the hormonal cycle.  The results of the displaced endometrial tissue is inflammation, scar tissue, and pain.  Scar tissue builds bridges between organs and the adhesions decrease the ability of the organs to slide and glide. The restricted mobility of the nerves, muscles, viscera and surrounding connective tissue can cause blockages and pain.

These abnormal growths can cause debilitating symptoms including unbearable menstrual cramps, pain with sex, pain with voiding, fatigue, diarrhea, constipation, bloating, and nausea. Some women will experience infertility.

Treatment options for endometriosis include pain medicine, hormonal treatment, surgery, and physical therapy.  Manual physical therapy has proven to be an effective treatment option for women with restrictions or decreased mobility due to endometriosis.  Visceral mobilization and soft tissue mobilization help free the restricted structures and decrease secondary muscle tightness.  Manual techniques do not prevent endometriosis, but decrease or eliminate pain by optimizing the available range of motion.

Surgical intervention is necessary for some women suffering from endometriosis.  Two common side effects of surgical intervention include constipation and urinary urgency.  Physical therapists trained in pelvic floor dysfunction are able to treat the musculoskeletal aspect of these voiding disorders.  Abdominal adhesions typically occur after surgical intervention.  Prophylactic post surgical physical therapy is beneficial to restore mobility, increase core stability, retrain posture, and advise appropriate therapeutic exercise.

March is endometriosis awareness month. Reach out to the women in your life in crisis.  End the myth “it’s just cramps that I have to deal with” and encourage them to ask their physician about their symptoms.  Sex doesn’t have to be painful.  It is important to get a proper diagnosis.  Musculoskeletal causes of pelvic and abdominal pain are very common and can be the reason for pain.

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