Endometriosis and Physiotherapy: How Pelvic Health Physio Helps

If you are living with endometriosis, you already know how much it can affect your daily life. This guide explains how pelvic health physiotherapy can help you manage pain, improve your pelvic floor function and support your overall quality of life.

Endometriosis is one of the most common gynaecological conditions in Australia, affecting approximately 1 in 9 females. Despite this, many women wait years for a diagnosis, and finding effective ways to manage the pain and other symptoms can feel like an uphill journey.

While there is no cure for endometriosis, there is growing evidence that pelvic health physiotherapy can play an important role in managing endometriosis-related pain and improving your day-to-day function. At Active Women’s Health, we work alongside your medical team to provide hands-on support that addresses the physical effects of endometriosis on your body.
This guide will help you understand how endometriosis affects your pelvic floor, what physiotherapy involves, and what you can do to feel more in control of your symptoms.

What is Endometriosis?

Endometriosis is a condition where tissue similar to the lining of the uterus (the endometrium) grows in other parts of the body, most commonly in the pelvis. This tissue responds to hormonal changes during your menstrual cycle, which can cause inflammation, pain and, over time, the formation of scar tissue (adhesions).

Endometriosis can be found on the ovaries, fallopian tubes, the tissue lining the pelvis, the bowel, the bladder and, in rare cases, other parts of the body. The severity of symptoms does not always match the extent of the disease, as some women with widespread endometriosis have mild symptoms, while others with minimal disease experience significant pain.

Common Symptoms of Endometriosis

The symptoms of endometriosis can vary widely from person to person. Common symptoms include:

• Severe period pain (dysmenorrhoea) that may not respond well to over-the-counter pain relief
• Persistent pelvic pain (the experience of pain in your pelvic area most days, which lasts for more than six months)
• Deep pain during or after sexual intercourse (dyspareunia)
• Pain with bowel movements or urination, particularly around your period
• Heavy or irregular periods
• Bloating, sometimes called “endo belly”
• Fatigue and low energy, especially around the time of your period
  Difficulty becoming pregnant (infertility)
• Back pain, leg pain or referred pain to other areas

If you are experiencing any of these symptoms, we encourage you to speak with your GP or gynaecologist. Early assessment and a coordinated approach to care can make a real difference.

How Endometriosis Affects Your Pelvic Floor

Many women with endometriosis are surprised to learn that the condition can have a significant effect on their pelvic floor muscles. Understanding this connection is key to understanding how physiotherapy can help.

Why Your Pelvic Floor Matters

Your pelvic floor is a group of muscles that sit at the base of your pelvis, supporting your bladder, uterus and bowel. These muscles play an important role in bladder and bowel control, sexual function, and providing stability to your pelvis and lower back.

When your pelvic floor is working well, you probably don’t notice it. But when these muscles are affected by pain, tension, inflammation or changes in how you move, they can contribute to a range of symptoms.

The Pelvic Floor and Pain Connection

Persistent pelvic pain, which is common in endometriosis, can cause your pelvic floor muscles to become overactive, meaning they are held in a tightened or shortened state much of the time. This is sometimes called “high-tone” pelvic floor.

When your pelvic floor muscles are overactive, they can contribute to:

• Increased pelvic pain, even outside of your period
• Pain during intercourse
• Difficulty emptying your bladder or bowel
• Urgency or frequency of urination
• A feeling of pressure or heaviness in the pelvis

Over time, your body may also develop protective movement patterns in response to ongoing pain, such as bracing your abdominal muscles, holding your breath, or avoiding certain movements. These patterns, while understandable, can increase tension in your pelvic region and contribute to a cycle of pain that becomes harder to manage on your own.

This is where pelvic health physiotherapy can make a meaningful difference.

How Physiotherapy Helps with Endometriosis

Pelvic health physiotherapy is a specialised area of physiotherapy focused on the muscles, joints and connective tissues of the pelvis. For women with endometriosis, physiotherapy aims to address the physical effects of the condition, particularly pelvic floor dysfunction, pain and reduced movement, as part of a broader, multidisciplinary approach to care.

A recent meta-analysis published in Pain Medicine (2026) found that physiotherapy techniques were effective in reducing endometriosis-associated pain, with locally applied techniques (such as pelvic floor therapy and manual therapy) offering the greatest benefit.

At Active Women’s Health, our physiotherapists use a range of evidence-based approaches tailored to your individual symptoms and goals.

Pelvic Floor Assessment and Retraining

One of the most important things a pelvic health physiotherapist can do is assess how your pelvic floor muscles are actually functioning. Many women with endometriosis have pelvic floor muscles that are overactive rather than weak, and the approach to managing these two situations is very different.

Your physiotherapist will assess your pelvic floor, which may include an external assessment using real-time ultrasound and, where appropriate, a gentle internal assessment (always with your full consent and at your own pace). This helps us understand whether your muscles are overactive, underactive, or a combination of both.

Based on your assessment, your physiotherapist may guide you through:

Pain Education and Nervous System Calming

When you live with persistent pain, your nervous system can become sensitised. This means it becomes more reactive to pain signals over time, even when there is no new tissue damage occurring. This is not imagined pain; it is a well-documented change in how your nervous system processes information.

Understanding how pain works can be genuinely empowering. Your physiotherapist will help you understand the relationship between your endometriosis, your pelvic floor, your nervous system and your pain experience. This education is a key part of treatment and can help reduce the fear and anxiety that often accompany persistent pain conditions.

We also incorporate nervous system calming strategies into your care, including diaphragmatic breathing, progressive relaxation and body awareness techniques. These are practical tools you can use every day to help down-regulate your pain response.

Manual Therapy and Myofascial Release

Endometriosis and the associated inflammation can lead to tightness and restriction in the muscles, fascia and connective tissues of the pelvis, abdomen and hips. Manual therapy techniques, including gentle myofascial release, soft tissue massage and trigger point therapy, can help reduce this tension and improve comfort.

For some women, internal pelvic floor release techniques (performed vaginally, with your consent) can be particularly helpful in addressing deep pelvic floor tension and trigger points that contribute to pain during intercourse or bowel movements.

Your physiotherapist will always explain what they are doing, why, and will proceed only with your comfort and consent.

Therapeutic Exercise

Exercise is an important part of managing endometriosis, but it needs to be the right type and intensity for you. Research supports regular physical activity as a way to help manage pain, improve mood and support overall wellbeing in women with persistent pelvic pain.

Your physiotherapist will work with you to develop an exercise program that:

• Is tailored to your current symptoms, fitness level and flare patterns
• Includes gentle core and pelvic stability work that does not increase pelvic floor tension
• Incorporates flexibility and mobility exercises to reduce muscular tightness
• Builds gradually so you can stay active without triggering symptom flares
• Includes strategies for exercising during different phases of your menstrual cycle, when symptoms may vary

Working with Your Medical Team

Endometriosis is best managed by a team of health professionals working together. At Active Women’s Health, we work alongside your GP, gynaecologist, pain specialist and any other members of your care team to ensure your physiotherapy is coordinated with your broader treatment plan.

This might include supporting you before and after endometriosis surgery (such as laparoscopic excision), managing symptoms alongside hormonal treatments, or helping you return to activity after a flare.

Our team has experience working with many of Brisbane’s gynaecological surgeons, and this collaborative approach means your care is connected, not fragmented.

What to Expect at Your First Appointment

We understand that seeing a physiotherapist for endometriosis might be a new experience for you. Here is what you can expect when you visit Active Women’s Health.

Your first appointment will typically include:

• A thorough conversation about your symptoms, medical history, what treatments you have tried, and what you are hoping to achieve
• An assessment of your posture, movement and breathing patterns
• A pelvic floor assessment — this may be external (using real-time ultrasound) or, where appropriate and with your consent, an internal assessment. You are always in control and can stop at any time
• An explanation of your findings and a discussion about how physiotherapy can help in your specific situation
• An initial treatment plan, which may include hands-on treatment, exercises and self-management strategies to get started

We take the time to listen, explain and make sure you feel comfortable throughout. Many of our patients tell us that simply having someone take the time to understand their experience and explain what is happening in their body makes a significant difference.

You do not need a referral to see a pelvic health physiotherapist. However, if you would like to access a Medicare rebate, your GP can set up a Chronic Disease Management Plan (also called a GP Management Plan).

Living Well with Endometriosis: Self-Management Strategies

Alongside physiotherapy and medical treatment, there are practical things you can do every day to help manage your symptoms and support your wellbeing.

Movement and Exercise

Staying active, even gently, can help with pain, mood and energy levels. Activities like walking, swimming, gentle yoga and Pilates can be beneficial. The key is finding what works for you and being flexible, and remember that some days you may manage more than others, and that is okay.

Breathing and Relaxation

Diaphragmatic breathing (breathing deeply into your belly rather than your chest) is one of the most effective tools for calming your nervous system and reducing pelvic floor tension. Try practising for five minutes twice a day, and use it as a go-to strategy when pain increases.

Bowel and Bladder Strategies

Endometriosis can affect your bowel and bladder function. Staying well hydrated, eating adequate fibre, and using good toileting posture (feet supported on a small stool, leaning forward with forearms on thighs) can all help. Your physiotherapist can give you specific advice based on your symptoms.

Other strategies that may help include:

• Heat packs on your lower abdomen or lower back during flares
• Pacing your activities — balancing rest and activity to avoid the “boom and bust” cycle
• Keeping a symptom diary to identify patterns and triggers
• Connecting with support organisations such as Endometriosis Australia (endometriosisaustralia.org) for peer support and reliable information