Did You Know: A Pelvic Floor Physical Therapist Can Be Key in Resolving
your Pelvic Pain?
Information on Endometriosis:
A Monthly Feature
Andrew S. Cook, M.D
EndometriosisZone Advisory Board Member
Reproductive Endocrinologist / Gynecologist
Medical Director / Founder
Vital Health Institute
Los Gatos, CA
Essay: A Pelvic Floor Physical Therapist Can Be Key In Resolving Your Pelvic
For many patients with endometriosis, pelvic pain and painful sex, a pelvic
floor physical therapist can be an integral part in resolving the pain. The
pubic bone is in the front and the tailbone is in the back. In between these two
bones are a series of muscles that make up the pelvic muscle floor. When you sit
down you are sitting on your pelvic muscle floor. It is common, after months and
years of being in pain to develop spasm of the pelvic muscle floor. While muscle
spasm may not sound too bad, it can be the worst, 10 out of 10 pain.
Many of us have experienced a "Charlie Horse" or severe muscle cramping/spasm in
the calf. Those that have know how painful this can be. The natural reaction is
to grab the muscle and stretch it out. This helps it come out of spasm and ease
Over time the pelvic floor muscles are in a low-grade spasm. Various events,
including activity or anything going through the pelvic muscle floor, such as
urination, sex or bowel movements, can trigger severe spasm. When the pelvic
muscle floor goes into severe spasm, you cannot grab it and stretch it out, it
just takes you down with severe pain.
For patients with endometriosis, physical therapy alone will usually not fix the
problem. As long as the endometriosis is present, it is like having a knife
stabbing you in the pelvis and the muscles will continue to go into spasm, even
with a great physical therapist. Surgery done correctly is a key step in
recovering from endometriosis and pelvic pain, but often not the complete
Your doctor should be able to tell you if you have pelvic muscle floor spasm
before your surgery. If it is present then often you will need to see a physical
therapist that has received specialized training in treatment of this condition.
Just like physicians who specialize in treating endometriosis and pelvic pain,
there is not official subspecialty for physical therapists that treat pelvic
floor problems and pelvic pain. The physical therapists have to actually put
their fingers inside of your vagina to work on your muscles. I know it seems
kind of strange at first, but the muscles are the same as anywhere else in the
Surprisingly, many doctors are not aware of what pelvic floor physical
therapists or the importance they can play in your recovery. You will often need
a referral request from your doctor to see a physical therapist. The American
Physical Therapy Association website (www.apta.org) is a good resource for
finding a pelvic floor physical therapist in your area. Once in the "find a PT"
section, put in your zip code and select "Women's Health". This will produce a
list of PT's in your area. You will need to read through each description, as
actually only a few will treat pelvic pain and pelvic muscle floor spasm.