Debilitating pain is often a major symptom of endometriosis, interfering with a woman’s daily activities and overall quality of life. Traditional treatments range from lifestyle and diet modifications to medications and even surgery.

However, those are not the only options. Pelvic physiotherapy, or pelvic physical therapy, is an option that can be powerfully effective in providing relief for those suffering from endometriosis pain.

In a recent podcast interview, Dr. Amanda Olsen, a leading pelvic physiotherapist, and award winner of the 2025 Elizabeth Novel Award from the Academy of Pelvic Health and Physical Therapy, shared her insights with ENDOSURE, INC.’s Mark Noar and EndoDiagnosis’ Carolyn Plican on how pelvic physiotherapy can help patients manage endometriosis symptoms. 

What Is Pelvic Physiotherapy? 

For nearly 45 years, pelvic physiotherapy has offered patients struggling with pelvic floor dysfunction specialized, targeted therapy to regain control of their pelvic floor. It is an area of medicine that continues to grow, with widespread availability in many parts of the world, including the United States, Canada, Australia, the United Kingdom, and South Africa. 

How to Access a Pelvic Physiotherapist 

There are a number of ways to access a pelvic physiotherapist. Patients can go through their primary care provider, gynecologist, gastroenterologist, or pain specialist, depending on country of residence. In many states within the United States, patients can schedule an appointment directly with a physiotherapist without needing to obtain a referral from their primary care physician. 

In recent years, physiotherapy has grown in popularity, as more patients advocate for themselves. Dr. Olsen reflects, “I’ve been doing pelvic health for 15 years now, and when I started 15 years ago, it was a big undertaking to inform not just the patient population, but also providers as to what our skillset is and what we have to offer. Now the popularity is growing a lot. There’s been a lot more patient advocacy on behalf of themselves. They are requesting it from their providers, and they are seeking us out individually.” 

No matter how a patient may access a physiotherapist, the therapist will coordinate with the patient’s doctor and care team about the plan of care to ensure a comprehensive approach to care. 

Pelvic Physiotherapy for Patients with Endometriosis 

Physiotherapists assess patients with pelvic pain differently from those diagnosed with endometriosis. Having an endometriosis diagnosis first will influence their treatment approach.

When patients present with pelvic pain, a physiotherapist will generally complete a thorough evaluation, paying special attention not only to the pelvic floor but also to how the patient’s spine and hips move as well as the strengths and weaknesses of relevant muscles. 

On the other hand, when patients present with pelvic pain associated with endometriosis, the physiotherapist will take a more holistic assessment because they already know they are managing much more than a musculoskeletal condition. They are managing a complex, systemic disease that affects the entire body. 

The therapist will assess the patient’s daily activities, exercise levels, and nutrition intake. They will also look for certain patterns unique to those with endometriosis, such as: 

• Guarding tendencies in the pelvic floor (tight, rigid muscles) 
• Weak muscle coordination 
• Muscles that are painful and tender when palpated (possibly indicating endometriomas in the muscles or fascia) 

Benefits of Pelvic Physiotherapy for Patients with Dyspareunia 

For patients with dyspareunia, or painful intercourse, due to endometriosis, pelvic physiotherapy may provide relief. Dyspareunia is often the result of subconscious contractions of the pelvic floor muscles when penetration is about to occur, making it impossible or challenging and painful. It can also be caused by the presence of tight points in the muscles deep in the pelvic floor.   

Pelvic physiotherapy addresses these issues by using gentle manual techniques or special tools, like a pelvic wand or dilators, to improve mind-body coordination so that the vaginal muscles relax and better positioned. Physiotherapy also enables the muscles themselves to be more flexible and mobile to facilitate easier penetration. 

Benefits of Pelvic Physiotherapy for Patients with Adhesions 

For patients with adhesions, there are some manual techniques a physiotherapist can employ to increase blood flow. Therapists trained in visceral mobilization manually enter the pelvic floor or abdomen to encourage pelvic muscles to relax. In cases of severe endometriosis and complex adhesions, however, therapists should defer to surgeons. 

For Patients without an Endometriosis Diagnosis: The ENDOSURE TEST Fills the Gap 

Though a diagnosis is helpful, if a patient has not been formally diagnosed with endometriosis, it does not mean a physiotherapist cannot help. In fact, a physiotherapist may actually be able to raise suspicion of endometriosis. 

“It’s really helpful to have that diagnosis in place ahead of time,” Dr. Olsen explains, “but if they don’t have it when we are examining, our suspicion level rises when the muscles are not responding in a very linear pattern like we’d expect them to.” 

Fortunately, with the ENDOSURE TEST, it is possible for patients to have an accurate diagnosis before they see a physiotherapist. The easy-to-use, non-invasive, highly accurate, 30-minute TEST enables healthcare providers to quickly resolve whether endometriosis is the source of the patient’s pain. 

With an accurate diagnosis to guide pelvic therapy, physiotherapists are empowered to offer the targeted, personalized therapy patients need to find relief from their endometriosis symptoms. 

Pelvic Physiotherapy as a Treatment Alternative to Surgery for Select Patients 

When it comes to treatments for pain and other symptoms commonly associated with endometriosis, medication, diet, and surgery are well-known options. However, pelvic physiotherapy can also offer some patients significant relief – sooner than surgery and for far less cost. 

In Dr. Olsen’s estimation, ten percent of all endometriosis patients may be able to avoid surgery by seeing a pelvic physiotherapist. For that reason, she strongly recommends patients consult with one before considering surgery. 

“A lot of times when someone is staring down the barrel of surgery, they have to look at their whole life, like when am I going to be able to schedule this, or what’s the cost going to be. That’s a problem here in the United States,” says Dr. Olsen. 

“A lot of providers are cash only or it is a high deductible on their insurance plan, so they’re having to schedule it out. It’s not going to be next week, [which means] they’re not going to get relief next week. It might be months out,” she explains. “We’re going to help them taper that pain down today. It’s not going to be a magic wand, and it’s not going to be easy, but we are there to help them start making changes right away.” 

Daily Function Value 

Pelvic physiotherapy is also helpful for daily function. A therapy program can educate and empower patients with the tools they need to make life easier at home. Daily functions such as having bowel movements, for instance, can be especially challenging for those with endometriosis.

Physiotherapy instructs patients on appropriate body positioning to facilitate movement. Specific programs can also provide personalized exercise recommendations to maintain patients’ mobility. 

Post Surgical Value 

Pelvic physiotherapy aids in restoring function and mobility after surgery. A physiotherapist can also assess whether scars are healing appropriately and address muscle restrictions that may develop around the scars early with manual techniques to maintain mobility. 

Additionally, a therapist can evaluate the patient’s pelvic floor to ensure normal muscle contractions and relaxations. Early intervention may be able to prevent neuromuscular patterns that can interfere with normal bowel, bladder, and sexual functions. Dr. Olsen recommends patients follow up with a physiotherapist six weeks after surgery. 

What Newly Diagnosed Endometriosis Patients Should Know 

How Soon Should Patients Seek Pelvic Physiotherapy? 

Dr. Olsen recommends patients see a physiotherapist immediately after being diagnosed. In many cases, patients have been experiencing endometriosis symptoms for years before diagnosis. Immediate intervention will allow some patients to begin experiencing relief and improve daily function. 

Is There an Age Limit for Pelvic Physiotherapy? 

No. Pelvic physiotherapists work with endometriosis patients of all ages. They will modify treatment depending on the age of the patient though. For example, Dr. Olsen explains adolescent patients will not receive an internal evaluation without first being evaluated by their gynecologist, obtaining parental consent, and consenting to it themselves. 

What to Expect at the First Appointment 

The first appointment with a pelvic physiotherapist will focus on understanding the patient’s medical history, defining goals for therapy, completing a physical assessment to identify areas to improve, and even validating their experience. 

Example Questions Regarding Medical History 

• How well is your bladder functioning? 
• How many times a day do you urinate? 
• Do you ever leak urine? 
• How well is your bowel moving? 
• What does your stool look like? Is it difficult? Is it painful? 
• Are you sexually active? Do you experience pain? Is the pain when you first start or is it when it’s deeper in? 

Goals for Therapy 

These goals are established by the patient. Whether those goals are to work a full day without pain or to improve fertility for those wishing to conceive, the physiotherapist will structure their treatment plan to help the patient reach those goals.   

Physical Assessment 

During a physical assessment, the therapist will observe how the patient moves, including bending over and hip movement. The therapist will measure strength and gently press into the abdomen to see how well musculoskeletal structures are moving. 

Then, the therapist will complete a vaginal assessment. Unlike a typical visit with the gynecologist, this assessment does not involve a speculum. Instead, the therapist will use one finger to evaluate control of the pelvic floor and assess how well the mind and body coordinate to contract and relax those muscles. 

Last, the therapist will touch for areas of pain and document those areas for proper analysis. Once the full assessment is complete, the physiotherapist will develop a plan of care to begin therapy. 

Validation 

Unfortunately, the journey for many patients with endometriosis is often marked by supposedly “normal” imaging studies and improper dismissal despite their pain. Physiotherapy can provide patients with the validation they have been missing. Dr. Olsen shares: 

“What I’ve found in 15 years of practice is, a lot of times too, we’re the first person who’s heard them out and told them that they’re not crazy….  [Doctors have told them it] sounds like your periods are rough. You know, this is just how it goes for you. They are extremely traumatized by that because they feel like they’re crazy. So, we do spend a lot of time listening and reassuring and validating their experiences.” 

Conclusion 

Surgery is not the only treatment option available for those needing relief from the chronic, often debilitating symptoms of endometriosis. Pelvic physiotherapy is a non-invasive alternative that can offer some patients relief and greater control over their daily lives. 

 
If you have questions about whether pelvic physiotherapy is right for you, consult with your doctor. 

You can listen to Dr. Olsen's full interview here, or wherever you listen to your favorite podcasts. 

Learn more about the ENDOSURE TEST.