I recently had the opportunity to shadow an excellent pelvic floor physical therapist (PT) in action, and it was an eye-opening experience. Watching her work through a patient’s history and physical exam in such a detailed, thoughtful way helped me better understand why it is often pelvic floor PTs who refer patients to our clinic—they are skilled at recognizing patterns of symptoms that raise concern for endometriosis. They take the time to connect the dots—listening closely, asking the right questions, and performing a thorough musculoskeletal exam. In a healthcare system where many primary care and gynecology visits are limited to 15 minutes, that level of attention can make all the difference.

As many of you reading this may already know, pelvic floor dysfunction very frequently overlaps with endometriosis. Many patients develop chronic pelvic floor muscle tension or spasm over time. This can become a secondary pain generator—meaning that even if endometriosis is the underlying condition, the muscle dysfunction itself can perpetuate pain, discomfort, and urinary or bowel symptoms. Pelvic floor physical therapy plays a critical role in addressing this component, helping to reduce muscle spasm, improve coordination, and restore more normal function.

At the same time, there is often a limit to how much progress can be made with physical therapy alone when endometriosis is still active. Many patients notice meaningful improvement initially, only to reach a plateau where symptoms persist despite consistent therapy. Pelvic floor PTs are often the first to recognize this pattern. When progress stalls or the clinical picture suggests something more, they play a key role in referring patients for further evaluation—sometimes leading to a diagnosis of endometriosis that had previously been missed.

In our practice at Pacific Endometriosis and Pelvic Surgery, when a patient’s history, exam, and imaging raise concern for endometriosis alongside pelvic floor dysfunction, we typically recommend a combined approach—addressing the endometriosis through excision surgery while also incorporating pelvic floor physical therapy. Starting PT before surgery can help patients build awareness and begin addressing muscle tension early. After excision surgery, PT often becomes even more effective, as the underlying driver of inflammation and pain has been treated. Some patients may only need a short course of therapy postoperatively, while others—particularly those with long-standing or severe muscle dysfunction—may benefit from a more extended course. As with so much in endometriosis care, the right plan is highly individualized.

Ultimately, the best outcomes come from collaboration. Pelvic floor physical therapists bring a depth of expertise in musculoskeletal and functional pelvic health that is essential to comprehensive care. As surgeons, we rely on their insight just as they rely on us to address the underlying disease when needed. Together, this partnership allows us to treat not just endometriosis itself, but the full spectrum of symptoms patients experience—helping them move closer to lasting relief and improved quality of life.