Pelvic Floor Physical Therapy

By RRM Academy Reviewed by Dr. Naomi Whittaker, MD, Board-Certified OBGYN, MIGS, NFPMC, FCI Updated July 26, 2026

Pelvic floor physical therapy (PFPT) is a specialized rehabilitation discipline that evaluates and treats musculoskeletal contributors to chronic pelvic pain, dyspareunia, voiding and bowel dysfunction, and post-surgical or postpartum pelvic floor impairment. Pelvic floor therapists assess hypertonic or hypotonic pelvic floor muscles, myofascial trigger points, scar tissue restrictions, and neuromuscular coordination patterns. Treatment addresses the physical layer of conditions that also have gynecologic or hormonal contributors.¹

For patients with endometriosis and chronic pelvic pain, pelvic floor dysfunction frequently coexists with the underlying disease. Adhesions, inflammatory lesions, and guarding responses alter muscle tone and neuromuscular coordination. A randomized controlled trial enrolled 34 nulliparous women with deep infiltrating endometriosis and superficial dyspareunia. Researchers assigned them to five sessions of pelvic floor physiotherapy or no intervention. Of the 30 women reassessed at four months, the treated group showed greater pelvic floor muscle relaxation on transperineal ultrasound. Superficial dyspareunia and chronic pelvic pain both improved significantly compared to controls.² A separate analysis of the same cohort assessed urinary, bowel, and sexual function. No significant differences emerged between the treated and control groups. The treated group did trend toward improved constipation symptoms.³ Pelvic floor physiotherapy relaxes the pelvic floor and eases dyspareunia and pelvic pain. It does not, by itself, change broader urinary, bowel, or sexual function. A 2025 systematic review and meta-analysis found that physical rehabilitation reduces endometriosis and adenomyosis-related symptom burden.⁴

PFPT is not an alternative to gynecologic evaluation. It is adjunct care. Surgery addresses the anatomical source of disease. PFPT addresses the neuromuscular sequelae. Post-excision patients often benefit from pelvic floor rehabilitation to resolve guarding and scar tissue restrictions that persist after excision. The same applies after adhesiolysis or other pelvic reconstructive procedures.

Indications for referral to a pelvic floor therapist include chronic pelvic pain with a musculoskeletal component, dyspareunia, postpartum pelvic floor recovery, and voiding or bowel dysfunction. Evaluation by a pelvic floor therapist typically includes internal and external assessment of tone, trigger points, and functional movement patterns.

This content is for educational purposes only and does not constitute medical advice. Consult an RRM clinician or healthcare provider for guidance specific to your situation.