Pelvic floor dysfunction

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Another condition that can have overlapping symptoms with endometriosis is pelvic floor dysfunction (PFD). PFD involves abnormal functioning of the pelvic floor muscles (Grimes & Stratton, 2020). The muscles can be too tight (hypertonia), too lax (hypotonia), or just not coordinate appropriately (Grimes & Stratton, 2020). Fraga et al. (2021) reports that those with deep infiltrating endometriosis (DIE) had higher pelvic floor hypertonia, weaker muscle contraction, and inability to completely relax the pelvic floor muscles. They also noted shortening of the anterior thigh, piriformis, and iliotibial band muscles (Fraga et al., 2021). PFD can be seen frequently in those with endometriosis “even after surgical excision of the endometriosis lesions” (Hunt, 2019).

Shrikhande (2020) reports:

“The presence of endometriosis in the pelvis can cause a secondary chronic guarding of pelvic floor musculature. This chronic guarding state leads to nonrelaxing pelvic floor dysfunction and myofascial trigger points (MTrPs)…. The pelvic floor muscles in nonrelaxing pelvic floor dysfunction are short, spastic, weaker and poorly coordinated…. Myofascial trigger points (MTrPs) are short contracted taut bands of skeletal muscle that often co-exist with nonrelaxing pelvic floor dysfunction… Once formed, MTrPs can become a self-sustaining source of pain even after the endometriosis has been excised. Active MTrPs serve as a source of ongoing nociception; they can decrease pain thresholds, upregulate visceral and referred pain patterns, and sensitize the nervous system contributing to both peripheral and central sensitization. Therefore, it is important to treat a hypertonic nonrelaxing pelvic floor and associated MTrPs in endometriosis patients.”

For more information see:


Fraga, M. V., Oliveira Brito, L. G., Yela, D. A., de Mira, T. A., & Benetti‐Pinto, C. L. (2021). Pelvic floor muscle dysfunctions in women with deep infiltrative endometriosis: An underestimated association. International Journal of Clinical Practice75(8), e14350. DOI: 10.1111/ijcp.14350

Grimes, W. R., & Stratton, M. (2020). Pelvic floor dysfunction.

Hunt, J. B. (2019). Pelvic Physical Therapy for Chronic Pain and Dysfunction Following Laparoscopic Excision of Endometriosis: Case Report. Internet Journal of Allied Health Sciences and Practice17(3), 10. Retrieved from 

Shrikhande, A. A. (2020). The consideration of endometriosis in women with persistent gastrointestinal symptoms and a novel neuromusculoskeletal treatment approach. Archives of Gastroenterology Research1(3).