Sallie Sarrel Q& A About What to Expect During Pelvic Floor Therapy for Endometriosis Everyday Health MenuNewslettersSearch Endometriosis Sallie Sarrel Q& A About What to Expect During Pelvic Floor Therapy for Endometriosis Surgery alone often isn’t enough to relieve symptoms of endometriosis. That’s where pelvic floor therapy comes into play. By Beth LevineMedically Reviewed by Sanjai Sinha, MDReviewed: February 19, 2019Medically ReviewedShutterstockPhoto Courtesy of Sallie SarrelEndometriosis is a chronic condition where tissue similar to (but not the same as) uterine lining is found outside the uterus, causing pain, pain with sexual intercourse, and possibly infertility. Your doctor may recommend pelvic floor therapy (PFT) to help you manage endometriosis pain. If so, you may have some questions about what to expect at each appointment. Everyday Health spoke with Sallie Sarrel, PT, ATC, DTT, a pelvic floor physical therapist who specializes in endometriosis and who has also experienced PFT as a patient, about what PFT should — and shouldn’t — include. Everyday Health: First, what is PFT? Sallie Sarrel: PFT is a branch of physical therapy in which we deal with everything that affects your pelvic area, including muscles, bones, ligaments, and fasciae. Therapists are specially trained for this, and PFT for endometriosis is different from PFT for other issues, like incontinence and postpartum care. PFT for endometriosis can feature:Work on your core, hips, and feet, because the way your legs hit the ground affects the way your pelvis movesInternal physical therapy to work on the affected muscles that line the inside of the pelvisManual therapy to help break up scar tissueExercise, yoga, or PilatesBreathing exercises, as breathing affects the pelvis through the diaphragm EH: How does PFT help endometriosis symptoms? SS: Endometriosis can cause reactive pelvic floor spasms, as well as pain and spasms throughout the pelvis. It can also turn up the volume on the nerves in your pelvis and abdomen, and that can create pain. We know that the best way to treat endometriosis is to have an excision surgery — taking the disease out at its root — but some of the pain, as well as the adaptations the body may have made to cope with endometriosis pain for many years, is not solved with surgery alone. We need to attend to the nerve hypersensitivity, the muscle spasms, any postural alignment problems, the weakened core, and all the other things that have happened to the body as a result of endometriosis. Excising lesions will help with the disease, but I believe that to fully heal, it may take physical therapy to nudge the person toward wellness. Learn what others with endo have to say about their experience with pelvic floor PT on Tippi EH: Does all the work occur during therapy sessions, or will the therapist give you tools and exercises to do at home? SS: I work on the patient one-to-one for a full hour, and then I send her home with a very strict home exercise program. EH: Are there any red flags women should watch out for, or things they should know about? SS: These points are very important — I can’t stress them enough:PFT should not be painful. While it may not feel like a trip to a spa, it should not trigger your symptoms beyond one to two days, if at all. If you are bedridden for a week after PFT, then I’d wonder how many pelvic pain patients your therapist has had experience with — you might consider searching for a more experienced practitioner.Not all PFT consists of internal manipulation. While that’s one item in our tool kit, it’s not the only one. I have patients who are abuse survivors or who aren’t comfortable with any internal manipulation, and that’s fine. They can make progress without it. Your therapist should give you that option. The therapist should be trained to be able to use different techniques to get the same results.Your therapist should follow appropriate behavior at all times — and always wear gloves. Larry Nassar, the sports physician who treated the U.S. Olympic women gymnasts with inappropriate PFT and was convicted of sexual abuse, never wore gloves during internal manipulation. Also, Nassar lay on top of his patients while he worked. These things should never happen — no exception.PFT is not the only treatment you should be getting. It’s part of a multidisciplinary treatment approach that should also include a combination of dietary modifications, nonsteroidal anti-inflammatory medications, hormonal therapy, surgery, and alternative therapies such as biofeedback.You should be given the option of having someone present in the room during your therapy session.If the therapist can’t explain to you in detail why a particular tool is being used, that would also be a warning sign that something’s not right. EH: As you mentioned, there are specialists who are specifically trained in PFT. What qualifications should patients look for? SS: Pelvic floor therapists are not just therapists who graduate from physical therapy school. They need to go on for further education in the pelvis. We are very specialized. I have more than two years of training beyond doctoral level physical therapy school. For help in finding a qualified pelvic floor specialist, look at the physician directories at the American Physical Therapy Association’s section on Women’s Health. EH: What questions should you ask before scheduling an appointment with a pelvic floor therapist? SS: I would ask what techniques the therapist uses:Do they use Barral Visceral Manipulation, a technique to lengthen tissue around adhesions, or scar tissue?Are they trained in some of the gentler techniques of myovascular (muscle and blood vessel) spasm relief?Are they aware of Maya Abdominal Massage, a uterine-based technique?How many cases of endometriosis have they treated? Have they seen one complex case, or do they treat endometriosis regularly? More in Endometriosis 7 Self-Care Tips for Women Who Have Endometriosis 7 Ways to Boost Your Sex Life Why You Should Keep a Period DiaryNEWSLETTERS Sign up for our Women' s Health Newsletter SubscribeBy subscribing you agree to the Terms of Use and Privacy Policy. 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