I recommend pelvic floor rehabilitation therapy to all our endometriosis patients after surgery.
I do believe that pelvic floor dysfunction does play a big role in endometriosis pain. If the pelvis, including the pelvic floor muscles are subjected to intense inflammation due to the endometriosis, then we would it is easy to understand that these muscles would be more irritable and have unwanted contractions resulting in pain. The premise of this study, like so many is directed at the downstream problem of levator muscle spasm and not at the underlying issue of endometriosis and inflammation. Yes if you prevent the spasm, pain will get better, just as lupron and extreme estrogen deprivation will decrease the metabolic activity of the endometriosis lesions and reduce pain. Birth control pills decreases pain in teenagers also, but studies verify that the disease continues to march on causing infertility later etc. So at what cost do we offer such therapies. I propose that the treatment of endometriosis is always to resect (cure) the disease first addressing all pain generators followed by pelvic floor therapy. The pelvic floor therapy post operatively is primarily to strengthen the pelvic floor that has been underutilized because contractions of pelvic floor muscles caused pain in the presence of endometriosis. Secondarily PFT will “re-train” the muscles to decrease unwanted contractions. As always, the goal is to cure the disease followed by pain relief.
Michael D. Fox, MD