Pelvic Physical Therapy for Chronic Pain and Dysfunction Following Laparoscopic Excision of Endometriosis: Case Report

Abstract

Background: Pelvic pain and abnormal pelvic floor muscle (PFM) tension frequently are present in individuals with endometriosis and often persist even after surgical excision of the endometriosis lesions. Physical therapists are educated in improving muscle tone and function for individuals who have sustained injury, have had surgery, or have required rehabilitation for various pelvic health conditions. More scientific evidence is needed to support the benefits of physical therapy (PT) interventions for individuals with a history of endometriosis. Case Description: The 50-year old female patient presented in this case report underwent laparoscopic excision of endometriosis, yet she continued to experience discomfort in her left lower abdomen and vaginal area after surgery. Within a four month period, the patient participated in ten sessions of pelvic physical therapy that included manual therapy, instruction in relaxation techniques, and a home program. Outcomes: At the time of her discharge from physical therapy, the patient reported a reduction in symptoms on the Pelvic Floor Impact Questionnaire - Short Form 7 (PFIQ-7) and was able to resume activities that she had not previously tolerated because of abdominal and pelvic pain. Discussion: Identifying effective interventions for patients that have received surgical management is important. Pelvic physical therapy may help individuals avoid surgery and eliminate or reduce the use of medications. Because of the positive outcomes of this case report, it is recommended that when endometriosis is suspected or diagnosed, a pelvic physical therapy evaluation should be considered. Further research is needed to assess physical therapy as part of the standard of care for women with suspected or diagnosed endometriosis.