Endometriosis has the potential to wreak havoc on various bodily functions, including the pelvic floor muscles (PFMs). ⁽¹⁾ People with endometriosis often experience pelvic pain, which can have detrimental effects on the pelvic floor's function.⁽¹⁾ Pain is a key symptom of endometriosis, manifesting as dysmenorrhea (painful menstruation), chronic pelvic pain, dyspareunia (painful intercourse), dysuria (painful urination), and vulvodynia (pain at the vaginal entrance). In response to pain, our muscles tend to tighten involuntarily. ⁽²⁾ If you experience recurring pain during your menstrual cycle or even more frequently, your muscles become adept at clenching, reaching a point where you may not even realize you're holding them tightly. Consequently, the pelvic floor loses its ability to contract and relax properly. A shortened or tight muscle may be just as incapable of Tips to manage chronic pain. exerting force as a lax or weak muscle. Being tight does not mean your pelvic floor is strong. Neither tight nor loose are healthy or desirable. 
 
In the grand scheme of things, it's possible to have a weak pelvic floor, a tight pelvic floor, or even a blend of both. However, engaging in Kegel exercises won't solve the issue as the weakness is often caused by tightness in this case. Therefore, it is crucial to tackle this tightness before anything else. 
 
If you suspect you have pelvic floor dysfunction, seeking assistance from a specialized pelvic floor physiotherapist and talking to your doctor is highly recommended. Physiotherapy for tight and weak pelvic floor may include techniques such as: 
 
- Desensitizing the nervous system through movement, manual therapy, and breathing exercises 
- Relaxation and stretching exercises for the pelvic floor muscles, hips, and pelvis 
- Utilizing feedback devices, like EMG biofeedback or real-time ultrasound, to aid in pelvic floor relaxation 
- Pelvic wand therapy or dilator therapy. 

REFERENCES: 

1. Fraga MV, Oliveira Brito LG, Yela DA, de Mira TA, Benetti-Pinto CL. Pelvic floor muscle dysfunctions in women with deep infiltrative endometriosis: An underestimated association. Int J Clin Pract. 2021 Aug;75(8):e14350. doi: 10.1111/ijcp.14350. Epub 2021 May 24. PMID: 33973308. 

2. Allaire C, Bedaiwy MA, Yong PJ. Diagnosis and management of endometriosis. CMAJ. 2023 Mar 14;195(10):E363-E371. doi: 10.1503/cmaj.220637. PMID: 36918177; PMCID: PMC10120420.