Why pelvic floor evaluation is essential for comprehensive endometriosis care
When it comes to managing endometriosis, surgery and medication often take center stage. But according to Dr. Madhu Bagaria, a renowned excision surgeon and pelvic floor specialist at Endometriosis Surgical Specialists International (ESSI), one critical piece of the puzzle is often overlooked: the pelvic floor.
In this interview, Dr. Bagaria shares why she personally performs pelvic floor evaluations and how this often-missing step can unlock real and lasting relief for patients with endometriosis.
Q: Dr. Bagaria, can you begin by explaining what the pelvic floor is and why it matters in endometriosis care?
A: The pelvic floor is a group of muscles and connective tissue that support the uterus, bladder, and rectum. In patients with endometriosis, chronic pain and inflammation often lead these muscles to become tight, guarded, or dysfunctional. This condition—called pelvic floor dysfunction—can continue to cause pain even after successful surgical treatment if it isn’t properly addressed.
Q: Why is pelvic floor evaluation so essential for patients with endometriosis?
A: Endometriosis affects the whole body, not just isolated tissue. Many patients still experience pain after excision surgery because their pelvic floor muscles remain in a hyperactive, protective state. That’s why I always include pelvic floor evaluation as part of care. I perform these assessments myself to understand how the muscles are contributing to each patient’s symptoms and to design a personalized recovery plan.
Q: What symptoms might suggest pelvic floor dysfunction?
A: Symptoms can include:
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Painful intercourse
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Urinary urgency or hesitancy
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Constipation or incomplete bowel movements
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Pelvic pressure
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Persistent pelvic or lower back pain
These often overlap with endometriosis symptoms, so a proper evaluation is key to identifying their true source.
Q: When do you typically perform pelvic floor evaluations?
A: I may assess the pelvic floor during the initial consultation if symptoms suggest muscular involvement. I also reassess after surgery, especially if pain lingers or recovery isn’t progressing as expected. This ensures we’re addressing the entire pain picture—not just the visible disease.
Q: What does your pelvic floor evaluation involve?
A: I start with a full medical history and a whole-body postural and movement assessment. When appropriate, I perform a gentle internal pelvic exam to assess muscle tone, trigger points, and coordination. Everything is done with full informed consent and focused on patient comfort. My goal is to offer clarity—not create additional anxiety or discomfort.
Q: How does your dual training in excision surgery and pelvic floor care benefit your patients?
A: It allows me to treat the whole patient, not just remove disease. I can recognize and treat the muscular pain patterns that develop from living with chronic pelvic conditions. This integrated approach leads to more complete, individualized care—from diagnosis through recovery.
Q: Is pelvic floor dysfunction often missed in traditional gynecology?
A: Unfortunately, yes. Many patients are told that their pain is simply “part of endometriosis” or that it will disappear after surgery. But muscles that have been tight and reactive for years don’t automatically reset. If pelvic floor dysfunction isn’t evaluated and addressed, that layer of pain can persist.
Q: Some patients may feel nervous about pelvic floor assessments. What would you say to them?
A: It’s completely normal to feel hesitant. But these assessments are performed gently, respectfully, and always with full consent. My goal is to empower patients by helping them understand what their body is doing—and showing them that relief is possible.
Q: Where can patients see you for surgery and pelvic floor care?
A: I currently see patients in New York and New Jersey. I personally provide both excision surgery and pelvic floor evaluations as part of my practice. Whether someone is preparing for surgery, experiencing lingering pain, or just seeking answers, they can book a consultation with me directly. Together, we’ll explore both the visible disease and the muscular factors that may be contributing to pain.
If you’re dealing with persistent pelvic pain or preparing for endometriosis treatment, a consultation with Dr. Madhu Bagaria can help uncover the full picture. Her integrated approach combines advanced surgical care with hands-on pelvic floor therapy—offering patients a more complete path to healing and lasting relief.
