Pelvic floor dysfunction in women with deep infiltrating endometriosis: from bench to bedside

ABSTRACT

Deep Infiltrating Endometriosis (DIE) is a severe form of endometriosis that affects the pelvic organs and often leads to pelvic floor dysfunction (PFD). This review explores the relationship between DIE and PFD, analyzing diagnostic approaches, therapeutic strategies, and novel imaging tools. A narrative review was conducted using PubMed and EMBASE with no time restrictions, following SANRA guidelines. Thirteen studies were included, comprising clinical trials, observational studies, and systematic reviews. Evidence indicates that women with DIE experience pelvic floor muscle hypertonia, impaired relaxation, and heightened pain sensitivity. Pelvic floor physiotherapy (PFP) shows benefit in reducing dyspareunia and improving muscle relaxation, though its impact on urinary, bowel, and sexual functions remains inconclusive. Surgical interventions, particularly colorectal resections, are effective in alleviating dyspareunia and fecal incontinence, yet data on urinary improvement are limited. Transperineal ultrasound and elastography emerge as promising tools for diagnosing and monitoring PFD. While surgery currently represents the most effective strategy for symptom relief, integrating non-invasive options and advanced imaging may enhance outcomes. Standardized protocols and high-quality studies are needed to refine management of PFD in DIE.