Pelvic Floor Physio and Recovery After Endometriosis Surgery
Endometriosis is a chronic condition where tissue similar to the lining of the uterus grows outside of it, often on the ovaries, bowel, bladder or pelvic ligaments. It can cause severe pelvic pain, painful periods, painful intercourse, bowel or bladder symptoms, and sometimes infertility.
The gold standard treatment for endometriosis is laparoscopic excision surgery. During this procedure, a surgeon makes small incisions in the abdomen and carefully removes endometriosis lesions and adhesions. This approach is preferred over ablation as it is more effective at reducing pain and recurrence. Despite successful surgery, some people continue to experience pain due to long-standing muscle tension, nerve sensitisation, and changes in how the body moves and functions.
What to Expect After Surgery
After surgery, it is normal to experience incisional pain, bloating from the gas used during laparoscopy and general fatigue. As healing progresses, some people notice new or ongoing issues such as:
• Tight or sore scar tissue and adhesions
• Persistent pelvic floor muscle tension or guarding from years of pain
• Bladder or bowel changes due to the surgery or pre-existing habits
• Discomfort with sexual activity
• Changes in posture and movement patterns that can lead to hip or back pain
Even when endometriosis lesions have been removed, the pelvic floor muscles may remain overactive or tender because they have been guarding for years. Without support, this tension can continue to cause pain or difficulty with bladder, bowel or sexual function.
The Role of Pelvic Floor Physiotherapy
As Pelvic floor physiotherapists we assess the muscles, fascia and nerves of the pelvic floor and surrounding areas. Treatment focuses on improving muscle tone, mobility, nerve health and movement patterns. Evidence shows that pelvic floor physiotherapy can significantly reduce pelvic pain, improve sexual function and ease bowel and bladder symptoms in people with endometriosis.
Before surgery, physiotherapy can be helpful to:
• Teach strategies to relax the pelvic floor and reduce muscle guarding
• Improve hip and pelvic mobility to reduce strain on affected areas
• Provide education about breathing, posture and movement to prepare the body for surgery
After surgery, physiotherapy can begin once the surgeon has cleared you to start gentle rehabilitation, usually one to two weeks after surgery once the wounds have healed.
The first appointment involves a thorough reassessment of pain, mobility, bladder and bowel function and scar healing. Treatment may include:
• Gentle scar tissue mobilisation to prevent adhesions and improve tissue glide
• Internal or external release techniques to reduce muscle tension
• Breathing and movement retraining to restore normal patterns of muscle activity
• Biofeedback or electrical stimulation to support muscle coordination
• Education on bladder and bowel habits and strategies to return to sexual activity and exercise safely
When to Book an Appointment
It is recommended to book an appointment 2-3 weeks after surgery once the wounds are closed and healing well or as advised by your surgeon. This allows early intervention to prevent long-term issues such as scar adhesions, chronic muscle tension and bladder or bowel dysfunction. People should also seek physiotherapy if they continue to experience pain, discomfort with intercourse, difficulty emptying the bladder or bowels, or if they feel restricted in returning to exercise or normal activities.
Research has shown that physiotherapy interventions can reduce pelvic pain by an average of two points on a ten-point pain scale. Local techniques such as internal release and electrotherapy have been particularly effective. Randomised controlled trials and case reports have found that over 60 percent of people reported improvements in pain and sexual function after a short course of pelvic floor physiotherapy.
Long Term Recovery
Endometriosis is best managed with a multidisciplinary team. Surgery can address the disease, but physiotherapy plays an essential role in restoring normal function and preventing ongoing pain. By working on scar mobility, pelvic floor relaxation, breathing, posture and education, physiotherapy supports a smoother recovery and empowers people to take control of their long-term pelvic health.
If you are preparing for endometriosis surgery or are in the early stages of recovery, seeing one of our pelvic floor physiotherapists can make a significant difference to your outcome. Early treatment supports faster healing and reduces the risk of persistent pain or dysfunction.
