Endometriosis is a condition in which tissue similar to the inner lining of the uterus (the endometrium) grows outside of the uterus, often referred to as endometrial implants.

These grow on areas such as on the ovaries, fallopian tubes, and other pelvic tissues. The growth of this tissue causes a variety of uncomfortable symptoms, many of which can disrupt an individual’s quality of life.

There are many surgical procedures available for individuals with endometriosis that can restore organ function and relieve pain or other symptoms. These surgeries look to remove the endometrial tissue or address other aspects caused by endometriosis, such as:

• Pelvic adhesions
• Ovarian cysts
• Heavy, painful menstruation
• Organ dysfunction
• Bladder or bowel complications
• Issues of the diaphragm or appendix
• Nerve dysfunction
• Fertility issues

While not every person with this chronic condition will need surgery, some severe cases or certain patient needs may create the need for surgical interventions. For those who do present the need for endometriosis surgery, some common methods include the following:

Laparoscopy

A minimally invasive surgery performed using small incisions. This is the most common option for endometriosis surgeries, and can help improve organ mobility and reduce pain.

The type of laparoscopy commonly used in the case of endometriosis is excision surgery, where the small incisions are used to locate and remove endometrial tissue or address adhesions.

Laparotomy

A more invasive surgical approach, in which a larger incision is created to perform open surgery. This is typically only used in severe cases of endometriosis, as it can address deeper endometrial tissue or large endometrial cysts.

Endometrial Ablation

This surgery is typically used to eliminate the endometrium within the uterus, which is often the cause of very heavy menstrual bleeding for individuals with endometriosis.

After this surgery, individuals may experience much lighter or even a lack of menstrual bleeding, which alleviates the intense pain many experience due to the chronic condition.

Ovarian Cyst Removal

Endometriosis can cause the formation of endometriomas, which are ovarian cysts that can cause pain, discomfort, and fertility difficulties. Surgery to remove these cysts can restore ovarian function and relieve pain.

Hysterectomy

A procedure that removes the uterus, sometimes done alongside a salpingo-oophorectomy (removal of fallopian tubes and ovaries).

This surgery is typically only performed in extreme cases of endometriosis, and in situations where the other treatments have failed to provide relief. May also be combined with excision surgery (mentioned previously).

Adhesion Removal

Removal of problematic adhesions caused by endometriosis, which can cause pain, limit organ mobility, and affect bladder or bowel function.

Addressing Affected Organs

In some cases, endometriosis can affect other organs such as the intestines, appendix, bladder, diaphragm, and nerves.

To restore function and relieve symptoms, some surgeries may look to remove endometriosis implants from these organs. In more severe cases, the organ itself may require partial or total removal. Some examples of these surgeries include:

• Bowel Resection: Removal of endometrial implants from the bowels, or removal of damaged areas of the bowels. This surgery restores bowel function and alleviates symptoms of pain, constipation, or diarrhea.
• Bladder Surgery: Removal of endometrial implants from the bladder or urinary tract to resolve urinary pain and other symptoms. 
• Diaphragmatic Surgery: Endometrial implants on this organ can cause trouble with breathing, chest pain, or abdominal pain; therefore, this surgery looks to remove implants from the diaphragm.
• Appendectomy: In rare cases, endometriosis can cause appendicitis—therefore, measures may be taken to remove endometrial tissue or the appendix itself.
• Nerve Surgery or Neuromodulation: Endometriosis can cause nerve damage or entrapment. Therefore, removal of problematic endometrial tissue and neuromodulation (altering of nerve activity) may be necessary to protect or restore nerve function.

Start Healing with Hive

As mentioned before, not every person with endometriosis needs surgery.

Nonsurgical treatment options like hormonal therapy, pain management, and physical therapy can allow many individuals with the condition to manage their symptoms long-term.

However, there are some cases in which surgery may be necessary or preferable for the patient. In most cases, it can include situations where:

• The individual’s symptoms are very extreme and make it difficult to function daily.
• Fertility has been compromised by endometrial tissue, disrupting the individual’s personal needs.
• Organ function or health becomes threatened by the overgrowth of deep endometrial tissue.
• Nonsurgical treatments become unable to sufficiently manage symptoms.

While many nonsurgical treatments can lessen pain, maintain function, and increase mobility for those with endometriosis, sometimes the condition can create symptoms that are too strong to maintain with those options.

For example, physical therapy can help manage pain and lessen muscle tension, but cannot directly address or remove the endometrial tissue causing those issues.

If the endometrial tissue becomes too widespread or deep, surgical interventions may be necessary to achieve lasting relief.

This is also true for when endometrial tissue begins to grow on other organs or disrupt fertility—surgery is typically the only treatment that can directly solve those problems. Surgical interventions are used to:

• Remove endometriomas.
• Remove endometrial tissue that causes extreme pain or disrupts bladder, bowel, or sexual function.
• Remove adhesions that cause restricted organ mobility, pain, and pelvic floor dysfunction.
• Improve fertility outcomes by removing endometrial tissue or inflammation that can affect ovary function or egg implantation.
• Prevent or solve deep infiltrating endometriosis that may be altering organ function and affecting internal structures.

Regardless of the reason for endometriosis surgery, pelvic floor physical therapy plays a major role in both preparation and recovery!

One of the main goals will be to prepare and care for your pelvic floor, an important group of muscles that supports your pelvic organs and allows for many important functions (urination, bowel movements, and sexual appreciation).

The health of these muscles can be affected by endometriosis, and your experience with endometriosis surgery is dependent on the health of your pelvic floor! Therefore, you can expect to care for your pelvic floor both before and after surgery.

Preparation

You may not realize that preparing your body for surgery can prove extremely beneficial. Not only does it allow for a better recovery period, but it also improves your understanding of what to expect while healing.

Physical therapy can improve your mobility and muscle function beforehand to support more efficient healing and lessen the risk of complications.

To prepare your body for surgery, your physical therapist will work to:

• Optimize your posture to reduce abdominal or pelvic tension and prevent worsened pain post-surgery.
• Curate a stretching, mobility, or exercise routine to optimize mobility of the hips, low back, and abdominals.
• Teach you to counteract pain guarding, which will increase tension in the abdominals and pelvic floor.
• Address tight, weak, or poorly coordinated pelvic floor muscles. Reducing pelvic floor dysfunction before surgery will help support better recovery post-surgery.
• Teach you relaxation techniques and breathing exercises that will help relax your pelvic floor and ease anxiety.
• Teach proper toilet posture or restroom habits to lessen pelvic floor tension and promote better pelvic floor health.
• Prepare you for movements or positions that will be difficult post-surgery, and suggest modifications to make them easier.

Your pelvic floor therapist will help set your expectations for the healing period, which can help ease fears or anxiety associated with the surgery process.

Additionally, engaging in physical therapy before surgery can get you familiar with the physical therapy process beforehand, rather than when you are in recovery.

Recovery

Post-surgery, pelvic floor therapy is essential to encourage healing, manage pain and swelling, restore mobility and function, address scar tissue, and resolve complications such as pelvic floor dysfunction.

Pelvic floor dysfunction after an endometriosis surgery is likely, especially considering many of these surgeries take place in the lower abdominal area.

Pelvic floor dysfunction is even more likely when other organs are affected by endometriosis, such as the bladder or bowels.

Therefore, anyone who has endometriosis or undergoes surgery for the condition will want to engage in pelvic floor therapy.

Pelvic floor physical therapy can support recovery of the abdominal area itself, which may experience tension and restrictive scar tissue after surgery. A pelvic floor physical therapist can help reduce this tension, manage scar tissue or adhesions, and restore normal movement patterns.

Pelvic floor therapy can also play more specific roles, depending on the type of endometriosis surgery:

• Ablation: Restoring pelvic floor function, reducing tension, and alleviating pelvic pain that is not directly solved by ablation.
• Hysterectomy: Pelvic floor therapy can manage scar tissue, restore pelvic floor function, and reduce pain while healing from hysterectomy.
• Cyst Removal: Restoring pelvic floor function, alleviating pain, and reducing muscle tension caused by painful cysts.
• Nerve-Related Surgeries: Retraining muscle function and releasing tension after neuromodulation.
• Bladder or Bowel Surgeries: Restore bladder or bowel function that was compromised by endometriosis and reduce the effects of post-surgical pelvic floor dysfunction. 
• Diaphragm-Related Surgery: Restore core function, pelvic floor coordination, and breathing patterns.
• Multi-System Support: Restore muscle coordination and pelvic floor function for bowels, bladder, or any groups of affected organs or systems.

All of these listed benefits for preparation and recovery can be achieved through a curated treatment plan based on your individual needs.

There are many different treatments utilized at Hive Therapy and Wellness to provide a holistic care experience, such as the ones listed below:

• Neuromuscular re-education 
• Manual therapy
• Exercise prescription 
• Dry needling 
• Cupping 
• Tissue scraping 
• Behavioral modifications 
• Therapeutic activities 
• Electrical muscle stimulation
• Spinal manipulation 
• Therapeutic modalities 
• Biofeedback