Endometriosis Relief Post Surgery: Managing Pain Symptoms with Pelvic Floor Physical Therapy

At our clinic we work closely with patients who have been diagnosed with Endometriosis and have undergone excision surgery with the hope that it would finally resolve their pain. While excision surgery is the best and most effective treatment for removing Endometriosis lesions, many patients continue to experience ongoing symptoms such as bladder irritation, bowel changes, pelvic discomfort, pain with intimacy, or general body pain. It's important to note that persistent pain post surgery is not uncommon. Even after lesions have been removed, your pelvic floor muscles, connective tissues and nerves may have already adapted to being in a state of chronic pain and inflammation leading to ongoing pain & discomfort. This can feel frustrating and discouraging, leaving patients wondering if they will ever find lasting relief. This is where pelvic floor physical therapy can play a vital role in your pain management.

How Pelvic Floor PT Can Help with Bladder Issues Caused by Endometriosis

Endometriosis can affect the urinary system in several ways. Lesions and inflammation near the bladder, ureters, or surrounding pelvic tissues can irritate nerves and create chronic pelvic pain, which may trigger urinary urgency, frequency, a sensation of incomplete emptying, accidentally leakage when exercising, coughing, laughing, or jumping, and discomfort during urination. Additionally, scar tissue and adhesions can alter the normal positioning and mobility of the bladder, affecting how it fills and empties. The pelvic floor muscles may also tighten or overcompensate in response to pain, further contributing to bladder dysfunction. Together, these changes can make everyday activities more challenging and create a cycle of discomfort and urgency that makes you feel like you have to plan your days around having constant access to the bathroom. Pelvic PT can help by addressing tension and overactivity in the pelvic floor muscles that often accompany bladder irritation to help reduce nerve sensitivity, improve bladder control and help you regain confidence in your bladder function.

How Pelvic Floor PT Can Help with Bowel Issues Caused by Endometriosis

Similar to the affect Endometriosis has on the bladder, it can also impact the bowel through both direct and indirect mechanisms. Lesions or adhesions near the rectum, colon, or other pelvic structures can cause localized inflammation and tissue scarring, which may interfere with normal bowel motility. Chronic pain and inflammation can also lead to reflexive tightening of the pelvic floor muscles, making it harder to fully relax during bowel

movements. These changes can contribute to symptoms such as chronic constipation, diarrhea (or an alternating mix of the two), bloating or abdominal fullness (aka "Endo belly"), or pain during defecation. Over time, this combination of muscular, neural, and structural alterations can make bowel movements unpredictable and uncomfortable, significantly affecting daily life. Pelvic PT works to address existing muscle tension and improving coordination, helping the bowel function more efficiently and making bowel movements feel more complete, comfortable, and back in your control.

How Pelvic Floor PT Can Help with Pain with Sex Caused by Endometriosis

One of the most common symptoms of Endometriosis is pain with intimacy, even after surgery. Sexual activity can be extremely painful due to the chronic inflammation in the pelvic region, nerve irritation and the presence of scar tissue which can restrict normal tissue mobility. Additionally, in response to chronic pain, the body often “guards” itself by

tightening the pelvic floor muscles, which can make penetration or certain movements uncomfortable or even painful. Over time, this can create a feedback loop in which anticipation of pain triggers further muscle tension and anxiety, affecting the way someone experiences intimacy. Ongoing pain and discomfort can influence sexual desire, confidence, and body awareness, compounding discomfort and stress. Pelvic PT can help by gently releasing muscle tension, improving tissue mobility, and retraining the pelvic floor and nervous system, allowing for more comfortable, relaxed and pain-free sexual activity where your body is able to respond naturally and is no longer stuck in a stress response.

Conclusion

Even with successful excision of endometriosis lesions, your pain can still (unfortunately ) persist. Pelvic floor therapy works best when integrated into a multidisciplinary approach to endometriosis care. Combining surgery, medical management, lifestyle strategies, and PT ensures that both the underlying disease and its muscular and neurological consequences are treated.

Endometriosis can feel overwhelming, isolating, and can make every aspect of life feel like jumping hurdles. It is common for patients to worry that surgery alone won’t provide complete relief. Pelvic PT offers a complementary path toward improved comfort, function, and quality of life. By addressing the muscular and neurological aspects of pelvic pain, therapy helps patients regain control over their bodies, improve day-to-day comfort, and reclaim activities that pain once made difficult or impossible.

If you or someone you know is living with Endometriosis and has undergone surgery and is still experiencing pain, click the button below to schedule a free, 20-minute consult with one of our trusted physical therapists to discuss a treatment plan that is right for your individual needs and lifestyle. We know how difficult & painful Endometriosis can be, but know that you're not alone and relief is possible.

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