You have endometriosis, you know you are getting surgery.  So why waste time and money seeing a pelvic floor PT before surgery?! 

What people don’t realize is it may take you months to get into a quality surgeon.  Months- as in plural.  Also, most people who suffer from endometriosis suffer from other co-morbidities, here are just a few:

• Hip pain

• Back pain

• Abdominal pain

• Bowel issues

• Bladder issues

• Numbness and tingling in lower extremities

• Walking and sitting funny

• Even difficulties eating 

Having surgery, may fix some of this, but it may not fix all of it and it is important to work with a competent physical therapist to help you sift through what could be due to endometriosis and what may be an independent co-morbidity.   

Some examples:

• I had a patient who had a lot of diffuse pain, but would always talk about this particular flaring spot that went down the front of her thighs/ groin- I suspected a labral tear, so while waiting for surgery we worked on hip stability and sure enough her pain did get better. After much discussion with her we agreed to go with a hypothesis of a hip issue and opted not do a MRI/ x-ray.  That doesn’t necessarily mean she needs hips surgery pronto, but it was important for her to be mindful of how she recovers from surgery so as not to flare her hips.  We worked to make sure she understood how to maintain some hip/ gluteal stability during those initial weeks post op and also maintain range of motion in a SAFE way.  (Hint, hint: avoid fetal position)  So checking in with her post surgery, was easy because her end result was better, but her hips were also doing just fine!

• A common issue that runs with endo is overactive pelvic floor muscles, common symptoms of that can be pain with sex, urinary frequency, leaking, etc.  Physical therapy helps these muscles relax and allow you to gain control to contract and relax them.  This is huge, also important to maintain that control post surgery, even immediately post surgery.  Doing the proper breathing ( hint, hint Moo’ing) exercises helps!

We also discuss the importance of watching irritating/ triggering foods pre and post surgery.  Just because your surgery is friday,  that doesn’t give you the excuse to have a sugar/ dairy/ gluten-full/acid filled meal right before- there is no last supper!

Finally, the education of what pain is and how it works and managing expectations.  This one is delicate.  Chances are you will feel better post surgery, but you may not feel 100% better- and that just sucks a big one!  But we need to go to the neuroscience of pain.  You have been in pain for years and it takes time for your body to process the lack of pain input and focus other things.  

Imagine this, if every time you drive to work you notice a ton of traffic and accidents and a lot of aggressive driving that makes you anxious.  You get to work and look like you just survived a war.  Well what if one day you drive to work and there is no traffic, no honking, and no accidents.  Great . . . except you start to freak out- is it Saturday?  Are you late? Or you early? What the heck is going on?!  Are you losing your mind??  ‘You never just say oh great, no traffic, la di da! Am I right?

So how do you adjust to a pain free/ less painful life- with conscious movement even immediately post surgery!  So we plan for that and you work through it.  That can be as simple as rolling out of bed safely, going up and down stairs, stretching and deep breathing without aggravated your stitches.

Reality check: even though surgery is laparoscopic, it is a big recovery, and is usually ROUGH!  Some things can be addressed now, rather than post surgery.  Don’t get me wrong you will still need surgery, but pelvic floor physical therapy can make it easier!