Physical Therapy After Endometriosis Excision

This is a randomized controlled pilot study conducted at a single institution comparing a home pelvic floor physical therapy program to routine post-operative care for patients undergoing endometriosis excisional surgery without hysterectomy. Patients will be recruited from a referral gynecological surgery group specializing in the diagnosis and treatment of pelvic pain and endometriosis. The goal is to assess the role of the active recovery program on quality of life and on pain and endometriosis symptoms.

Subjects will be randomized to routine post-operative care or to a home physical therapy program, in which they will receive written instruct ions and videos of exercises to complete immediately after surgery. The home exercise program was developed by the Department of Urogynecology in conjunction with pelvic floor physical therapists, and includes videos created by the education communications division. Quality of life, pain score, and endometriosis symptoms will be assessed at their pre-operative appointment, and at 6 and 12 weeks postoperatively.

Inclusion criteria

• Premenopausal
• English speaking
• Undergoing endometriosis excision surgery without hysterectomy at Legacy Health with subspecialty-trained surgeons specializing in endometriosis care
• History of chronic pelvic pain (defined as >= 6 months of pain in the anatomic pelvis)
• Diagnosis of high tone pelvic floor dysfunction on examiniation
• Have access to reliable email and phone for study-related communication

Exclusion criteria

• Non-English speaking
• Unable to consent
• Unable to sustain 30 minutes of moderate activity at baseline
• Uses a mobility assistive device at baseline
• Chronic opioid use
• No histologic diagnosis of endometriosis on surgical pathology
• Need for additional pelvic rest (>2 weeks) postoperatively
• Pregnancy or planning to pursue pregnancy or undergo fertility treatments within 12 weeks postoperatively